From the Guidelines
Curettage is a recommended treatment approach for superficial basal cell carcinoma (BCC) when the lesion is well-defined, superficial, and less than 2 cm in diameter, located on the trunk or extremities, as it offers a high cure rate and is a relatively simple procedure. The procedure involves scraping away the cancerous tissue with a curette, a spoon-shaped instrument with sharp edges, followed by electrodesiccation to destroy any remaining cancer cells and control bleeding 1. This technique is effective because superficial BCCs have a different consistency than normal skin, allowing for tactile differentiation during scraping, and the electrodesiccation helps destroy any microscopic tumor cells that might remain after curettage.
The cure rates for properly selected lesions treated with this method range from 85-95% 1. It is essential to note that curettage is most suitable for low-risk lesions and is generally contraindicated for high-risk facial lesions due to the high risk of tumor recurrence 1. The procedure typically requires local anesthesia injection at the tumor site, and the wound is dressed with petroleum jelly and a bandage, with healing occurring by secondary intention over 4-6 weeks. Patients should keep the area clean, apply petroleum jelly daily, and protect it from sun exposure.
Some key points to consider when using curettage for superficial BCC include:
- The lesion should be well-defined and superficial, with a diameter of less than 2 cm.
- The lesion should be located on the trunk or extremities, as curettage is less effective for facial lesions.
- The procedure should be performed by an experienced clinician, as the results are highly operator-dependent.
- The patient should be instructed on proper wound care and follow-up to ensure optimal healing and minimize the risk of recurrence.
Overall, curettage is a viable treatment option for superficial BCC, offering a high cure rate and a relatively simple procedure, but it is crucial to carefully select the appropriate lesions and follow proper technique to ensure optimal outcomes 1.
From the Research
Treatment Approach for Superficial Basal Cell Carcinoma (BCC) using Curettage
- Curettage is a simple and quick destructive treatment method used for many benign skin lesions and has been evaluated for the treatment of superficial BCC (sBCC) 2.
- A study compared the effectiveness of curettage vs. cryosurgery for sBCCs in terms of overall clinical clearance rates after 1 year as well as wound healing times, and found that curettage reduced the wound healing time 2.
- Curettage only (i.e. without subsequent cryosurgery or electrodesiccation) has been shown to have high clinical clearance rates after 1 year, with a clinical clearance rate of 95.7% 2.
- Preoperative curettage may be helpful in delineating BCC margins, especially in nodular and superficial BCC, and may lead to a complete or almost complete tumor removal 3.
- Curettage followed by imiquimod 5% cream has been shown to be effective for the treatment of primary nodular basal cell carcinoma on the trunk and limbs, with a histological clearance rate of 94% 4.
Comparison with Other Treatment Methods
- Curettage has been compared to cryosurgery, which has a higher clinical clearance rate of 100% after 1 year, but longer wound healing times 2.
- Other treatment methods for sBCC include surgical excision, Mohs micrographic surgery, photodynamic therapy, and topical imiquimod 5% cream, each with their own advantages and disadvantages 5, 6.
- Imiquimod 5% cream is a topical, noninvasive agent that has been shown to be safe and well tolerated, and may be efficacious in the treatment of BCC, especially in patients with multiple or large sBCCs or those who wish to avoid surgical approaches 5, 6.