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Monique R. T. M. Thissen, MD; Martino H. A. Neumann, MD, PhD; Leo J. Schouten, MD

Arch Dermatol. 1999;135:1177-1183.

Objective  To systematically review the literature for studies reporting on recurrence rates of basal cell carcinomas (BCCs) after different therapies.

Design  We reviewed all studies published in English, French, German, Dutch, Spanish, or Italian between 1970 and 1997 that prospectively examined recurrence rates for at least 50 patients with primary BCCs observed for at least 5 years after treatment with Mohs micrographic surgery, surgical excision, curettage and electrodesiccation, cryosurgery, radiotherapy, immunotherapy with interferon or fluorouracil, or photodynamic therapy.

Setting  Department of Dermatology, University Hospital Maastricht, Maastricht, the reference center for dermatologic oncology and Mohs micrographic surgery in the Netherlands.

Main Outcome Measures  The recurrence rates after different therapies for BCCs, resulting in the development of guidelines for the treatment of these disorders.

Results  Of 298 studies found in several electronic databases, only 18 met the requirements and could be used for analysis. Tumors treated with Mohs micrographic surgery show the lowest recurrence rates after 5 years, followed in order by those treated with surgical excision, cryosurgery, and curettage and electrodesiccation.

Conclusions  Recurrence rates for different therapies could not be compared because of a lack of uniformity in the method of reporting, so evidence-based guidelines could not be developed. We surmise that Mohs micrographic surgery should be used mainly for larger, morphea-type BCCs located in danger zones. For smaller BCCs of the nodular and superficial types, surgical excision remains the first treatment of choice. Other treatment modalities can be used in patients in whom surgery is contraindicated. Immunotherapy and photodynamic therapy are still investigative.

From the Department of Dermatology, University of Maastricht Medical Center (Drs Thissen and Neumann), and the Department of Cancer Registration and Epidemiology, Comprehensive Cancer Center Limburg (Dr Schouten), Maastricht, the Netherlands.

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