Background/Objectives: To evaluate the clinical and histological efficacy, safety, and cosmetic outcomes of 5% imiquimod (IMQ) cream, used in monotherapy or in combination, for periocular superficial and nodular basal cell carcinoma (BCC). Methods: A systematic search of MEDLINE, PubMed, and Google Scholar (inception—12 June 2025) identified studies reporting IMQ treatment of eyelid/periocular BCC. Randomized, nonrandomized and observational designs were eligible. Risk of bias was assessed with Cochrane RoB 2 or ROBINS-I, and certainty of evidence graded with GRADE. Results: Seven studies (n= 152 lesions) met the inclusion criteria. The pooled clinical-plus-histological clearance across case series was 82% (95% CI 72–90%). The single RCT (n= 27) reported 100% histological clearance for both IMQ and radiotherapy at 3 months, but IMQ produced superior cosmetic results. Combination immunocryosurgery (IMQ + cryotherapy) achieved 87.5% sustained remission at ≤5 years. Local adverse events—erythema, crusting, or conjunctivitis—occurred in ≥70% (85/122) of treated cases but were mild-to-moderate and self-limiting; systemic reactions were not reported. Forty-seven additional patients in a dedicated safety cohort showed only transient ocular irritation. The certainty of evidence was moderate for short-term clearance and low for long-term control because of small samples and heterogeneous follow-up. Conclusions: IMQ 5% is a useful, tissue-sparing option for selected (superficial and nodular subtypes) periocular BCCs where surgery is contraindicated or cosmesis is paramount. Overall clearance is slightly lower than Mohs surgery but comparable to radiotherapy, and cosmetic outcomes are favorable. Larger, standardized RCTs with ≥3-year follow-up are needed to confirm durability, optimize dosing schedules, and validate patient-reported outcome measures.
背景/目的：评估5%咪喹莫特（IMQ）乳膏单用或联合治疗眼周浅表性与结节性基底细胞癌（BCC）的临床与组织学疗效、安全性及美容效果。方法：系统检索MEDLINE、PubMed及Google Scholar数据库（建库至2025年6月12日），纳入报道IMQ治疗眼睑/眼周BCC的研究。随机、非随机及观察性研究均符合纳入标准。采用Cochrane RoB 2或ROBINS-I工具评估偏倚风险，使用GRADE系统评价证据质量。结果：共7项研究（152个病灶）符合纳入标准。病例系列研究的临床联合组织学清除率汇总值为82%（95% CI 72–90%）。唯一随机对照试验（n=27）显示3个月时IMQ与放疗均达到100%组织学清除率，但IMQ组美容效果更优。联合免疫冷冻疗法（IMQ+冷冻治疗）在≤5年随访中实现87.5%的持续缓解。局部不良事件（红斑、结痂或结膜炎）发生率≥70%（85/122），但均为轻中度且具有自限性；未报告全身性反应。专项安全性队列中47例患者仅出现短暂眼部刺激。证据质量评估显示：短期清除证据质量为中等，长期控制证据质量为低级（受限于小样本量及异质性随访）。结论：对于手术禁忌或美容要求优先的特定眼周BCC（浅表型与结节型亚类），5% IMQ是一种有效的组织保留治疗方案。其总体清除率略低于莫氏手术，但与放疗相当，且美容效果良好。未来需开展更大规模、标准化的随机对照试验（随访≥3年）以确认疗效持久性、优化给药方案并验证患者报告结局指标。
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