Curettage Versus Excision in Nodular and Superficial Basal Cell Carcinomas

Basal cell carcinoma (BCC) is the most frequent skin cancer. Uncontrolled growth destroys local anatomic structures. There are various treatment alternatives with different recurrence rates and expenses. After surgical excision, the recurrence rate is in between 3 and 4% and the procedure is relatively expensive. Photodynamic therapy as well as imiquimod 5% are expensive therapies with high recurrence rates, that lack histologic evidence of BCC. Cryosurgery and curettage are inexpensive, although the recurrence rates are higher than after surgical excision. This prospective, randomized trial compares recurrence rates, cosmetic outcome, and surgery-related complications after curettage versus surgical excision in nodular and superficial BCC. About 600 tumors will be included. One half is treated by curettage, the other half by surgical excision. The follow-up period is four years. If the difference between recurrence rates is ≤7% and the cosmetic outcome as well as the surgery-related complications are not worse after curettage, surgical excision must be considered an overtreatment.

Sex

All

Inclusion Criteria:

* Clinical or histologic diagnosis of BCC

Patient Dependent Exclusion Criteria:

* \> 5 BCCs at presentation
* Immunosuppressive drugs
* Pregnancy
* Disability to give informed consent
* Synchronous participation in other studies
* Progeroid syndromes
* Other malignant tumors, except for BCC and squamous cell carcinoma, or monoclonal neoplasms of the hematopoietic or immune system
* Critical illness precluding sufficient follow-up visits

Tumor Exclusion Criteria:

* Recurrent BCC
* Nodular BCC with an exophytic part of \> 1.5 mm above skin level
* Nodular BCC with a diameter of \> 10 mm
* Superficial BCC with a diameter of \> 20 mm
* Ulceration
* Scarring
* Blurred margins
* Histopathologic evidence of a tumor type different from nodular or superficial BCC