Treatment of Verrucous Carcinoma of the Lower Lip with Topical Imiquimod (AldaraⓇ) and Debulking Therapy treatment, such as flap surgery. Imiquimod, a toll-like receptor 7 agonist, is a patient- applied cream that is used in treatment of certain diseases of the skin, including various forms of skin cancer (basal cell carcinoma, Bowen’s disease, superficial squamous cell carcinoma, some superficial malignant melanomas, and actinic keratosis) as well as genital warts11-16. The exact mechanism of imiquimod is not known; however, its effects are thought to be a result of augmentation of immune response through induction of interferon alfa17. Imiquimod has been used in conjunction with a carbon dioxide laser for treatment of perianal verrucous carci- noma18. In addition, Schalock et al.19 described 2 cases of verrucous carcinoma of the foot, which were treated with imiquimod for more than 1 year. We did not perform a biopsy after treatment; therefore, we cannot confirm that the tumor has been resolved. However, no further relapse has been observed for 30 months since the last treatment. In summary, here we describe two cases of rapidly growing oral verrucous carcinoma of the lip, which were treated with a combination of topical imiquimod and debulking therapy. There was no recurrence of the carcinoma for more than 3 months and the cosmesis was excellent. Taken together, these findings suggest that combination therapy of topical imiquimod and a debulking method may be useful for treatment of some cases of verrucous carcinoma. REFERENCES 1. Ackerman LV. Verrucous carcinoma of the oral cavity. Surgery 1948;23:670-678. 2. Freedberg IM, Eisen AZ, Wolff K, Austen KF, Glidsmith LA, Katz SI, et al. Fitzpatrick’s dermatology in general medicine. 6th ed. New York: Mcgraw-Hill, 2003:742-743. 3. Creasman C, Haas PA, Fox TA Jr, Balazs M. Malignant transformation of anorectal giant condyloma acuminatum (Buschke-Loewenstein tumor). Dis Colon Rectum 1989; 32:481-487. 4. Kao GF, Graham JH, Helwig EB. Carcinoma cuniculatum (verrucous carcinoma of the skin): a clinicopathologic study of 46 cases with ultrastructural observations. Cancer 1982; 49:2395-2403. 5. Diaz-Pérez JL, Moreno J, Burgos J. Ackerman's verrucous carcinoma on the lower lip. Med Cutan Ibero Lat Am 1981;9:105-110. 6. Krutchkoff DJ, Chen JK, Eisenberg E, Katz RV. Oral cancer: a survey of 566 cases from the University of Connecticut Oral Pathology Biopsy Service, 1975-1986. Oral Surg Oral Med Oral Pathol 1990;70:192-198. 7. Zielonka E, Goldschmidt D, de Fontaine S. Verrucous carcinoma or epithelioma cuniculatum plantare. Eur J Surg Oncol 1997;23:86-87. 8. Garven TC, Thelmo WL, Victor J, Pertschuk L. Verrucous carcinoma of the leg positive for human papillomavirus DNA 11 and 18: a case report. Hum Pathol 1991;22: 1170-1173. 9. Knobler RM, Schneider S, Neumann RA, Bodemer W, Radlwimmer B, Aberer E, et al. DNA dot-blot hybridization implicates human papillomavirus type 11-DNA in epithelioma cuniculatum. J Med Virol 1989;29:33-37. 10. Stephen JM, Vincent RH. Plastic surgery. 6th ed. Phila- delphia: Elsevier Inc, 2006:799-800. 11. Marks R, Gebauer K, Shumack S, Amies M, Bryden J, Fox TL, et al. Imiquimod 5% cream in the treatment of superficial basal cell carcinoma: results of a multicenter 6-week dose-response trial. J Am Acad Dermatol 2001; 44:807-813. 12. Mackenzie-Wood A, Kossard S, de Launey J, Wilkinson B, Owens ML. Imiquimod 5% cream in the treatment of Bowen's disease. J Am Acad Dermatol 2001;44:462-470. 13. Kaspari M, Gutzmer R, Kiehl P, Dumke P, Kapp A, Brodersen JP. Imiquimod 5% cream in the treatment of human papillomavirus-16-positive erythroplasia of Queyrat. Dermatology 2002;205:67-69. 14. Steinmann A, Funk JO, Schuler G, von den Driesch P. Topical imiquimod treatment of a cutaneous melanoma metastasis. J Am Acad Dermatol 2000;43:555-556. 15. Bong AB, Bonnekoh B, Franke I, Schön MP, Ulrich J, Gollnick H. Imiquimod, a topical immune response modifier, in the treatment of cutaneous metastases of malignant melanoma. Dermatology 2002;205:135-138. 16. Tyring S. Imiquimod applied topically: a novel immune response modifier. Skin Therapy Lett 2001;6:1-4. 17. Hengge UR, Ruzicka T. Topical immunomodulation in dermatology: potential of toll-like receptor agonists. Dermatol Surg 2004;30:1101-1112. 18. Heinzerling LM, Kempf W, Kamarashev J, Hafner J, Nestle FO. Treatment of verrucous carcinoma with imiquimod and CO2 laser ablation. Dermatology 2003;207:119-122. 19. Schalock PC, Kornik RI, Baughman RD, Chapman MS. Treatment of verrucous carcinoma with topical imiquimod. J Am Acad Dermatol 2006;54(5 Suppl):S233-235. Vol. 23, Suppl. 1, 2011 S71