Surgery Reduces Recurrence Risk in Patients with Nodular Basal Cell Carcinoma

Surgery Reduces Recurrence Risk in Patients with Nodular Basal Cell Carcinoma

Among patients with nodular basal cell carcinoma of the skin, surgery results in a lower risk of recurrence, but also a worse cosmetic result, than photodynamic therapy. These results were published in the Archives of Dermatology.

Each year, more than one million new cases of skin cancer are diagnosed in the United States.[1] Skin cancer is often divided into two broad categories: melanoma and non-melanoma. Non-melanoma skin cancer refers to several different types of skin cancer, but the most common types are basal cell carcinoma and squamous cell carcinoma.

Basal cell carcinoma accounts for roughly 80% of all cases of non-melanoma skin cancer.[2] Basal cell carcinoma most commonly develops on sun-exposed skin, with the head (particularly the nose) and neck being the most common sites. The appearance of basal cell carcinoma varies. It often appears as a raised bump with a smooth, pearly or waxy appearance. It may also look like a firm, flat scar.[3] Basal cell carcinoma very rarely metastasizes (spreads beyond the skin), but it can cause extensive local damage to the skin and surrounding tissues. Nodular basal cell carcinoma is the most common type of basal cell carcinoma.

Surgery is the mainstay of treatment for non-melanoma skin cancer, and several different types of surgery are available. Certain patients, however, may be candidates for non-surgical treatments, such as radiation therapy, topical therapy (application of medications to the skin), or photodynamic therapy. Photodynamic therapy involves the use of an agent that collects in cancer cells and makes them sensitive to light. Light is then applied to the area in order to destroy the cancer cells.

To compare surgical excision to photodynamic therapy in the treatment of nodular basal cell carcinoma, researchers conducted a clinical trial among 97 patients.[4]

  • During five years of follow-up, 4% of patients treated with surgery and 14% of patients treated with photodynamic therapy experienced a recurrence of basal cell carcinoma.
  • A good or excellent cosmetic result was achieved in 54% of patients treated with surgery and 87% of patients treated with photodynamic therapy.

These results indicate that in the treatment of nodular basal cell carcinoma, surgical excision results in a lower risk of recurrence, but also a worse cosmetic result, than photodynamic therapy. The researchers conclude that while surgical excision is likely to remain a standard treatment for nodular basal cell carcinoma, consideration of photodynamic therapy may be appropriate when cosmetic outcome is important. The researchers note that photodynamic therapy “is also an effective treatment.”

References:

[1]American Cancer Society. Cancer Facts and Figures 2007. Available at http://www.cancer.org/docroot/stt/stt_0.asp (Accessed September 25, 2007)

[2] Rubin AI, Chen EH, Ratner D. Basal-Cell Carcinoma. New England Journal of Medicine. 2005;353:2262-2269.

[3] National Cancer Institute. Skin Cancer (PDQ®): Treatment. Patient Version. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/skin/patient (accessed September 25, 2007)

[4] Rhodes LE, de Rie MA, Leifsdottir R et al. Five-year follow-up of a randomized, prospective trial of topical methyl aminolevulinate photodynamic therapy vs surgery for nodular basal cell carcinoma. Archives of Dermatology. 2007;143:1131-1136.

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