New Study Reveals Differences in Treatment Outcomes for Nodular Basal Cell Carcinoma

Topline Findings

In a pivotal new study, researchers have found that the recurrence rate is significantly higher after treating nodular basal cell carcinoma (nBCC) with superficial curettage (SC) combined with imiquimod cream compared to surgical excision (SE). This crucial information can help dermatologists and patients make more informed decisions about treatment options.

Methodology of the Study

The study drew data from the SCIN trial, a randomized clinical trial that analyzed 145 patients, with 53.1% being male and the median age at 68 years. All participants had histologically confirmed primary nBCC lesions measuring between 4 and 20 mm in size. Patients were enrolled from two outpatient dermatology departments in the Netherlands between January 2016 and November 2017.

Participants were randomly assigned to one of two treatment arms: SC followed by the application of 5% imiquimod cream (n = 73) or SE (n = 72). The primary outcome measure was the 5-year probability of remaining free from treatment failure. Treatment failure was defined as the development of a histologically confirmed BCC within a clinically suspicious area close to the treatment site (within 10 mm of the scar).

Additional secondary endpoints included assessing the cosmetic outcomes of the scars and long-term patient satisfaction with their chosen treatment.

Key Takeaways

At the 5-year mark, the probability of remaining free from treatment failure was markedly lower in the SC plus imiquimod group (77.8%) compared to the SE group (98.2%). The relative risk was 15.93, with a confidence interval ranging from 2.10 to 120.64. Despite the wide confidence interval, this data does not establish the noninferiority of SC plus imiquimod.

Interestingly, 10 out of 15 treatment failures in the SC plus imiquimod group occurred within the first year, whereas only one recurrence was observed in the SE group throughout the follow-up period. During the study, 20 deaths were reported among participants, though none were attributed to BCC.

Dermatologists assessed higher cosmetic outcomes for SC plus imiquimod compared to SE. However, patient-reported outcomes regarding satisfaction and willingness to repeat or recommend the treatment were similar between the two groups.

Practical Implications for Clinicians

The study’s authors concluded that while SC plus imiquimod may not be noninferior to SE, it is substantially less effective in preventing recurrence of nodular basal cell carcinoma. This finding highlights the need for careful counseling of patients about the relative benefits and trade-offs associated with different treatment approaches.

Physicians can use this information to educate patients about the likelihood of treatment failure and the expected outcomes of each treatment option, thereby empowering patients to make well-informed decisions.

Conclusion

This comprehensive study provides valuable insights into the comparative effectiveness of superficial curettage with imiquimod cream versus surgical excision for treating nodular basal cell carcinoma. It underscores the importance of considering recurrence rates when choosing a treatment plan. While SC plus imiquimod may offer certain advantages in terms of cosmetic results, SE appears to be superior in terms of long-term effectiveness.

As always, patient education and shared decision-making will play critical roles in guiding the selection of appropriate therapeutic strategies for managing nBCC.

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