Would you favor radiation or immune modulating treatment like imiquimod to treat an uncomplicated basal cell carcinoma on the nose in an elderly patient for whom you'd like to avoid surgery?

If my patient was concerned about deformity, with 10 to 15 years of life remaining, unquestionably, I would recommend radiation.

Would depend on size, treatment goal and general health/condition of patient.

Radiotherapy is in general better in terms of cure and likely easier for the average patient to tolerate if logistical issues are discounted.

If it is a smaller lesion, a simple curettage and electrodesiccation is a reasonable alternative. Can be done at the time of the biopsy/clinical evaluation. Reasonable cure rate, and acceptable cosmetic outcome in most cases.

I like Dr. @Dr. First Last's and Dr. @Dr. First Last's - sometimes will combine -biopsy/ED&C followed by imiquimod if it is on a sebaceous nose where it is hard to ensure adequate tx - couple case reports.

I do find the most problematic thing about these patients is wound care. Often, they are brought in by the nursing home or family because the lesion bleeds. For these patients, IGSRT is great because wound is managed during the treatment and has very high cure rates.

For nodular BCCs for patie...

Agree — also have seen excellent outcomes as well with application of imiquimod qhs for 6-12 weeks for bccs with non-high risk pathology.