Curettage and cryosurgery both effective treatment options for superficial basal cell carcinoma

Sweden: Both curettage and cryosurgery are associated with a high rate of clinical clearance in superficial basal cell carcinoma (sBCC) while wound healing time is faster in curettage, states study results published in The Journal of the European Academy of Dermatology and Venereology

Basal cell carcinoma (BCC) is the most common form of skin cancer amongst humans. Reports on incidence trends confirm a relative increase of superficial BCCs (sBCC) compared to other subtypes. Currently, sBCC has several treatment options but clearance rates with destructive methods have varied greatly.

The most studied methods for sBCC are cryotherapy with or without prior curettage, curettage, and electrodesiccation, while curettage alone has not been extensively evaluated. Factors like physician experience, type of device used, meticulous application, and others affect the efficacy of these treatments. Curettage only (i.e. without subsequent cryosurgery or electrodesiccation) is a simple and quick destructive treatment method used for many benign skin lesions.

In this single-centre noninferiority clinical trial, E.J. Backman, University of Gothenburg, Sweden, and colleagues compared the effectiveness of curettage versus cryosurgery for superficial basal cell carcinoma (sBCC) in terms of overall clinical clearance after treatment.

For the study, in total 228 sBCCs with a diameter of 0.5–2 cm were randomized 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 also assessed.

Results

• 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. However, the non-inferiority analysis was inconclusive.

• Wound healing times were shorter for curettage (4 weeks) compared to cryosurgery (5 weeks) and cosmesis was similar in both groups

• Overall, patient satisfaction was high after 1 year.

Researchers conclude that both curettage and cryosurgery in a single freeze-thaw cycle show promising 1-year results regarding clinical clearance, whilst curettage reduced the wound healing time. This study provides new evidence for use of simple destructive treatment methods to treat sBCC effectively

The strength of the present study is its precisely described treatment methods but the small size of the study and a short follow-up period present potential weaknesses, so longer follow-up and larger studies are needed to confirm efficacy. Also, studies on specific subtypes of BCCs are recommended by the authors.

Reference:

E.J. Backman,S. Polesie,S. Berglund,M. Gillstedt,A. Sjöholm,M. Modin,J. Paoli   First published: 11 May 2022. https://doi.org/10.1111/jdv.18209