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Imiquimod similar to photodynamic therapy for BCC treatment

Clinical Question:
What is the most effective therapy for the treatment of primary superficial basal cell carcinoma?

Bottom Line:
Nonsurgical treatments for superficial basal cell carcinoma (sBCC) have similar outcomes. Unfortunately, head-to-head trials are lacking. (LOE = 2a)

Reference:
Roozeboom MH, Arits AH, Nelemans PJ, Kelleners-Smeets NW. Overall treatment success after treatment of primary superficial basal cell carcinoma: a systematic review and meta-analysis of randomized and nonrandomized trials. Br J Dermatol 2012;167(4):733-756.  [PMID:22612571]

Study Design:
Meta-analysis (other)

Funding:
Self-funded or unfunded

Setting:
Outpatient (specialty)

Synopsis:
There are a number of treatments for primary sBCC: surgical excision, photodynamic therapy, imiquimod, cryotherapy, and 5-fluorouracil cream. The authors did a careful search of PubMed and EMBASE to identify clinical trials and observational studies that report clinical outcomes for a treatment modality for sBCC. They reviewed 903 abstracts and ended up with 36 studies, including 14 randomized controlled trials. Only a handful of studies looked at cryotherapy, surgery, or 5-fluorouracil, and those studies were not pooled. Pooling of data was limited to photodynamic therapy and imiquimod. The 2 primary outcomes were complete response to therapy (28 studies) and tumor-free survival (23 studies). The rates of complete response to therapy were 86.2% for imiquimod and 79.0% for photodynamic therapy (P = 0.17). There was also no significant difference between groups regarding tumor-free survival at 1 year (87.3% vs 84.0%). The limited data regarding other treatments found a tumor-free survival rate of 99% for surgical excision at 1 year, 67% for cryotherapy at 5 years, and 79% at 1 year for pulsed dye laser treatment. The overall quality of studies was poor, and less than half were randomized. The authors also identified a significant risk of publication bias (ie, a failure to publish smaller studies that showed a lack of treatment effect).

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