Surgical Excision versus Curettage plus Cryosurgery in the Treatment of Basal Cell Carcinoma

• Published in: Dermatologic surgery 2007-05, Vol.33 (5), p.579-587
• Main Authors: KUIJPERS, DANIELLE I. M., THISSEN, MONIQUE R. T. M., BERRETTY, PAUL J. M., IDELER, FONS H. L. B., NELEMANS, PATTY J., NEUMANN, MARTINO H. A. M.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Carcinoma, Basal Cell - mortality; Carcinoma, Basal Cell - pathology; Carcinoma, Basal Cell - surgery; Cryosurgery - methods; Curettage - methods; Dermatology; Disease-Free Survival; Face; Female; Humans; Male; Medical sciences; Middle Aged; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - surgery; Netherlands; Skin Neoplasms - mortality; Skin Neoplasms - pathology; Skin Neoplasms - surgery; Skin plastic surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Treatment Outcome; Tumors of the skin and soft tissue. Premalignant lesions
• ISSN: 1076-0512; 1524-4725
• DOI: 10.1111/j.1524-4725.2007.33117.x

BACKGROUND Both cryosurgery, with and without prior curettage, and surgical excision (SE) are common therapeutic strategies for basal cell carcinoma (BCC). OBJECTIVE The objective was to compare the efficacy between curettage plus cryosurgery (C&C) and SE in nonaggressive BCC of the head and neck. MATERIALS AND METHODS A randomized controlled trial was carried out, in which tumors were assigned to either C&C (n=51) or SE (n=49). C&C was performed with a double freeze–thaw cycle after prior curettage of the tumor. SE was performed with a margin of 3 mm and with delayed histologic examination. RESULTS Recurrences occurred 9 times after C&C (17.6%) and 4 times after SE (8.2%). The overall 5‐year recurrence probability was 19.6% for C&C and 8.4% for SE (p=.10). A hazard ratio of 2.57 (95% CI, 0.79–8.34) indicated a putative, but not statistically significant, advantage of SE. CONCLUSION These data reflect the outcome of the first randomized controlled trial with long‐term follow‐up in the treatment of BCC, comparing C&C with SE. Although not statistically significantly different, the observed differences could still be of clinical relevance. Owing to the trend toward lower recurrence rates, better cosmetic results, and reduced wound healing time, we believe that SE should be preferred to C&C in the treatment of primary, nonaggressive BCC of the head and neck.