The management of basal cell carcinoma
Non-surgical techniques
Destructive techniques without histological control
Curettage and cautery/electrodesiccation
There are wide variations in how this technique is performed (e.g. type of curette used, number of cycles of treatment) and both experience in the technique and appropriate selection of cases is crucial to success. Curettage and cautery is best used for selected low-risk lesions (small, well defined primary lesions with non-aggressive histology usually in non-critical sites where 5-year cure rates of up to 97% are possible. Curettage and cautery is not recommended for the management of large and other 'high-risk' tumours.42,45-48
Tumour size is an important factor as the recurrence rate rises dramatically with increasing tumour size.
A literature review of all studies published since 1947 suggested an overall 5-year cure rate of 92.3% following curettage and cautery for primary BCC. 41 However, a similar review of all studies published since 1945 suggested an overall 5-year cure rate of 60% following curettage and cautery for recurrent BCC. This supports the view that curettage and cautery is much less useful in the treatment of recurrent BCC, especially in high-risk sites.
Cryotherapy
Cryosurgery is widely used to treat solitary and multiple BCCs. Individual technique can vary considerably, using the open or closed spray techniques and single, double or triple freeze/thaw cycles.
Many large published series specifically exclude the treatment of very high-risk BCCs, emphasizing the importance of careful selection of appropriate lesions with non-aggressive histology, away from critical facial sites in order to achieve high cure rates. There are reports in the ophthalmological literature recommending the use of cryo-surgery for periocular BCC, although full-thickness eyelid defects may occasionally result and require subsequent plastic surgical reconstruction.
Thorough curettage immediately prior to cryosurgery may help to increase the cure rate.
As with most treatment modalities, cryosurgery is less useful in the treatment of recurrent BCC.
Post-operative wound care can be a problem. However, the treatment is usually well tolerated when performed on a local anaesthetic, outpatient basis and the cosmetic results can be excellent.
Carbon dioxide laser
Carbon dioxide (CO2) laser surgery is not a widely used form of treatment and there is little published follow-up data. The treatment is mainly recommended for low-risk lesions. When combined with curettage, CO2 laser surgery may be useful in the treatment of large or multiple superficial BCCs.
Non-surgical techniques
Destructive techniques without histological control
Curettage and cautery/electrodesiccation
There are wide variations in how this technique is performed (e.g. type of curette used, number of cycles of treatment) and both experience in the technique and appropriate selection of cases is crucial to success. Curettage and cautery is best used for selected low-risk lesions (small, well defined primary lesions with non-aggressive histology usually in non-critical sites where 5-year cure rates of up to 97% are possible. Curettage and cautery is not recommended for the management of large and other 'high-risk' tumours.42,45-48
Tumour size is an important factor as the recurrence rate rises dramatically with increasing tumour size.
A literature review of all studies published since 1947 suggested an overall 5-year cure rate of 92.3% following curettage and cautery for primary BCC. 41 However, a similar review of all studies published since 1945 suggested an overall 5-year cure rate of 60% following curettage and cautery for recurrent BCC. This supports the view that curettage and cautery is much less useful in the treatment of recurrent BCC, especially in high-risk sites.
Cryotherapy
Cryosurgery is widely used to treat solitary and multiple BCCs. Individual technique can vary considerably, using the open or closed spray techniques and single, double or triple freeze/thaw cycles.
Many large published series specifically exclude the treatment of very high-risk BCCs, emphasizing the importance of careful selection of appropriate lesions with non-aggressive histology, away from critical facial sites in order to achieve high cure rates. There are reports in the ophthalmological literature recommending the use of cryo-surgery for periocular BCC, although full-thickness eyelid defects may occasionally result and require subsequent plastic surgical reconstruction.
Thorough curettage immediately prior to cryosurgery may help to increase the cure rate.
As with most treatment modalities, cryosurgery is less useful in the treatment of recurrent BCC.
Post-operative wound care can be a problem. However, the treatment is usually well tolerated when performed on a local anaesthetic, outpatient basis and the cosmetic results can be excellent.
Carbon dioxide laser
Carbon dioxide (CO2) laser surgery is not a widely used form of treatment and there is little published follow-up data. The treatment is mainly recommended for low-risk lesions. When combined with curettage, CO2 laser surgery may be useful in the treatment of large or multiple superficial BCCs.
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