A Conservative Combined Laser Cryoimmunotherapy Treatment vs. Surgical Excision for Basal Cell Carcinoma

Abstract

Surgical excision is the standard treatment for basal cell carcinoma (BCC), but it can be challenging in elderly patients and patients with comorbidities. The non-surgical guidelines procedures are usually regarded as monotherapy options. This quasi-experimental, non-randomized, comparative effectiveness study aims to evaluate the efficacy of a combined, conservative, non-surgical BCC treatment, and compare it to standard surgical excision. Patients with primary, non-ulcerated, histopathologically confirmed BCCs were divided into a conservative treatment (129 patients) and a standard surgery subgroup (50 patients). The conservative treatment consisted of ablative CO2 laser, cryosurgery, topical occlusive 5-fluorouracil, and imiquimod. The follow-up examinations were performed 3 months after remission, then every 3 to 6 months, and were extended with telephone follow-ups. Cosmetic-self assessment was recorded during a telephone follow-up. Subjects from the conservative subgroup presented a clearance rate of 99.11%, and a recurrence rate of 0.98%. No recurrences were recorded in the surgical group, nor during the telephone follow-up. There were no differences regarding adverse events (p > 0.05). A superior self-assessment cosmetic outcome was obtained using the conservative method (p < 0.001). This conservative treatment is suitable for elders and patients with comorbidities, is not inferior to surgery in terms of clearance, relapses, or local adverse events, and displays superior cosmetic outcomes.

Keywords: 5-fluorouracil; CO2 laser; basal cell carcinoma; cryoimmunotherapy; cryosurgery; imiquimod.

Figure 1

Conservative treatment methodology. This method comprises an initial CO₂ laser ablation, followed by self-application of antibiotic powder, two cryosurgery sessions, three 5-FU chemowraps (after CO₂ laser and cryosurgery), and eight occlusive self-applications of imiquimod. A total of four visits to the physician’s office (including the last one to establish BCC clearance) are required to complete the conservative treatment. 5-FU: 5-fluorouracil.

Figure 2

Subjects’ disposition in conservative and surgical subgroups.

Figure 3

Initial (a,d,g,j), intermediate (b,e,h,k), and 12-month follow-up (c,f,i,l) clinical appearance in four patients with different BCC localizations (arm, nose, auricle, and anterior thorax). The 12-month evaluation displays satisfactory cosmetic outcomes.

Figure 4

Adverse events (local pain and pruritus) experienced in treatment subgroups. The numbers in brackets represent the percentages with respect to the cardinal of the group. (Surgery with blue).

Figure 5

Advantages and disadvantages of conservative and surgical treatments for BCC.