PARIS Surgical excision is more effective than photodynamic therapy for the treatment of nodular basal cell carcinoma, based on the results of a study of more than 100 patients.
The cumulative incidence of failure was 2% for surgical excision, compared with 30% for photodynamic therapy at a 3-year interim analysis.
In all, 171 primary basal cell carcinomas in 149 patients were treated88 in the surgical excision group and 83 in the phototherapy group. At 3-month follow-up, there were five basal cell carcinoma treatment failures in the phototherapy group (6%) and two (2.3%) in the surgical excision group.
"There's actually a higher risk of incomplete treatment after treatment with photodynamic therapy for primary basal cell carcinomas," Dr. Klara Mosterd of the department of dermatology at the University Hospital Maastricht (the Netherlands), said at the annual congress of the European Academy of Dermatology and Venereology.
For the study, primary basal cell carcinomas with a maximum size of 2 cm were randomly assigned to either photodynamic therapy or surgical excision. Exclusion criteria included tumors with mixed histology, recurrent basal cell carcinoma, three or more tumors per patient, and short life expectancy, among others.
Tumors treated with photodynamic therapy first underwent surgical debulking 2 weeks prior to treatment. Illumination was performed 4 hours after application of 5-aminolevulinic acid (ALA) cream. Tumors that were illuminated were illuminated again an hour later (from 585 nm to 720 nm, 75 J/cm
Surgical excision was performed under local anesthesia, using a 3-mm margin. Histologic examination then was performed. Any residual tumor found on follow-up was excised again, Dr. Mosterd said at the meeting.
After the first follow-up visit at 3 months, all patients were seen every 6 months up to 2 years and then once yearly up to 5 years.
Although surgical excision is the treatment of choice in patients with nodular basal cell carcinoma, photodynamic therapy has been shown to be an effective treatment for superficial basal cell carcinoma. This prompted the researchers to explore the effectiveness of photodynamic therapy on nodular basal cell carcinoma.