BMJ  2004;329:705 (25 September), doi:10.1136/bmj.38219.515266.AE (published 13 September 2004)

Paper

Interventions for basal cell carcinoma of the skin: systematic review

Fiona Bath-Hextall, senior lecturer, school of nursing1, Jan Bong, consultant2, William Perkins, consultant2, Hywel Williams, professor of dermato-epidemiology1

1 Centre for Evidence-Based Dermatology, Queen's Medical Centre, Nottingham NG7 2UH, 2 Department of Dermatology, Queen's Medical Centre

Correspondence to: F Bath-Hextall fiona.bath-hextall{at}nottingham.ac.uk

Objectives To assess the effects of treatments for basal cell carcinoma.

Methods Systematic review of randomised controlled trials.

Main outcome measure Recurrence of basal cell carcinoma at three years or beyond, assessed clinically.

Studies reviewed Randomised controlled trials of interventions for histologically confirmed basal cell carcinoma (published and unpublished material; no language restrictions).

Results 25 studies were identified, covering seven therapeutic categories. Only one study of surgical excision versus radiotherapy contained primary outcome data, which showed significantly more persistent tumours and recurrences in the radiotherapy group compared with surgery (odds ratio 0.09, 95% confidence interval 0.01 to 0.67). One study compared cryotherapy with surgery, with inconclusive results at one year. In a comparison of radiotherapy with cryotherapy, significantly more recurrences occurred at one year in the cryotherapy group. Preliminary studies suggest a short term success rate of 87-88% for imiquimod cream in the treatment of superficial basal cell carcinoma, although this cream has not been compared with surgery. No consistent evidence was found for the other treatment modalities.

Conclusions Little good quality research has been done on the treatments used for the most common cancer in humans. Most trials have included only people with basal cell carcinoma occurring at low risk sites. Only one trial measured recurrence at four years; recurrence rates at one year should be interpreted with caution. Surgery and radiotherapy seem to be the most effective treatments; surgery showed the lowest failure rates. Other treatments might have some use but need to be compared with surgery.


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