The combination of curettage and cryosurgery may be a safe and effective treatment method for patients with basal cell carcinoma, according to a novel study published by Backman et al in the Journal of the American Academy of Dermatology.
Background
The incidence of skin cancer is continuing to rise sharply across the world, involving high costs for a health-care economy already under severe strain. Basal cell carcinoma, the most common type of skin cancer, is mainly caused by the harmful effects of prolonged sun exposure on the skin. The disease is uncommon before the age of 40; however, its incidence increases with age. Over 60,000 new cases are reported each year in Sweden alone.
Basal cell carcinoma tumors rarely metastasize but may grow locally and cause wounds that do not heal. Some of the tumors can exhibit an infiltrative growth pattern and are often harder to delineate. In such cases, surgery—including Mohs surgery—is the most suitable treatment option. However, this method is time- and resource-intensive, representing a need to further evaluate and refine safe and effective treatment options for this patient population.
The faster method of curettage and cryosurgery has been used internationally since the 1960s, but many have been skeptical about its efficacy because of a lack of clearly defined treatment protocols. Therefore, the effects have varied widely. The method involves first scraping the lesions with an instrument called a curette, followed by cryosurgery using liquid nitrogen in a hand-held spray gun. The procedures are performed using local anesthetic and take less than 5 minutes.
“Health care faces significant challenges, with a growing population that is also living longer. It feels gratifying being able to demonstrate that old treatment methods still play a pivotal role in the treatment armamentarium for [basal cell carcinoma],” underscored lead study author Eva Backman, MD, a doctoral student in the Department of Dermatology and Venereology at the Institute of Clinical Sciences at the University of Gothenburg Sahlgrenska Academy.
Study Methods and Results
In the new study, researchers applied and analyzed two different variants of the combination of curettage and cryosurgery in 116 patients with a median age of 72 years who had a total of 202 basal cell carcinoma tumors. Half of the tumors were treated with one session of freezing, and the other half with two sessions of freezing.
Although the treatment produced wounds that took a few weeks to heal and left scars, the combination treatment was well tolerated by the patients involved in the study. After 1 year of follow-up, the researchers found that among the 202 tumors treated, only 1 of them recurred.
Conclusions
“Our research clearly shows that, when carried out properly, this method is both safe and cost-effective compared to other commonly used and more resource-intensive methods,” highlighted Dr. Backman. “We therefore hope that the results will be disseminated throughout Sweden, but also internationally,” she concluded.
Disclosure: For full disclosures of the study authors, visit jaad.org.
