Interventions for BCC

Interventions for basal cell carcinoma of the skin.Author(s): Bath-Hextall F; Perkins W; Bong J; Williams H;

BACKGROUND: Basal cell carcinoma (BCC) is the commonest skin cancer. BCCs
are slow-growing, locally invasive, epidermal skin tumours which mainly
affect white skinned people. The first line treatment is usually surgical
excision, but numerous alternatives are available. OBJECTIVES: To assess
the effects of treatments for basal cell carcinoma. SEARCH STRATEGY: We
searched the Cochrane Skin Group Specialised Register (January 2006),
the Cochrane Central Register of Controlled Trials (The Cochrane LIbrary
Issue 1, 2006), the Cochrane Database of Systematic Reviews (The Cochrane
Library Issue 1, 2006), MEDLINE (2004 to January 2006), EMBASE (2005 to
January 2006), the metaRegister of Controlled Trials (February 2006).
Cited references of all trials identified and key review articles were
searched. Pharmaceutical companies were contacted where appropriate for
reviews or unpublished trials. SELECTION CRITERIA: Inclusion criteria
were adults with one or more histologically proven, primary basal cell
carcinoma. The primary outcome measure was recurrence at three to five
years, measured clinically. The secondary outcome included early treatment
failure within six months, measured histologically. Adverse treatment
effects included aesthetic appearance and pain during and after treatment.
DATA COLLECTION AND ANALYSIS: Two authors independantly carried out study
selection and assessment of methodological quality. MAIN RESULTS: Twenty
seven studies were identified. Only one RCT of surgery versus radiotherapy
had primary outcome data at four years, showing significantly more persistent
tumours and recurrences in the radiotherapy group as compared to the surgery
group, (RR 0.09, 95%CI, 0.01 to 0.69). One study found no significant
difference for recurrence at 30 months when Moh's micrographic surgery
was compared to surgery for high risk facial BCCs, (RR 0.64, 95%CI 0.16,2.64).
One study of methylaminolevulinate photodynamic therapy (MAL PDT) versus
cryotherapy found no significant difference in recurrences in the MAL
PDT group when compared to cryotherapy at one year (RR 0.50, 95% CI 0.22,1.12).
Cryotherapy showed no significant difference in recurrences at one year
when compared to surgery on one small study. When radiotherapy was compared
to cryotherapy there were significantly fewer recurrences at one year
in the radiotherapy group compared to the cryotherapy group.Short-term
studies suggest a success rate of 87 to 88% for imiquimod in the treatment
of superficial BCC using a once-daily regimen for 6 weeks and a 76% treatment
response when treating nodular BCC for 12 weeks, when measured histologically.
AUTHORS' CONCLUSIONS: Overall there has been very little good quality
research on treatments for BCC. Most trials have only evaluated BCCs in
low risk locations. Surgery and radiotherapy appear to be the most effective
treatments with surgery showing the lowest failure rates. Although cosmetic
outcomes appear good with PDT, long term follow up data are needed. Other
treatments might have some use but few have been compared to surgery.
An ongoing study comparing imiquimod to surgery should clarify whether
imiquimod is a useful option.

Cochrane database of systematic reviews (Online: Update Software); 2007
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Number of References: 63