Is cryotherapy effective for treating a small basal cell carcinoma on the face?

From the Guidelines

Cryotherapy is not the preferred treatment for small basal cell carcinomas on the face due to its potential for hypopigmentation and lower cosmetic outcomes compared to other treatments. For small, superficial BCCs on the face (typically less than 1 cm), cryotherapy has cure rates of approximately 85-90% 1. The procedure involves applying liquid nitrogen to freeze and destroy the cancerous tissue, usually requiring 1-2 freeze-thaw cycles lasting about 30-60 seconds each. However, facial treatments require special consideration due to cosmetic concerns, as cryotherapy can cause hypopigmentation (lightened skin), which may be particularly noticeable on the face.

Key Considerations

• Cryotherapy has similar efficacy to photodynamic therapy (PDT) but with worse cosmetic outcomes 1.
• Alternative treatments like Mohs surgery offer higher cure rates (up to 99%) with better cosmetic outcomes for facial BCCs, though they are more invasive.
• The decision should be made in consultation with a dermatologist who can evaluate the specific characteristics of the lesion, its location, and the patient's preferences regarding treatment options and cosmetic outcomes.

Treatment Options

• PDT has similar efficacy to cryotherapy but with better cosmetic outcomes 1.
• Imiquimod and fluorouracil have similar efficacy and cosmetic outcomes to PDT, although the risk of recurrence may be somewhat higher with PDT versus imiquimod 1.
• Mohs surgery offers higher cure rates and better cosmetic outcomes, but is more invasive.

Recommendations

• Cryotherapy should not be the first-line treatment for small basal cell carcinomas on the face due to its potential for hypopigmentation and lower cosmetic outcomes.
• Patients should consult with a dermatologist to determine the best treatment option based on the specific characteristics of the lesion, its location, and the patient's preferences regarding treatment options and cosmetic outcomes.

From the Research

Effectiveness of Cryotherapy for Basal Cell Carcinoma

• Cryotherapy is considered a suitable alternate treatment option for primary low-risk basal cell carcinoma lesions, particularly for superficial and nodular subtypes 2, 3.
• The efficacy of cryotherapy alone or with curettage is comparable to photodynamic therapy and surgery for primary superficial and nodular basal cell carcinoma 3.
• However, cryotherapy is inferior to radiation in terms of recurrence rate 3.
• Most patients have better cosmetic outcomes with photodynamic therapy and surgery compared to cryotherapy alone, and cryotherapy with curettage 3.

Considerations for Facial Basal Cell Carcinoma

• For basal cell carcinoma on the face, particularly in the H region, surgery is often the gold standard of treatment, especially for high-risk lesions 4, 5.
• Other treatment options, including cryotherapy, may be considered based on factors such as tumor location, size, and patient condition 4, 5.
• The choice of treatment should take into account the potential complications of surgical approaches, such as healing defects and wound infection 4.

Comparison with Other Treatments

• Topical treatments like imiquimod and 5-fluorouracil are efficacious and safe for superficial basal cell carcinoma, but not for other subtypes or squamous cell carcinoma 6.
• Photodynamic therapy has varied cure rates and is not as effective as surgery, but may be considered for certain cases 6.
• Radiation therapy is a suitable alternate for surgical methods, particularly for older patient populations or in cases where surgery is not feasible 2, 5.