Superficial curettage, imiquimod cream 5% sees more failure at 5 years in nodular BCC

Key takeaways:

• Five years after treatment, results showed a freedom from treatment failure rate of 77.8% among the superficial curettage plus imiquimod group.
• The surgical excision group saw a failure rate of 98.2%.

Superficial curettage plus imiquimod cream 5% in the treatment of nodular basal cell carcinoma showed more treatment failure at 5 years vs. surgical excision, according to a study.

“Surgical excision is the most effective treatment of [nodular basal cell carcinoma (nBCC)], with higher efficacy rates when compared with noninvasive treatments,” Babette J.A. Verkouteren, MD, PhD, a dermatology resident at Maastricht University Medical Center in the Netherlands, and colleagues wrote. “However, noninvasive therapies lead to a better cosmetic outcome and may therefore be preferred as treatment of lesions in visible areas.”

One such noninvasive option includes superficial curettage followed by imiquimod cream 5% — a method which has demonstrated long-term efficacy for superficial BCC but has yet to demonstrate the same for nBCC.

To determine if superficial curettage followed by imiquimod cream 5% was noninferior to surgical excision for the long-term treatment of nBCC, Verkouteren and colleagues conducted a secondary analysis of a randomized clinical trial including 145 patients (median age, 68 years; 53.1% men) with primary, histologically proven nBCC assigned to either superficial curettage plus imiquimod (n = 73) or surgical excision (n = 72).

Five years after the initial treatment, results showed a freedom from treatment failure rate of 77.8% (95% CI, 65.7%-86%) among the superficial curettage plus imiquimod group and 98.2% (95% CI, 88%-99.8%) in the surgical excision group.

Superficial curettage plus imiquimod had a higher risk for treatment failure (HR = 15.93; 95% CI, 2.1-120.64) compared with surgical excision, including the 5.22 noninferiority margin.

Twenty patients died due to causes deemed unrelated to BCC; however, four of these patients were diagnosed with treatment failure before death. On the other hand, the remaining 16 patients died before being diagnosed with treatment failure, making death a competing risk with a competing risk regression of 16.16 (95% CI, 2.18-119.72).

The superficial curettage plus imiquimod group reported better cosmetic outcomes, with physicians observing higher rates of good to excellent outcomes vs. the surgical excision group. Although not considered statistically significant, 94.1% of patients in the superficial curettage plus imiquimod groups stated they were satisfied with the cosmetic result, whereas 90.9% in the surgical excision group reported the same.

Ultimately, Verkouteren and colleagues concluded that the study could not support surgical curettage plus imiquimod cream 5% as noninferior to surgical excision for the treatment of nBCC.

“The information in this trial can be used to counsel patients on the relative benefits and trade-offs of the different treatment options for nBCC,” the authors concluded.