A systematic review of treatment modalities for primary basal cell carcinomas

Objective: To systematically review the literature for studies reporting on recurrence rates of basal cell carcinomas (BCCs) after different therapies . Design: We reviewed all studies published in English, French, German, Dutch , Spanish, or Italian between 1970 and 1997 that prospectively examined rec urrence rates for at least 50 patients with primary BCCs observed for at le ast 5 years after treatment with Mohs micrographic surgery, surgical excisi on, curettage and electrodesiccation, cryosurgery, radiotherapy, immunother apy with interferon or fluorouracil, or photodynamic therapy. Setting: Department of Dermatology, University Hospital Maastricht, Maastri cht, the reference center for dermatologic oncology and Mohs micrographic s urgery in the Netherlands. Main Outcome Measures: The recurrence rates after different therapies for B CCs, resulting in the development of guidelines for the treatment of these disorders. Results: Of 298 studies found in several electronic databases, only 18 met the requirements and could be used for analysis. Tumors treated with Mohs m icrographic surgery show the lowest recurrence rates after 5 years, followe d in order by those treated with surgical excision, cryosurgery, and curett age and electrodesiccation, Conclusions: Recurrence rates for different therapies could not be compared because of a lack of uniformity in the method of reporting, so evidence-ba sed guidelines could not be developed. We surmise that Mohs micrographic su rgery should be used mainly for larger, morphea-type BCCs located in danger tones. For smaller BCCs of the nodular and superficial types, surgical exc ision remains the first treatment of choice. Other treatment modalities can be used in patients in whom surgery is contraindicated. Immunotherapy and photodynamic therapy are still investigative.