This article is more than 5 years old. Information may no longer be current.
Evidence lacking for comparative effectiveness, safety of skin cancer treatments
Click Here to Manage Email Alerts
A review published in Annals of Internal Medicine found that although several treatment methods for basal cell carcinoma, including surgery, external beam radiation and topical creams, appear effective, evidence is too sparse to determine a best option between the interventions.
“The US Agency for Healthcare Research and Quality noticed that there were many treatments available for basal cell carcinoma and were unsure of how effective they were,” Aaron M. Drucker, MD, ScM, from Alpert Medical School of Brown University, told Healio Internal Medicine. “In order to improve treatment and health-policy decisions, a systematic appraisal and analysis of the existing literature was needed.”
Therefore, Drucker and colleagues analyzed 40 randomized trials and five nonrandomized studies that investigated 18 common interventions for treating basal cell carcinoma in adults to determine their effectiveness and safety. The researchers reviewed and compared data on recurrence, histologic clearance, clinical clearance, cosmetic outcomes, quality of life and mortality for each intervention.
Data indicated that excision (3.8%; 95% CI, 1.5-9.5), Mohs surgery (3.8%; 95% CI, 0.7-18.2), curettage and diathermy (6.9%; 95% CI, 0.9-36.6) and external-beam radiation (3.5%; 95% CI, 0.7-16.8) had similar estimated rates of recurrence.
Conversely, cryotherapy (22.3%; 95% CI, 10.2-42), curettage and cryotherapy (19.9%; 95% CI, 4.6-56.1), 5-fluorouracil (18.8%; 95% CI, 10.1-32.5), imiquimod (14.1%; 95% CI, 5.4-32.4) and photodynamic therapy using methyl-aminolevulinic acid (18.8%; 95% CI, 10.1-32.5) or aminolevulinic acid (16.6%; 95% CI, 7.5-32.8) had higher rates of recurrence.
More patients undergoing photodynamic therapy using methyl-aminolevulinic acid (93.8%; 95% CI, 79.2-98.3) or aminolevulinic acid (95.8%; 95% CI, 84.2-99) reported good or better cosmetic outcomes than those undergoing excision (77.8%; 95% CI, 44.8-93.8) or cryotherapy (51.1%; 95% CI, 15.8-85.4).
The researchers could not determine interventions’ effects on quality of life and mortality due to limited data.
“For some commonly used treatments like excision, clinicians and patients can be reassured that they are effective at treating basal cell carcinoma,” Drucker said. “For other commonly used treatments such as electrodesiccation with curettage, thousands of which are performed every year, there is very little data on its effectiveness. Clinicians and patients should be aware that current clinical decisions regarding basal cell carcinoma treatment options are based on very little information.”
New, well-executed randomized controlled trials are needed to confirm the comparative effectiveness of commonly used treatments for basal cell carcinoma, he said.
“The uncertainty in our results should not necessarily prompt changes in the way basal cell carcinoma are currently managed,” he said. “However, when discussing treatment options with patients for shared decision-making, clinicians should explain that there is uncertainty around the relative effectiveness of the many different treatments.”
In an accompanying editorial, Brittany O. Dulmage, MD, and Shuai Xu, MD, MSc, both from Northwestern University Feinberg School of Medicine, wrote that the study by Drucker and colleagues provides insight into the comparative effectiveness of various treatments for basal cell carcinoma, but since the available data are sparse it is difficult to draw reliable conclusions about the most effective treatment methods.
“The suffering these tumors cause to patients, coupled with increasing prevalence and cost, underscores the urgent need for better evidence to inform both clinical decision-making and health care policy,” they concluded. – by Alaina Tedesco
Disclosure: Drucker reports receiving grants from AHRQ, serving as an investigator and receiving research funding from Sanofi and Regeneron, consulting for Canadian Agency for Drugs and Technology in Health, Eczema Society of Canada, Sanofi and RTI Health Solutions and receiving honoraria from Astellas Canada, CME Outfitters, Eczema Society of Canada Prime Inc. and Spire Learning. Please see study for all other authors’ relevant financial disclosures. Dulmage reports no relevant financial disclosures. Xu reports receiving personal fees from Aclaris Therapeutics and grants from Leo Pharma and Pfizer.