Interventions for basal cell carcinoma of the skin: systematic review

Abstract

Objectives To assess the effects of treatments for basal cell carcinoma. Methods Systematic review of randomised controlled trials. Main outcome measure Recurrence of basal cell carcinoma at three years or beyond, assessed clinically. Studies reviewed Randomised controlled trials of interventions for histologically confirmed basal cell carcinoma (published and unpublished material; no language restrictions). Results 25 studies were identified, covering seven therapeutic categories. Only one study of surgical excision versus radiotherapy contained primary outcome data, which showed significantly more persistent tumours and recurrences in the radiotherapy group compared with surgery (odds ratio 0.09, 95% confidence interval 0.01 to 0.67). One study compared cryotherapy with surgery, with inconclusive results at one year. In a comparison of radiotherapy with cryotherapy, significantly more recurrences occurred at one year in the cryotherapy group. Preliminary studies suggest a short term success rate of 87-88% for imiquimod cream in the treatment of superficial basal cell carcinoma, although this cream has not been compared with surgery. No consistent evidence was found for the other treatment modalities. Conclusions Little good quality research has been done on the treatments used for the most common cancer in humans. Most trials have included only people with basal cell carcinoma occurring at low risk sites. Only one trial measured recurrence at four years; recurrence rates at one year should be interpreted with caution. Surgery and radiotherapy seem to be the most effective treatments; surgery showed the lowest failure rates. Other treatments might have some use but need to be compared with surgery.

Five-Year Follow-up of a Randomized, Prospective Trial of Topical Methyl Aminolevulinate Photodynamic Therapy vs Surgery for Nodular Basal Cell Carcinoma

“…The cumulative 5-year lesion recurrence rate with methyl aminolevulinate PDT was 14% compared with 4% for excision surgery, the latter being consistent with the published low rate for this modality. 8,10,11 We anticipate that we have captured all relevant events and that a longer than 5-year follow-up would be unlikely to yield further recurrences because only 2 recurrent lesions were observed in the methyl aminolevulinate PDT group and 1 in the surgical group between 2 and 3 years' follow-up. There were no recurrent lesions observed in the methyl aminolevulinate PDT group and only 1 in the surgical group from 3 to 5 years' follow-up.…”

Predictors of Recurrence after Radiotherapy for Non-Melanoma Skin Cancer

“…Basal cell carcinoma (bcc) and squamous cell carcinoma (scc) are the two most common types of nmsc 2 . A number of treatment modalities are available for management, with surgery and radiotherapy being the mainstays 3 . Radiotherapy is also used as postoperative adjuvant therapy when high-risk features for recurrence are present.…”

Desmosomal Cadherins in Basal Cell Carcinomas

“…BCCs typically occur in adults, but the tumors can develop even in children (Kossard et al, 2006;Hakverdi et al, 2011). Furthermore, males show higher incidence of BCC than females (Bath-Hextall et al, 2004). The etiology of BCC is still unclear but appears to be of multifactorial origin, resulting from a complex interaction of both environmental and genetic factors (Hakverdi et al, 2011).…”

“…Prognosis is excellent with proper therapy. Growth of BCC is usually localized to the area of its origin (Bath-Hextall et al, 2004). BCCs typically occur in adults, but the tumors can develop even in children (Kossard et al, 2006;Hakverdi et al, 2011).…”