EVIDENCE-BASED ONCOLOGYLittle evidence available on treatments for basal cell carcinoma of the skin: Abstracted from:Bath-Hextall F, Bong J, Perkins W et al. Interventions for basal cell carcinoma of the skin: systematic review.BMJ2004;329:705–8.☆,☆☆,☆☆☆
Section snippets
Background
The most effective treatment for people with basal cell carcinoma of the skin is unknown.
Objective
To determine the most effective treatment for people with basal cell carcinoma of the skin.
Method
Systematic review.
Search strategy
MEDLINE (1966 to December 2003); EMBASE (1980 to December 2003); the Cochrane Skin Group specialised register (December 2003); the Cochrane Library (2004, Issue 1); handsearching reference lists of identified studies and review articles, and contact with pharmaceutical companies and experts in the field.
Inclusion criteria
Randomised controlled trials (RCTs) of interventions for histologically confirmed basal cell carcinoma. Studies published in abstract form only were excluded.
Main outcomes
Primary outcome: clinical recurrence of basal cell carcinoma at three to five years. Secondary outcomes: recurrence at shorter follow-up time; histological treatment failure up to 6 months; adverse effects (described qualitatively).
Main results
Eighteen RCTs were included (see Evidence Table 1). Four of these RCTs were considered high quality. Only one of the 18 RCTs, a high-quality study (n = 347), examined the primary outcome. It found that surgical excision reduced recurrence of basal cell carcinoma compared with radiotherapy at 4 years. The review described adverse effects qualitatively (see Evidence Table 2).
Authors’ conclusions
There are few high-quality RCTs that have compared interventions for basal cell carcinoma. There is some evidence to suggest that surgical excision is more effective than radiotherapy. There is no reliable evidence on the long term effect of cryotherapy, photodynamic therapy, interferon, or fluorouracil on the recurrence of basal cell carcinoma.
Method notes
Search method MEDLINE (1966 to December 2003); EMBASE (1980 to December 2003); the Cochrane Skin Group specialised register (December 2003); the Cochrane Library (2004, Issue 1); handsearching reference lists of identified studies and review articles, and contact with pharmaceutical companies and experts in the field Selection criteria Randomised controlled trials (RCTs) of interventions for histologically confirmed basal cell carcinoma. Studies published in abstract form only were excluded
Commentary
The systematic review by Bath-Hextall et al.1 makes a valuable contribution. Basal cell cancer (BCC) is by far the most common skin cancer. BCC is often regarded as a disease of elderly men. However, recent studies show that it is now more common among younger patients and among women.2 Treatment of BCC aims to clear all tumour tissue, principally to prevent recurrence, since metastasis is rare. Other important goals of treatment are to limit treatment-related adverse effects while optimising
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Network geometry shows evidence sequestration for medical vs. surgical practices: Treatments for basal cell carcinoma
2014, Journal of Clinical EpidemiologyCitation Excerpt :Lastly, because the costs of the treatments change over time and the treatment costs vary between cities and countries, a future study comparing not only the effectiveness of the treatments but also the cost-effectiveness of the treatments in different settings may be helpful in further strengthening the evidence base of the best treatments for BCC. Early systematic reviews and commentaries had observed that the evidence base for BCC treatment is suboptimal because only a few randomized trials were available at that time [3,61]. Although numerous trials have been conducted since then, many important comparisons still have not been made.
Dermatology of the head and neck: Skin cancer and benign skin lesions
2012, Dental Clinics of North AmericaCitation Excerpt :Newer topical therapies such as imiquimod and photodynamic therapy have been shown to be useful for superficial lesions. However, there are few randomized controlled studies comparing different skin cancer treatments, and much of the published literature has low patient numbers and short-term follow-up.43 Cryosurgery, involving freezing of the lesion with liquid nitrogen, is the mainstay treatment for AKs, the precursor lesion of SCC.
Management of basal cell carcinomas with positive margins
2007, Actas Dermo-SifiliograficasCancer-associated immune-mediated syndromes: Pathogenic values and clinical implementation
2007, Biomedicine and PharmacotherapyCitation Excerpt :Occasionally, however, some types of BCC, e.g., metatypical BCC (basosquamous carcinoma or metatypical skin cancer/MSC) behave aggressively with deep invasion, recurrence, and potential regional and even distant metastasis. At the same time, banal BCC might undergo spontaneous regression in the absence of therapy, and the latter in epithelial skin tumors is a common phenomenon [8–13]. Recently published evidence has indicated the importance of CTLs in anti-tumor immunity, i.e., the importance of CD8+ CTLs of hosts against neoplasm, including GBM and BCC.
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2007, Journal of Investigative DermatologyCitation Excerpt :Using a skin-specific instrument we demonstrated that, in a substantially larger sample of patients, both excision and Mohs surgery improved tumor-related quality of life in all domains, and that ED&C did not improve quality of life in any domain. In the US, NMSC is the fifth most costly cancer to treat in the Medicare population (after lung, prostate, colon, and breast) (Housman et al., 2003), and Mohs surgery is commonly used (overall, about 30% of facial basal cell carcinomas are treated with Mohs surgery (Smeets, 2005)). ED&C is the least expensive method of treatment.
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Sources of funding: None.
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For Correspondence: Fiona Bath-Hextall. E-mail: [email protected].
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Abstract provided by Bazian Ltd., London.