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Recurrence and Cosmetic Outcomes With Treatments for Primary Basal Cell Carcinoma of the Skin

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Key Points

  • Surgical treatments and external-beam radiation appeared to be associated with the lowest recurrence rates.
  • Photodynamic therapy with aminolevulinic acid or methyl-aminolevulinic acid appeared to be associated with better cosmetic outcomes.

In a systematic review and meta-analysis reported in Annals of Internal Medicine, Drucker et al found differences in recurrence rates and patient-reported cosmetic outcomes among various treatments for mostly low-risk primary basal cell carcinoma of the skin.

Study Details

The study involved data from 40 randomized trials and 5 nonrandomized studies identified in literature searches through May 2018. Recurrence analysis included data on 2,204 lesions. Cosmetic outcome analysis included data on 739 lesions. Most lesions in the included studies were histologically low-risk cases of superficial or nodular disease, the most common subtypes. Relative intervention effects and mean outcome frequencies were estimated using frequentist network meta-analyses.

Recurrence and Cosmetic Outcomes

Estimated recurrence rates were 3.5% (95% confidence interval [CI] = 0.7%–16.8%) for external beam radiation; 3.8% (95% CI = 1.5%–9.5%) for excision; 3.8% (95% CI =0.7%–18.2%) for Mohs surgery; 6.9% (95% CI = 4.6%–56.1%) for curettage and diathermy; 14.1% (95% CI = 5.4%–32.4%), for imiquimod; 16.6% (95% CI = 7.5%–32.8%) for photodynamic therapy using aminolevulinic acid; 18.8% (95% CI = 10.1%­–32.5%), for photodynamic therapy using methyl-aminolevulinic acid; 18.8% (95% CI = 10.1%–32.5%) for fluorouracil; 19.9% (95% CI = 4.6%–56.1%) for curettage and cryotherapy; and 22.3% (95% CI = 10.2%–42.0%) for cryotherapy.

Proportions of patients reporting good or better cosmetic outcomes were 95.8% for photodynamic therapy using aminolevulinic acid; 93.8% for photodynamic therapy using methyl-aminolevulinic acid; 77.8% for excision; 51.1% for cryotherapy; and 20.0% for photodynamic therapy with laser preparation of the lesion.

Data on quality of life and mortality associated with different treatments were insufficient for analysis.

The investigators concluded, “Surgical treatments and external-beam radiation have low recurrence rates for the treatment of low-risk [basal cell carcinoma], but substantial uncertainty exists about their comparative effectiveness vs other treatments. Gaps remain regarding high-risk [basal cell carcinoma] subtypes and important outcomes, including costs.”

The study was funded by the Agency for Healthcare Research and Quality.

Aaron M. Drucker, MD, ScM, of Women's College Hospital, Toronto, is the corresponding author for the Annals of Internal Medicine article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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