In a new study, correctly-performed combined curettage and cryosurgery with standardized protocols provided excellent clinical clearance rates for basal cell carcinoma (BCC) with both one and two freeze-thaw cycles. The authors report that self-reported times with oozing wounds were short and patients were generally satisfied with the cosmetic outcome.
The study was published in the Journal of the American Academy of Dermatology.
In a press release, the researchers note that the number of skin cancer cases continues to rise, which results in significant costs to healthcare systems. While surgery is the most recommended treatment for BCCs, the investigators write that it is time- and resource-intensive.
They write that the faster method of curettage and cryosurgery has been used internationally since the 1960s but has been questioned due to a lack of clearly defined treatment protocols. The effects have therefore also varied widely.
The primary objective of this study was to compare clearance rates after one year for curettage and cryosurgery in one (C&Cx1) or two freeze-thaw cycles (C&Cx2) for non-facial BCCs with clinically nodular features. The secondary objectives were to compare wound healing times and to evaluate patient satisfaction with the scars.
A total of 202 tumours were treated in 116 patients, 40 of whom were women. The median age for the group was 72 years.
At one year, a single recurrence was found in the C&Cx1 group resulting in clearance rates of 99% versus 100%, proving the non-inferiority hypothesis with an absolute difference <8%.
The mean time for oozing wounds was 1.0 (SD = 1.3) week for C&Cx1 and 1.2 (SD = 1.2) weeks for C&Cx2 (p=0.062). After four to six weeks, 71% of the wounds had remaining crusts, 13% still had oozing, and 11% were completely healed without any significant differences between the 2 groups.
The only relevant factor the investigators found that significantly increased wound healing times was larger lesion size (p=0.0008). After one year, 105 patients reported satisfaction with their scars, one was unsatisfied and four felt neutral about the cosmesis. Data on six patients were missing.
Overall, the researchers reported nine treatment-related adverse events. Two were wound infections, six were lesions with prolonged wound healing, and there was one report of itching three months after treatment.
The study was led by Eva Backman, MD, a doctoral student in dermatology and venereology at the University of Gothenburg’s Sahlgrenska Academy and a consultant in dermatovenerology at Sahlgrenska University Hospital in Göteborg, Sweden.
“Our research clearly shows that, when carried out properly, this method is both safe and cost-effective compared to other commonly used and more resource-intensive methods,” Dr. Backman said in the release. “We, therefore, hope that the results will be disseminated throughout Sweden, but also internationally.”
“Healthcare faces significant challenges, with a growing population that is also living longer,” said Dr. Backman. “It feels gratifying being able to demonstrate that old treatment methods still play a pivotal role in the treatment armamentarium for our most common type of cancer.”