CRYOSURGERY IN THE TREATMENT OF BASAL-CELL CARCINOMA - ASSESSMENT OF ONE AND 2 FREEZE-THAW CYCLE SCHEDULES

BACKGROUND. It has become routine practice in many centers to use two successive freeze-thaw cycles in the treatment of the common types of basal cell carcinoma. Because of the potential morbidity caused by thi s, we have investigated the cure rate achieved with one freeze-thaw cy cle compared with that achieved with two freeze-thaw cycles in the tre atment of facial basal cell carcinomas of a uniform type and clinicall y in the best prognostic group. Superficial truncal basal cell carcino mas are reported to respond to less aggressive cryosurgery, and we hav e investigated the cure rate achieved with one freeze-thaw cycle. OBJE CTIVE. TO compare the efficacy of one freeze-thaw cycle versus two fre eze-thaw cycles in the treatment of facial basal cell carcinomas, Seco nd, to investigate the efficacy of one freeze-thaw cycle in the treatm ent of superficial truncal basal cell carcinomas. This was investigate d in a prospective randomized posttreatment follow-up study. METHODS. Over the past 7 years,, we have treated 84 facial basal cell carcinoma s with either a single 30-second freeze-thaw cycle or a double 30-seco nd freeze-thaw cycle. Patients were allocated randomly into one of the two treatment schedules, and the cure rates achieved were compared. S econd, 29 superficial truncal basal cell carcinomas were treated with a single 30-second freeze-thaw cycle. Patients were followed tip to as sess response to therapy. RESULTS. A 95.3% cure rate was achieved in t he treatment of facial basal cell carcinomas with a double freeze-thaw cycle. This compared with a cure rate of only 79.4% when facial lesio ns were treated with a single freeze-thaw cycle. Treatment of superfic ial truncal basal cell carcinomas with a single freeze-thaw cycle achi eved a cure rate of 95.5%. CONCLUSION. We recommend that, in order to achieve high cure rates that are equivalent to many reports of formal excision or radiotherapy, facial basal cell carcinomas require a doubl e freeze-thaw cycle with liquid nitrogen. One freeze-thaw cycle to tru ncal basal cell carcinomas achieves high cure rates, equal to that ach ieved with a double freeze-thaw cycle to facial basal cell carcinomas. (C) 1996 by the American Society for Dermatologic Surgery, Inc.