From the Guidelines
Surgical resection is generally preferred over cryotherapy for most basal cell carcinoma (BCC) cases, especially for high-risk BCCs, due to its higher cure rates and ability to confirm clear margins. The choice between surgical resection and cryotherapy should consider tumor characteristics (size, location, subtype), patient factors (age, comorbidities, medication use), cosmetic concerns, and provider expertise.
- Surgical excision with histological margin assessment (Mohs surgery or standard excision with 4-6mm margins) offers the highest cure rates (95-99%) and allows for pathological confirmation of complete removal 1.
- Cryotherapy, which uses liquid nitrogen to freeze and destroy cancer cells, is best reserved for small (less than 2cm), well-defined, superficial BCCs in low-risk areas like the trunk or extremities, with cure rates around 85-90% for appropriate cases 1.
- The advantages of cryotherapy include being quick, relatively inexpensive, and requiring no anesthesia, but it doesn't provide tissue for pathological examination and may result in hypopigmentation.
- For recurrent, aggressive, or facial BCCs, surgical approaches are strongly favored due to their higher cure rates and ability to confirm clear margins 1. Some key points to consider when choosing between surgical resection and cryotherapy for BCC include:
- Tumor size and location: Surgical resection is generally preferred for larger tumors or those located in high-risk areas, such as the face or ears.
- Tumor subtype: Surgical resection is generally preferred for more aggressive subtypes, such as nodular or morpheaform BCC.
- Patient factors: Surgical resection may be preferred for patients with a history of skin cancer or those who are at high risk for recurrence.
- Cosmetic concerns: Cryotherapy may be preferred for patients who are concerned about scarring or cosmetic outcome, as it can be less invasive than surgical resection. It's worth noting that the most recent and highest quality study 1 supports the use of surgical resection as the preferred treatment for most BCC cases, especially high-risk BCCs.
From the Research
Resection vs Cryotherapy for Basal Cell Carcinoma
- Resection is a common treatment for basal cell carcinoma, with studies showing that complete excision is vital to minimize the risk of recurrence 2
- The rate of incomplete excisions varies, with one study finding that 4.6% of 3911 BCC tumours were incompletely excised, with higher rates for facial tumours and those with aggressive histological subtypes 2
- Cryotherapy is also a treatment option, with studies showing that it can be effective in treating basal cell carcinoma, particularly when combined with imiquimod cream 3, 4
- A pilot study found that immunocryosurgery, which combines cryosurgery with topical imiquimod, had a clinical clearance rate of 100% and a cumulative efficacy of 95% after at least 18 months of follow-up 3
- Another study found that cryotherapy with liquid nitrogen followed by imiquimod cream 5% resulted in histologically confirmed clearance of a nodular BCC on the nose 4
Comparison of Treatment Options
- Surgical approaches, including Mohs micrographic surgery, provide the best outcomes for BCCs, with high cure rates and minimal tissue loss 5, 6
- Nonsurgical modalities, such as cryotherapy, may be used for low-risk BCCs when surgery is contraindicated or impractical, but have lower cure rates 6
- The choice of treatment should consider factors such as tumour size, location, and histological subtype, as well as patient preferences and contraindications 5, 6