DOES INFLAMMATION CONTRIBUTE TO THE ERADICATION OF BASAL-CELL CARCINOMA FOLLOWING CURETTAGE AND ELECTRODESICCATION

BACKGROUND. Curettage and electrodesiccation (C&D) is probably the tec hnique most frequently utilized by dermatologists to treat basal cell carcinomas (BCC). From histologic studies, it appears C&D does not com pletely mechanically remove all nests of BCC in a substantial number o f cases. Nevertheless, the reported 5-year reoccurrence rate following C&D is significantly less than this histologically observed residual tumor frequency immediately following C&D. Among the multiple possibil ities that exist to explain why these residual nests do not appear as recurrent tumor more frequently is the theory that inflammation develo ping after C&D clears residual tumor. OBJECTIVE. TO test the hypothesi s that inflammation developing after C&D clears residual tumor not mec hanically removed by the procedure. METHODS. The frequency of residual BCC detected histologically immediately following CBD was compared wi th the frequency 1 month after the C&D, an amount of time in which an effect (if any) of inflammation could occur. RESULTS. Twenty-two of 29 primary BCC < 1 cm treated by C&D were tumor free immediately followi ng the procedure (clearance rate, 75.9%). Eleven of 14 primary BCC <1 cm treated by C&D then allowed to granulate 2 month before excision an d histologic analysis were tumor free, for a clearance rate of 78.6%. Examination of larger tumors immediately following C&D revealed size i s a significant variable for clearance rates. Eleven primary BCC >1 cm but <2 cm were examined histologically immediately following C&D; onl y three were tumor free for a clearance rate of 27.3%. Only one of fiv e tumors >2 cm thus treated was tumor free, for a clearance rate of 20 %. Nine recurrent BCC of various sizes were treated by CBD and immedia tely examined histologically. Two were tumor free for a clearance rate of 22.2%. Two recurrent BCC were allowed to heal 1 month following C& D; one of these was tumor free when excised. CONCLUSION. For primary B CC <2 cm, no evidence was found that inflammation occurring over 2 mon th following C&D clears residual tumor. It was also noted that C&D fai ls to completely remove tumor in a large majority of primary BCC >1 cm , and in recurrent BCC. (C) 1997 by the American Society for Dermatolo gic Surgery, Inc.