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Surgery remains ‘gold standard’ for basal cell carcinoma
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Surgery remains the ideal treatment for patients with basal cell carcinoma, according to results of an evidence review.
Researchers with Columbia University Medical Center’s department of dermatology searched four databases — PubMed, Ovid MEDLINE, Cochrane Central Register of Controlled Trials and Cochrane Database of Systemic Reviews — to identify randomized controlled trials, systematic reviews or comparative studies that focused on treatment for basal cell carcinoma (BCC).
The investigators analyzed treatment patterns, and they also examined recurrence rates and cosmetic outcomes for each approach.
Researchers identified 615 relevant articles. Two independent reviewers chose 40 studies for analysis. They included 29 randomized controlled trials, seven systematic reviews, and four nonrandomized, prospective trials.
The studies focused on several treatment modalities, including: surgical therapy, photodynamic therapy (PDT), radiotherapy and cryotherapy, topical imiquimod, topical solasodine glycoalkaloids, topical 5-fluorouracil (5-FU), intralesional 5-FU, topical ingenol mebutate, intralesional interferon and oral hedgehog pathway inhibitors.
“The available data suggest that surgical methods remain the gold standard in BCC treatment, with Mohs’ micrographic surgery typically utilized for high-risk lesions,” the researchers wrote. “Suitable alternate treatment options for appropriately selected primary low-risk lesions may include PDT, cryotherapy, topical imiquimod and 5-FU. Radiotherapy is a suitable alternate for surgical methods for treatment in older patient populations.”
Results showed electrodesiccation and curettage often is used as primary treatment for low-risk lesions. However, no randomized controlled trials designed to assess that approach met the researchers’ inclusion criteria.
New hedgehog pathway inhibitors demonstrate promise as treatment for advanced disease, yet there are concerns about the potential for adverse effects in some patients, researchers wrote. Questions also remain about ideal treatment duration, recurrence risk and the potential for resistance.
The evidence about topical solasodine, topical ingenol mebutate, glycoalkaloids, interferon-alpha and intralesional 5-FU is insufficient to guide any recommendations, according to the researchers.
“Continued research on the efficacy of treatment modalities is needed,” they wrote. “In particular, studies should include histologic ascertainment of clearance, long-term follow-up, stratification based on tumor subtype, and comparison with surgical outcomes.”
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