Dermatologic Surgery
Recurrence rates of primary basal cell carcinoma in facial risk areas treated with curettage and electrodesiccation

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Background

The incidence of basal cell carcinoma (BCC) is increasing. Curettage and electrodesiccation (CE) are not recommended for BCC treatment at medium- and high-risk facial sites. Surgical excision has been proposed as the treatment of choice.

Objective

We sought to evaluate the cumulative recurrence rate (RR) of primary BCC in facial areas of medium and high risk after CE.

Methods

This nonrandomized, clinical trial enrolled 257 patients with primary BCC located in medium- and high-risk facial areas, and treated with 4 or 5 cycles of CE by a single operator from a section specializing in BCC CE in a tertiary teaching hospital in Oviedo, Spain. Exclusion criteria for study entry included: recurrent BCC, fibrosing BCC, ill-defined BCC, and BCC larger than 10 mm in diameter (high-risk facial sites) or larger than 15 mm in diameter (medium-risk sites); BCC smaller than 4 mm; and nonbiopsy-proven BCC. BCCs included in the study were from the nose, and paranasal and nasal-labial fold (n = 105); eyelids and canthi (n = 48); perioral areas (n = 12); ears (n = 11); forehead and temples (n = 48); periauricular areas (n = 14); and malar areas and cheeks (n = 19). The primary outcome was recurrence of carcinoma, which was clinically evaluated by at least two observers in consensus. Data were analyzed using both a life table method and Kaplan-Meier analysis. The statistical analysis included best- and worst-case scenarios (which means that all cases lost to follow-up were considered as recurrences).

Results

The 5-year cumulative non-RR in the best-case scenario was 98.80% (SE 0.70, 95% confidence interval 97.40%-100%); thus, a 5-year cumulative RR of 1.20% was found after CE in our medium- and high-risk BCCs of the face (best case). The 5-year cumulative non-RR in the worst-case scenario was 79.40% (95% confidence interval 78.90%-79.90%); thus, a 5-year cumulative RR of 20.60%.

Limitations

Retrospective design with a relatively small number of patients lost to follow-up is a study limitation.

Conclusion

High 5-year cure rates can be obtained after CE of primary, nonfibrosing BCCs of medium- and high-risk areas of the face performed in a specialized section.

Section snippets

CE section

All patients were treated in a tertiary teaching hospital in Oviedo, Spain, by a single dermatologist (T. R-V.) with more than 30 years of experience in the procedure, in a section specializing in BCC CE.

CE technique

The same type of curettes (standard round and oval head Fox, 4-10 mm in longest diameter, Aesculap, Tuttlingen, Germany) and electrodesiccation equipment (Erbetom T400C model, Erbe, Tübingen, Germany) (level 4 was the power setting used for electrodesiccation, with approximately 40-55 W) was

Results

The number of BCCs and their stratification according to the location and size is shown in Table I. A total of 176 tumors were located at high-risk sites and 81 tumors were located at medium-risk sites.

Data for follow-up time after treatment are also shown in Table I. The range of follow-up time was 1 to 8 years, with a mean of 5.34 years (SD 1.33).

There were 3 recurrences. One was located on the nose, one on the eyelid, and one on the periauricular area. All recurrences were observed between

Discussion

There are several excellent reviews reporting RR after CE of BCC,3, 10 and systematic reviews1, 11 and guidelines for the management of BCC edited by several dermatologic associations.12, 13, 14 Nevertheless, controversy remains. It is generally accepted that when correctly treated with CE by experts, cure rates of more than 95% can be expected for appropriately selected BCC.12, 13, 14 The types of BCC that should not be treated by CE include large tumors, infiltrating, fibrosing, and recurrent.

References (23)

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    Recurrence rates of treated basal cell carcinomas, part 1: overview

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  • Cited by (0)

    Funding sources: None.

    Conflicts of interest: None identified.

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