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Interventions for basal cell carcinoma of the skin: systematic review.

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Randomised controlled trials of interventions for histologically confirmed basal cell carcinoma (published and unpublished material; no language restrictions).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

SUBMITTER: Bath-Hextall F

PROVIDER: S-EPMC518891 | biostudies-other | 2004 Sep

REPOSITORIES: biostudies-other

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Interventions for basal cell carcinoma of the skin: systematic review.

Bath-Hextall Fiona F Bong Jan J Perkins William W Williams Hywel H

BMJ (Clinical research ed.) 20040913 7468

<h4>Objectives</h4>To assess the effects of treatments for basal cell carcinoma.<h4>Methods</h4>Systematic review of randomised controlled trials.<h4>Main outcome measure</h4>Recurrence of basal cell carcinoma at three years or beyond, assessed clinically.<h4>Studies reviewed</h4>Randomised controlled trials of interventions for histologically confirmed basal cell carcinoma (published and unpublished material; no language restrictions).<h4>Results</h4>25 studies were identified, covering seven t ...[more]

PMID: 15364703

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Project description:ObjectivesTo assess the effects of treatments for non-metastatic invasive squamous cell carcinoma (SCC) of the skin using evidence from observational studies, given the paucity of evidence from randomised controlled trials.DesignSystematic review of observational studies.Data sourcesMedline, Embase, to December 2012.Review methodsObservational studies of interventions for primary, non-metastatic, invasive, SCC of the skin that reported recurrence during follow-up, quality of life, initial response to treatment, adverse events, cosmetic appearance, or death from disease. Studies were excluded if data for primary cutaneous SCC was not separable from other data. Data were extracted independently by two reviewers. Meta-analysis was performed where appropriate using a random effects model to estimate the pooled proportion of an event with 95% confidence intervals.Results118 publications were included, covering seven treatment modalities. Pooled estimates of recurrence of SCCs were lowest after cryotherapy (0.8% (95% confidence interval 0.1% to 2%)) and curettage and electrodesiccation (1.7% (0.5% to 3.4%)), but most treated SCCs were small, low risk lesions. After Mohs micrographic surgery, the pooled estimate of local recurrence during variable follow-up periods from 10 studies was 3.0% (2.2% to 3.9%), which was non-significantly lower than the pooled average local recurrence of 5.4% (2.5% to 9.1%) after standard surgical excision (12 studies), and 6.4% (3.0% to 11.0%) after external radiotherapy (7 studies). After an apparently successful initial response of SCCs to photodynamic therapy, pooled average recurrence of 26.4% (12.3% to 43.7%; 8 studies) was significantly higher than other treatments. Evidence was limited for laser treatment (1 study) and for topical and systemic treatments (mostly single case reports or small non-comparative series with limited follow-up).ConclusionsMany observational studies have looked at different treatment modalities for SCC, but the evidence base for the effectiveness of these interventions is poor. Comparison of outcomes after different treatments should be interpreted cautiously owing to biases inherent in the types of study included, and lack of direct comparisons to enable the estimation of relative treatment effect. Further evidence is needed to develop a prognostic model and stratify individuals at high risk of developing SCC, to improve the evidence base for this common cancer and to optimise clinical management.Protocol registrationInternational Prospective Register of Systematic Reviews (PROSPERO) registration number CRD42011001450.

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Interventions for basal cell carcinoma of the skin: systematic review.

Publications

Interventions for basal cell carcinoma of the skin: systematic review.

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