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Curettage vs Cryosurgery for Superficial Basal Cell Carcinoma
TAKE-HOME MESSAGE
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In this single-center noninferiority clinical trial, the authors compared the effectiveness of curettage versus cryosurgery for superficial basal cell carcinoma (sBCC) in terms of overall clinical clearance after treatment. In total, 228 sBCCs were analyzed, and, at 1 year, the cryosurgery group had no tumor recurrence compared with five tumors in the curettage group. Curettage wounds tended to have shorter healing times, and cosmesis was similar in both groups.
- Curettage (without electrodessication) for nonaggressive BCC was associated with a high clinical clearance rate, although noninferiority could not be established compared with cryosurgery.
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
Basal cell carcinoma (BCC) is the most common cancer in the world and has a rising incidence. Current guidelines for low-risk BCC including superficial BCC (sBCC) recommend several treatment options including destructive treatment methods, such as cryosurgery with or without prior curettage or curettage and electrodesiccation. Curettage only (i.e. without subsequent cryosurgery or electrodesiccation) is a simple and quick destructive treatment method used for many benign skin lesions but has not been sufficiently evaluated for the treatment of sBCCs.
OBJECTIVES
The objective was to compare the effectiveness of curettage vs. cryosurgery for sBCCs in terms of overall clinical clearance rates after 1 year as well as wound healing times.
METHODS
A single-centre non-inferiority clinical trial was conducted. Non-facial sBCCs with a diameter of 5-20 mm were randomised to either cryosurgery using one freeze-thaw cycle or curettage. At follow-up visits, treatment areas were evaluated regarding the presence of residual tumour after 3-6 months and recurrence after 1 year. Further, wound healing times were assessed.
RESULTS
In total, 228 sBCCs in 97 patients were included in the analysis. At 3-6 months, no residual tumours were seen in any of the treated areas. After 1 year, the clinical clearance rates for curettage and cryosurgery were 95.7% and 100%, respectively (P = 0.060). However, the non-inferiority analysis was inconclusive. Wound healing times were shorter for curettage (4 weeks) compared to cryosurgery (5 weeks; P < 0.0001). Overall, patient satisfaction at 1 year was high.
CONCLUSIONS
Both treatment methods showed high clinical clearance rates after 1 year, whilst curettage reduced the wound healing time.
Additional Info
Curettage vs. cryosurgery for superficial basal cell carcinoma: a prospective, randomised and controlled trial
J Eur Acad Dermatol Venereol 2022 May 11;[EPub Ahead of Print], EJ Backman, S Polesie, S Berglund, M Gillstedt, A Sjöholm, M Modin, J PaoliFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Clearance rates of low-risk basal cell carcinoma treated with destructive methods have varied greatly. The most studied methods include cryotherapy with or without prior curettage, or curettage and electrodesiccation, while curettage alone has not been extensively evaluated. Efficacy of these methods can be affected by physician experience, type of device used, and thoroughness of application, among other variables.
This single-center Swedish study compared the effectiveness of curettage alone versus cryosurgery alone for superficial basal cell carcinoma (sBCC) of 0.5–2 cm diameter located in low-risk areas between the neck and knees. Patient-reported healing time for the two methods was also examined. In all, 97 patients with 228 sBCCs were followed for 1 year, when clearance rates were 95.7% with curettage and 100% with cryotherapy.
Strengths of this study included precisely described treatment methods. Cryotherapy applied into a neoprene cone until a 4-mm frost halo and a thaw cycle of at least 60 seconds were required. Disposable curettes, which are consistently sharp, were used in curettage procedures. Potential weaknesses included the small size of the study and a short follow-up period. Over a third of the lesions were diagnosed with dermoscopy, rather than histologically. In addition, 60 of the lesions underwent punch biopsy prior to treatment, which could hinder the effectiveness of curettage.
This study provides evidence that curettage alone and cryotherapy, when performed in prescribed fashion, have good 1-year clearance rates for sBCC ≤2 cm in low-risk anatomic sites, but longer follow-up and larger studies are needed to confirm efficacy.