From the Guidelines
Superficial basal cell carcinoma (BCC) can be effectively treated with various therapies, including topical imiquimod, photodynamic therapy (PDT), and cryosurgery, with similar efficacy and varying cosmetic outcomes.
Treatment Options
- Topical imiquimod: has been shown to be effective in treating primary small superficial BCC, with a complete response rate of 90% in one study 1.
- Photodynamic therapy (PDT): has been compared to cryotherapy and surgery in the treatment of BCC, with clinical clearance rates of 97% and 95%, respectively, and superior cosmetic outcomes 1.
- Cryosurgery: has been shown to be effective in treating superficial BCC, with a 5-year recurrence rate of 20% in one study 1.
Comparative Efficacy
- A meta-analysis of 23 randomized and non-randomized studies found no statistically significant difference in 1-year tumor-free survival between imiquimod and PDT (87% vs. 87%) 1.
- A randomized trial comparing MAL-PDT, imiquimod cream, and fluorouracil cream found similar treatment success rates (73%, 80%, and 79%, respectively) 1.
Cosmetic Outcomes
- PDT has been shown to provide superior cosmetic outcomes compared to cryotherapy, with a good or excellent outcome reported in 89% of patients 1.
- Imiquimod has been associated with moderate to severe local skin reactions, including redness, swelling, and erosion 1.
Safety and Tolerability
- PDT has been associated with moderate to severe pain during treatment administration, while imiquimod and fluorouracil have been associated with moderate to severe local skin reactions 1.
Clinical Guidelines
- The National Comprehensive Cancer Network (NCCN) recommends considering topical therapies, such as imiquimod, 5-fluorouracil, and PDT, for patients with low-risk, superficial BCC, where surgery or radiation is contraindicated or impractical 1.
From the Research
Comparative Treatments for Superficial Basal Cell Carcinoma (BCC)
- The most frequently applied treatment for BCC is surgical excision, but nonsurgical modalities also have an essential role in real settings 2.
- For superficial BCC, approved medications such as imiquimod and topical 5-fluorouracil are available, as is photodynamic therapy 3.
- Other ablative methods like laser and cryosurgery are applicable in some cases, and radiotherapy is an alternative treatment for invasive, inoperable BCC 3.
- A study comparing curettage vs. cryosurgery for superficial BCC found that both treatment methods showed high clinical clearance rates after 1 year, whilst curettage reduced the wound healing time 4.
- Topical photodynamic therapy (PDT) is an established treatment option for low-risk BCC, with excellent cosmesis and safety, although its efficacy is inferior to excisional surgery and imiquimod 5.
- A network meta-analysis comparing multiple treatment strategies for BCC found that invasive treatments like surgery and Mohs micrographic surgery had a significantly lower incidence of treatment-failure than superficial therapies like cryotherapy, photodynamic therapy, and topical therapies 6.
Treatment Options and Efficacy
- Imiquimod has a total remission rate of 82-90% for superficial BCC 3.
- Topical 5-fluorouracil has a total remission rate of 80% for superficial BCC 3.
- Photodynamic therapy has a total remission rate of 71-87% for superficial BCC 3.
- Cryosurgery has a clinical clearance rate of 100% after 1 year for superficial BCC 4.
- Curettage has a clinical clearance rate of 95.7% after 1 year for superficial BCC 4.
- Vismodegib has an objective response rate of 30-55% and tumor control rate of 80-90% for locally advanced or metastatic BCC 3.