"Basal cell carcinoma is one of the most common cancers and its incidence is increasing worldwide putting a significant burden on health services. Topical treatments are available for superficial basal cell carcinoma BCC but there has a lack of longterm followup data to guide treatment decisions. A threeyear randomized controlled clinical trial has found that two topical creams are effective in most primary lowrisk superficial BCC comparing favorably with photodynamic therapy PDT as reported by investigators in the Journal of Investigative Dermatology. More than  of all skin cancers are BCC arising from the basal cells i.e. small round cells found in the lower layer of the epidermis. There are over two million cases a year in the U.S. and the lifetime risk of developing a BCC before the age of  years is one in five people. The prognosis is excellent but it can cause significant disfigurement by invading surrounding tissues. While most types of BCC require surgery superficial BCC can be treated topically with noninvasive treatments such as PDT imiquimod cream fluorouracil cream cryosurgery or electrodessication and curettage.  Investigators in the Netherlands report the results of a threeyear followup of a randomized controlled trial that compared three noninvasive treatments that included imiquimod and fluorouracil cream. The main advantages of noninvasive treatments are good cosmetic outcome preservation of surrounding tissue and potential for home application of either creams explained lead investigator Marieke Roozeboom of the Department of Dermatology Maastricht University Medical Center in the Netherlands. Throughout the last two decades there has been a growing interest in these nonsurgical therapies which offer the possibility of avoiding surgery and reducing demands on busy medical practices.  However prior to this study there has been a lack of randomized controlled trials with a longterm followup that compare the effectiveness of noninvasive treatments. Consequently there is no consensus in international BCC guidelines on the first choice of noninvasive therapy for superficial BCC. A total of  patients with a superficial BCC participated in this study  patients were treated with methylaminolevulinate photodynamic therapy MALPDT  with imiquimod cream and  with fluorouracil cream. The three study groups had a similar distribution of baseline characteristics with the exception of tumor size. Around  of patients with superficial BCC were tumor free after imiquimod treatment after three years. The clearance rate was  for patients treated with fluorouracil and  for individuals receiving PDT. Based on our findings both imiquimod and fluorouracil are effective noninvasive treatments in most primary lowrisk superficial BCC but the data provide no definite evidence for superiority of imiquimod to fluorouracil commented Dr. Roozeboom. Both creams have an equal cosmetic outcome and risk of local adverse events. Fluorouracil has the advantage of being less expensive than imiquimod. However between one and threeyear followup more recurrences were diagnosed in the fluorouracil group compared with the imiquimod group. When choosing a treatment for an individual patient with a superficial BCC other factors like age compliance and patient preferences should always be taken into account. For example we have found that in superficial BCC on the lower extremities in older patients PDT should be prescribed rather than imiquimod. Our evidence indicates that a personalized treatment approach is necessary added Dr. Roozeboom.  Notes for editors Three year followup results of photodynamic therapy versus imiquimod versus fluorouracil for treatment of superficial basal cell carcinoma a single blind noninferiority randomized controlled trial by Marieke H. Roozeboom MD Aimee H.M.M. Arits PhD Klara Mosterd PhD Anja Sommer PhD Brigitte A.B. Essers PhD Michette J.M. de Rooij PhD Patricia J.F. Quaedvlieg PhD Peter M. Steijlen PhD Patty J. Nelemans PhD and Nicole W.J. KellenersSmeets PhD doi .j.jid... published online in the Journal of Investigative Dermatology by Elsevier. Full text of this article is available to credentialed journalists upon request. Contact George Woodward at  or g.woodwardelsevier.com mailtog.woodwardelsevier.com to obtain copies. Journalists who wish to speak with the authors should contact Marieke H. Roozeboom at   or mh.roozeboommumc.nl mailtomh.roozeboommumc.nl.  About the Journal of Investigative Dermatology Journal of Investigative Dermatology JID with an Impact Factor of . is the leading journal in dermatology. The journal publishes reports describing original research on all aspects of cutaneous biology and skin disease. Topics include biochemistry biophysics carcinogenesis cell regulation clinical research development embryology epidemiology and other populationbased research extracellular matrix genetics immunology melanocyte biology microbiology molecular and cell biology pathology percutaneous absorption pharmacology photobiology physiology skin structure and wound healing. http  Journal Citations Report published by Thomson Reuters  About Elsevier  Elsevier is a worldleading provider of information solutions that enhance the performance of science health and technology professionals empowering them to make better decisions deliver better care and sometimes make groundbreaking discoveries that advance the boundaries of knowledge and human progress. Elsevier provides webbased digital solutions  among them ScienceDirect Scopus Elsevier Research Intelligence and ClinicalKey  and publishes over  journals including The Lancet and Cell and more than  book titles including a number of iconic reference works. Elsevier is part of RELX Group a worldleading provider of information and analytics for professional and business customers across industries. http  Basal cell carcinoma is one of the most common cancers and its incidence is increasing worldwide putting a significant burden on health services. Topical treatments are available for superficial basal cell carcinoma BCC but there has a lack of longterm followup data to guide treatment decisions. A threeyear randomized controlled clinical trial has found that two topical creams are effective in most primary lowrisk superficial BCC comparing favorably with photodynamic therapy PDT as reported by investigators in the Journal of Investigative Dermatology. More than  of all skin cancers are BCC arising from the basal cells i.e. small round cells found in the lower layer of the epidermis. There are over two million cases a year in the U.S. and the lifetime risk of developing a BCC before the age of  years is one in five people. The prognosis is excellent but it can cause significant disfigurement by invading surrounding tissues. While most types of BCC require surgery superficial BCC can be treated topically with noninvasive treatments such as PDT imiquimod cream fluorouracil cream cryosurgery or electrodessication and curettage.  Investigators in the Netherlands report the results of a threeyear followup of a randomized controlled trial that compared three noninvasive treatments that included imiquimod and fluorouracil cream. The main advantages of noninvasive treatments are good cosmetic outcome preservation of surrounding tissue and potential for home application of either creams explained lead investigator Marieke Roozeboom of the Department of Dermatology Maastricht University Medical Center in the Netherlands. Throughout the last two decades there has been a growing interest in these nonsurgical therapies which offer the possibility of avoiding surgery and reducing demands on busy medical practices.  However prior to this study there has been a lack of randomized controlled trials with a longterm followup that compare the effectiveness of noninvasive treatments. Consequently there is no consensus in international BCC guidelines on the first choice of noninvasive therapy for superficial BCC. A total of  patients with a superficial BCC participated in this study  patients were treated with methylaminolevulinate photodynamic therapy MALPDT  with imiquimod cream and  with fluorouracil cream. The three study groups had a similar distribution of baseline characteristics with the exception of tumor size. Around  of patients with superficial BCC were tumor free after imiquimod treatment after three years. The clearance rate was  for patients treated with fluorouracil and  for individuals receiving PDT. Based on our findings both imiquimod and fluorouracil are effective noninvasive treatments in most primary lowrisk superficial BCC but the data provide no definite evidence for superiority of imiquimod to fluorouracil commented Dr. Roozeboom. Both creams have an equal cosmetic outcome and risk of local adverse events. Fluorouracil has the advantage of being less expensive than imiquimod. However between one and threeyear followup more recurrences were diagnosed in the fluorouracil group compared with the imiquimod group. When choosing a treatment for an individual patient with a superficial BCC other factors like age compliance and patient preferences should always be taken into account. For example we have found that in superficial BCC on the lower extremities in older patients PDT should be prescribed rather than imiquimod. Our evidence indicates that a personalized treatment approach is necessary added Dr. Roozeboom.  Notes for editors Three year followup results of photodynamic therapy versus imiquimod versus fluorouracil for treatment of superficial basal cell carcinoma a single blind noninferiority randomized controlled trial by Marieke H. Roozeboom MD Aimee H.M.M. Arits PhD Klara Mosterd PhD Anja Sommer PhD Brigitte A.B. Essers PhD Michette J.M. de Rooij PhD Patricia J.F. Quaedvlieg PhD Peter M. Steijlen PhD Patty J. Nelemans PhD and Nicole W.J. KellenersSmeets PhD doi .j.jid... published online in the Journal of Investigative Dermatology by Elsevier. Full text of this article is available to credentialed journalists upon request. Contact George Woodward at  or g.woodwardelsevier.com mailtog.woodwardelsevier.com to obtain copies. Journalists who wish to speak with the authors should contact Marieke H. Roozeboom at   or mh.roozeboommumc.nl mailtomh.roozeboommumc.nl.  About the Journal of Investigative Dermatology Journal of Investigative Dermatology JID with an Impact Factor of . is the leading journal in dermatology. The journal publishes reports describing original research on all aspects of cutaneous biology and skin disease. Topics include biochemistry biophysics carcinogenesis cell regulation clinical research development embryology epidemiology and other populationbased research extracellular matrix genetics immunology melanocyte biology microbiology molecular and cell biology pathology percutaneous absorption pharmacology photobiology physiology skin structure and wound healing. http  Journal Citations Report published by Thomson Reuters  About Elsevier  Elsevier is a worldleading provider of information solutions that enhance the performance of science health and technology professionals empowering them to make better decisions deliver better care and sometimes make groundbreaking discoveries that advance the boundaries of knowledge and human progress. Elsevier provides webbased digital solutions  among them ScienceDirect Scopus Elsevier Research Intelligence and ClinicalKey  and publishes over  journals including The Lancet and Cell and more than  book titles including a number of iconic reference works. Elsevier is part of RELX Group a worldleading provider of information and analytics for professional and business customers across industries. http"