Key Treatment

Mohs surgery (3 studies, n = 2660) is the "gold standard" but is not needed for all basal cell carcinomas. Recurrence rate was 0.8 to 1.1. Systematic review also showed the following (Thissen et al., 1999) (SOR: A):

Surgical excision (3 studies, n = 1303): recurrence rate was 2 to 8. Mean cumulative 5-year rate was 5.3. Recommended margins are 4 to 5 mm.

Curettage and desiccation (6 studies, n = 4212): recurrence rate was 4.3 to 18.1. Cumulative 5-year rate was 5.7 to 18.8. Three cycles of curettage and desiccation can produce higher cure rates then one cycle.

Cryosurgery (4 studies, n = 796): recurrence rate was 3.0 to 4.3. Cumulative 5-year rate (3 studies) was 0 to 16.5. Superficial BCC is effectively treated with imiquimod 5% cream (Gollnick et al., 2005) or 5-FU cream (Gross et al. 2007) (SOR: B).

Figure 33-82 Sclerosing basal cell carcinoma. © Richard P. Usatine and The Skin Cancer Foundation)

Figure 33-83 Pigmented nodular basal cell carcinoma. ©J Richard P. Usatine.)

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