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Pulsed CO2 laser ablation comparable to cryotherapy for superficial BCC

Although surgery showed greater efficacy and cosmetic outcome compared with pulsed CO₂ laser ablation, there was no statistically significant difference between laser ablation and cryotherapy in those outcomes for superficial basal cell carcinoma, according to study results.

Researchers studied 240 adults whites (mean age, 67.2 years; 139 men) with one superficial basal cell carcinoma (BCC) of the trunk, arm or leg who were enrolled at the outpatient clinic of the dermatology department of the University of Brescia, Italy,

Lesions were photographed at baseline, and patients were randomly assigned to treatment with cryotherapy (CRY-AC, Brymill Cryogenic Systems), pulsed CO₂ laser ablation (Spectra-PTSM, Lutronic Corp.) or surgery. The treatment area included a 3 mm to 4 mm rim of clinically uninvolved surrounding skin.

Efficacy and cosmetic outcome were measured at 90-day follow-up. Time to complete wound healing was recorded by patients, who also measured overall satisfaction.

The complete remission rate with pulsed CO₂ laser was 78.8%, which was not significantly different than the 85% remission rate with cryotherapy. The complete remission rate for surgery was 97.5%, which was significantly better than cryotherapy and CO₂ laser (P < .01 for both).

Cosmetic outcome was scored as good or excellent in 82.5% treated with surgery, compared with 56.2% with cryotherapy and 45% with CO₂ laser ablation.

The percentage of patients reporting treatment satisfaction as excellent or good was 72.5% with cryotherapy, 65% with CO₂ laser and 80% with surgery, with satisfaction with CO₂ laser significantly lower than surgery (P < .01) but not cryotherapy.

CO₂ laser treatment had the shortest mean time to wound closing (11.6 ± 2.6 days), compared with cryotherapy (13.6 ± 4.2 days; P < .01) and surgery (15.4 ± 2 days; P < .01).

“CO₂ laser ablation was inferior to surgery with respect to efficacy, cosmetic outcome and patient satisfaction,” the researchers wrote. “Its advantages were shorter time to wound closure, the lower cost and the lower cost-effectiveness ratio. In comparison to cryotherapy, signficant difference of efficacy, cosmetic outcome and patient satisfaction were not seen and cost-effectiveness ratios were quite similar.”

“The present findings may help to assess the role of CO₂ laser ablation in the therapeutic management of [superficial] BCC, although their significance is limited by the short follow-up period of 3 months.” – by Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures.