Recurrence Rates of Treated Basal Cell Carcinomas: Part 2: Curettage‐Electrodesiccation

Abstract

This is the second article in a series that reviews the experience in the Skin and Cancer Unit, from 1955 through 1982, with the treatment of basal cell carcinomas (BCCs). This report deals with 2314 previously untreated (primary) BCCs removed by curettage-electrodesiccation. Multivariate analysis showed that increasing lesion diameter (P less than .001), high-risk anatomic sites (nose, paranasal, nasal-labial groove, ear, chin, mandibular, peri-oral, and peri-ocular areas) (P less than .001), middle-risk anatomical sites (scalp, forehead, pre- and post-auricular, and malar areas) (P less than .001), and time-span treated (1955 to 1963) (P = .012) were independent risk factors for high recurrence rates. The patient's age, sex, and lesion duration before treatment did not affect the recurrence rates. In order to best illustrate our current experience with BCCs, the last time-span (1973 to 1982) was examined in detail. For the low-risk sites (neck, trunk, and four extremities), BCCs of all diameters responded well to curettage-electrodesiccation with an overall 5-year recurrence rate of 3.3% (SE = 1.5%) determined by the modified life-table method. In the middle-risk sites BCCs less than 10 mm in diameter had a recurrence rate of 5.3% (SE = 2.7%). Finally, in the high-risk sites, lesions less than 6 mm in diameter had a recurrence rate of 4.5% (SE = 2.6%). Thus, BCCs less than 6 mm in diameter, regardless of anatomic site, as well as selected larger BCCs depending on their anatomic site, are effectively treated by currettage-electrodesiccation.

Guidelines of care for the management of basal cell carcinoma

“…On the basis of the best available literature, the most useful stratification of BCC is provided by the National Comprehensive Cancer Network (NCCN) Guidelines (for recommendation, see Table II; for level of evidence/strength of recommendation, see Table III). 2,3,[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] The NCCN stratification, listed in Table IV, takes both clinical and pathologic parameters into account and is based on a combination of available evidence and expert multidisciplinary opinion, including representatives from dermatology, dermatopathology, head and neck surgery, plastic surgery, and surgical, radiation, and medical oncology. Treatment recommendations throughout the current guidelines are based on this stratification.…”

“…When the clinician is submitting biopsy tissue for histopathologic diagnosis, the work group recommends that whenever possible and appropriate, key elements of patient demographics, clinical presentation, and clinical history should be provided to the pathologist (see Table VI; for level of evidence/ strength of recommendations, see Table III). These include patient age and biologic sex, [17][18][19][20][21][22][23][24][25] anatomic location, [17][18][19][20][22][23][24][25][26] and any history of treatment at the same anatomic site. 17,18,22,23 Additional desirable relevant information includes the clinical size of the lesion 17,18,[20][21][22][23][24][25][26] and whether the patient currently, or previously encountered additional risk factors, such as immunosuppression, radiation treatment, or solid organ transplantation.…”

“…24,34,46,62,88,100,101 Several different types of radiotherapy can be used to treat BCC, including superficial radiation therapy, isotope-based brachytherapy (interstitial or topical contact), and external electron beam radiation. Primary or adjuvant radiation is an effective treatment option for selected patients with BCC, resulting in good tumor control and cosmesis, with the understanding that cure rates may be lower.…”

An Overview on Basal Cell Carcinoma

“…Recurrence rates are varied between 3% to 19%im 5 years (78). Recurrence was higher in nasal, paranasal, and forehead areas (78). Although ED & C appears to have a higher risk for disease recurrence compared with surgical excision, a nonrandomized retrospective chart review suggested that the two treatment modalities are not significantly different (79).…”

“…Typically two or three treatment cycles are recommended to completely remove the tumor (77). Recurrence rates are varied between 3% to 19%im 5 years (78). Recurrence was higher in nasal, paranasal, and forehead areas (78).…”