Basal cell carcinoma is one of the most common cancers and its incidence is increasing worldwide. Few non surgical treatments are available for superficial basal cell carcinoma (BCC) but there has a lack of long-term follow-up data to guide treatment decisions. A three-year trial has found that two topical creams are effective in most primary, low-risk superficial BCC, comparing favorably with photodynamic therapy (PDT). More than 80% of all skin cancers are BCC, arising from the basal cells (i.e., small, round cells found in the lower layer of the epidermis). The prognosis is excellent, but it can cause significant disfigurement by invading surrounding tissues.While most types of BCC require surgery, superficial BCC can be treated topically with noninvasive treatments such as PDT, imiquimod cream, cryosurgery or electrodessication and curettage. Investigators in the Netherlands report the results of a three-year follow-up of a trial that compared three noninvasive treatments that included imiquimod and fluorouracil cream. “The main advantages of noninvasive treatments are good cosmetic outcome, preservation of surrounding tissue, and potential for home application of either creams. Throughout the last two decades there has been a growing interest in these non-surgical therapies, which offer the possibility of avoiding surgery and reducing demands on busy medical practices. A total of 601 patients with a superficial BCC participated in this study: 202 patients were treated with methylaminolevulinate photodynamic therapy (MAL-PDT), 198 with imiquimod cream, and 201 with fluorouracil cream. Around 80% of patients with superficial BCC were tumor free after imiquimod treatment after three years. The clearance rate was 68% for patients treated with fluorouracil and 58% for individuals receiving PDT. Both creams have an equal cosmetic outcome and risk of local adverse events. Fluorouracil has the advantage of being less expensive than imiquimod but it is not approved by TGA for treatment of BCC in Australia.
A personalized treatment approach is necessary. For example, in superficial BCC on the lower extremities in older patients, PDT should be prescribed rather than imiquimod.
