What is the recurrence rate of nodular basal cell carcinoma (BCC) after curettage and cautery?

From the Guidelines

The recurrence rate of nodular basal cell carcinoma (BCC) after curettage and cautery is approximately 7.7% over a five-year follow-up period, as suggested by the overall 5-year cure rate of 92.3% following curettage and cautery for selected primary BCC 1.

Key Considerations

• This treatment method is most effective for small, well-defined, primary nodular BCCs located in low-risk areas such as the trunk and extremities.
• The recurrence rate increases significantly for larger tumors, those in high-risk locations, aggressive histologic subtypes, and recurrent tumors.
• Factors that influence recurrence include tumor size, location, histologic subtype, operator experience, and number of treatment cycles performed.
• Most practitioners perform 2-3 cycles of curettage followed by cautery to minimize recurrence.
• Regular follow-up examinations are essential after treatment, with more frequent visits during the first two years when most recurrences develop.

Alternative Treatments

• Mohs micrographic surgery has a lower recurrence rate of 1-3% 1.
• Standard surgical excision has a recurrence rate of 5-10% 1.
• Radiation therapy may be considered for patients who cannot undergo surgery.

Evidence-Based Recommendation

Curettage and cautery is a good treatment for low-risk BCC, with a strength of recommendation A and quality of evidence II-iii 1. However, for high-risk lesions, alternative treatments with lower recurrence rates should be considered. In the context of real-life clinical medicine, it is essential to prioritize treatments that minimize recurrence rates and optimize patient outcomes, particularly for high-risk lesions. The most recent guidelines suggest that curettage and electrodesiccation may be considered for low-risk tumors in non-terminal hair-bearing locations 1.

From the Research

Recurrence Rate of Modular BCC after Curettage and Cautery

• The recurrence rate of basal cell carcinoma (BCC) after curettage and cautery is a significant concern, with studies indicating varying rates of recurrence 2, 3.
• A study published in 2007 found that curettage and photodynamic therapy resulted in 5-year relapse rates of up to 70% 2.
• Another study published in 2013 reported a 27% recurrence rate for histologically aggressive BCCs treated with electrodesiccation and curettage (EDC) alone, with a median follow-up of 6.5 years 3.
• The effectiveness of curettage in delineating BCC margins is also a topic of debate, with some studies suggesting it may be helpful in certain cases, such as nodular and superficial BCC 4.
• However, other studies have raised concerns about the potential for curettage to damage surrounding healthy tissue and increase the final defect size 4.

Factors Affecting Recurrence Rate

• Tumor localization, T-stage, and method of treatment are significant predictors of the risk of recurrence 2.
• Aggressive histological types and positive excision margins are considered strong predictors of recurrence 5.
• The topographic localization of tumors, with areas such as the scalp and auricles having higher recurrence rates, is also an important factor 2, 5.

Treatment Options and Recurrence Rates

• Surgical excision and radiotherapy have been shown to have lower relapse rates compared to curettage and photodynamic therapy 2, 6.
• Mohs micrographic surgery is typically used for high-risk lesions and has been shown to have high cure rates 6.
• Other treatment options, such as topical imiquimod and 5-fluorouracil, may be suitable for low-risk lesions, but more research is needed to determine their efficacy and recurrence rates 6.