Tumor Recurrence 5 Years after Treatment of Cutaneous Basal Cell Carcinoma and Squamous Cell Carcinoma

Abstract

For most cutaneous basal cell and squamous cell carcinomas (nonmelanoma skin cancers [NMSC]) data are insufficient to permit evidence-based choices among treatments. To compare tumor recurrence after treatments, we conducted a prospective cohort study of consecutive patients with primary NMSC treated with the most common treatments in two practices in 1999–2000. Recurrence was determined from medical records by observers blinded to treatment type. 24.3% of tumors (N=361) were treated with destruction with electrodessication / curettage, 38.3% (N=571) with excision, and 37.4% (N=556) with histologically-guided serial excision (Mohs surgery). Follow-up was available for 1174 patients with 1488 tumors (93.8%) at median 7.4 years; overall 5-year tumor recurrence rate [95% Confidence Interval] was 3.3% [2.3, 4.4]. Unadjusted recurrence rates did not differ after treatments: 4.9% [2.3, 7.4] after destruction, 3.5% [1.8, 5.2] after excision, and 2.1% [0.6, 3.5] after Mohs surgery (P=0.26), and no difference was seen after adjustment for risk factors. In tumors treated only with excision or Mohs surgery, the hazard of recurrence was not significantly different, even after adjustment for propensity for treatment with Mohs surgery. These data indicate that common treatments for NMSC were at least 95% effective, and further studies are needed to guide therapeutic choices for different clinical subgroups.

A programme of research to set priorities and reduce uncertainties for the prevention and treatment of skin disease

“…Overlapping CIs for average effect estimates for the different treatments suggest that apparent differences between treatments may not be significant. This is in agreement with finding of Chren et al 659 who conducted a large prospective cohort study of all primary NMSCs and reported no significant difference in hazard of recurrence between surgically excised tumours and those treated with MMS.…”

“…It is also possible that SCCs that were treated by destructive modalities such as cryotherapy or 659 This was supported by our recent systematic review and pooled analysis of treatments for SCC in which there was significant overlap of CIs between different treatment modalities. 536 Although only a small percentage of SCCs recur, it is important to identify those that are at greatest risk of recurring at an early stage.…”

“…However, Mohs requires more resources than excision and is more costly, 685,686 and a large prospective cohort study has reported that outcomes after MMS for NMSCs are similar to those after excision. 659 A RCT of MMS versus excision has been conducted for BCCs, revealing similar 5-year recurrence rates for the two treatments; the investigators concluded that surgical excision is probably sufficient for most cases of primary BCC. 687 However, there have been no randomised studies comparing Mohs and surgical excision for SCC, so the proposed trial will be the first of its kind to be conducted.…”

Current Advances in the Treatment of Basal Cell Carcinoma

“…Standart eksizyon 5 yıllık rekürrens oranlarının %2-10 arasında değiştiği bütün primer BHK olgularda etkili tedavi seçeneğidir [20][21][22] . Genel kabul gören güvenli cerrahi sınır 3-5 mm.…”

Varian HDR surface applicators — commissioning and clinical implementation

“…Mohs surgery is a proven and well‐known procedure for skin cancer treatment, with five‐year cure rate of 97%‐99% (6) . However, Mohs surgery requires the preparation and examination of frozen pathology, representing a relatively labor‐intensive, time‐consuming, and expensive process.…”