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No Need to Fry Basal Cell Carcinomas

Uncomplicated primary BCCs are candidates for curettage alone.

Electrodesiccation and curettage is a time-honored treatment for uncomplicated basal cell carcinomas (BCCs). Electrodesiccation has been associated with increased risks for hypertrophic scarring and longer healing. Could the electrodesiccation component be dropped without altering the cure rate?

In this retrospective study, 136 patients with 302 clinically superficial or nodular BCCs underwent treatment with curettage alone. A diagnostic shave biopsy was obtained at each site; curettage was performed from three directions immediately afterward with variously sized curets and included a 2- to 5-mm margin of normal skin. Hemostasis was achieved with 20% aluminum chloride. Tumors underwent excision or Mohs surgery and were excluded from further analysis if they extended into the subcutaneous tissue; if they had predominantly micronodular, infiltrative, or morpheaform features; if they had indistinct clinical margins; or if a clinically normal base could not be reached. However, patients whose biopsy exams showed an aggressive histologic subtype and who declined alternate treatment remained in the study.

The tumors ranged in size from 0.1 to 2.5 mm in diameter. After a mean follow-up of 6.4 years, the recurrence rate was 5%; the 5-year recurrence rate was 4%. The rate of recurrence was not related to tumor location or size. The small group of patients with histories of immunosuppression or radiation did not have higher recurrence rates than the group as a whole. Superficial and nodular BCCs accounted for 85% of the tumors. Localized foci of more aggressive subtypes were identified in the remaining 15%. The same proportion of subtypes appeared in recurrences as in initial lesions. The greater the deep-margin involvement evident in the initial shave biopsy, the higher the risk for recurrence.

Comment: Primary uncomplicated superficial and nodular BCCs can be treated with careful curettage alone without compromising the cure rate. These results compare favorably with prior studies of curettage alone for BCC, in which cure rates of 90% to 91.5% were reported. The relatively high cure rate in this study may reflect its retrospective nature, as only patients with low-risk lesions were selected to undergo curettage alone.

— George J. Hruza, MD

Published in Journal Watch Dermatology July 14, 2006

Citation(s):

Barlow JO et al. Treatment of basal cell carcinoma with curettage alone. J Am Acad Dermatol 2006 Jun; 54:1039-45.

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