Researchers involved in a multicenter European randomized trial have reported superior efficacy for surgery compared to topical methyl aminolevulinate photodynamic therapy (PDT) for the treatment of nodular basal cell carcinoma (BCC). The details of this randomized trial were reported in the September 2007 issue of the Archives of Dermatology.

Basal cell carcinoma is the most common form of skin cancer affecting 800,000 Americans each year. This also makes BCC the most common cancer occurring in humans. It has been estimated that one out of every three new cancers is a skin cancer with the vast majority being basal cell carcinomas. The number of new cases has increased each year in the last few decades, but the average age of onset of the disease has steadily decreased. More men than women get basal cell carcinoma, but there has been an absolute increase in incidence in women.

Chronic exposure to sunlight is the cause of almost all BCCs, which occur most frequently on exposed parts of the body. Treatments for BCC include surgical excision, curettage, cryosurgery, laser treatment, surgical excision with predetermined margins of clinically normal tissue, surgical excision under frozen section control, Moh’s micrographic surgery, radiotherapy, immunomodulations, PDP and chemotherapy. Most of the literature on BCC consists of uncontrolled reports of a single treatment with very short observation times. The most common treatments appear to be surgery and radiotherapy.

The current multicenter University Hospital study randomly assigned 97 patients with nodular BCC to treatment with surgery or PDT. The five year recurrence rate was 14% for the PDT group and 4% for the surgery group. The estimated sustained complete response rates were 76% for the PDT group and 96% for the surgery group. Excellent cosmetic results were achieved in 87% of the PDT group and 54% of the surgery group. These authors concluded that surgery was more effective than PDT but was associated with worse cosmetic results.

Comments: This is one of the few randomized trials evaluating treatment of BCC. These results should help guide appropriate therapy for this disease.

Reference: Rhodes LE, de Rie MA, Leifsdottir R, et al. Five-year follow-up of a randomized, prospective trial of topical methyl aminolevulinate photodynamic therapy vs surgery for nodular basal cell carcinoma. Archives of Dermatology. 2007; 143:1131-1136.

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