WAIKOLOA, HAWAII – Curettage alone for the treatment of basal cell carcinomas offers several distinct advantages over the widely accepted technique of curettage followed by electrodesiccation, Dr. David L. Swanson said at the Hawaii Dermatology Seminar provided by the Global Academy for Medical Education/Skin Disease Education Foundation.
When he asked for an audience show of hands as to who treats BCCs using curettage without electrodesiccation, the packed auditorium full of dermatologists remained hands-down. But there is good evidence that curettage alone provides cure rates similar to published rates for curettage and electrodesiccation, along with improved cosmesis, faster healing, and fewer problems with scarring and hypopigmentation, according to Dr. Swanson, a dermatologist at Mayo Clinic Arizona, Scottsdale.
Dr. David L. Swanson
He cited a persuasive study by other dermatologists at Mayo Clinic Arizona (J Am Acad Dermatol. 2006 Jun;54[6]:1039-45).
“This article was transformative for my practice,” said Dr. Swanson, who wasn’t involved in the study.
The investigators reviewed the records of 302 biopsy-proven BCCs in 136 patients. All were amenable to curettage and electrodesiccation but were instead treated by curettage alone during 1993-1998. The BCCs lacked histopathologic high-risk features; most were superficial or nodular lesions. Nearly one-quarter of the BCCs, however, were located on high-risk anatomic sites.
The 5-year cure rate was 96%. The authors’ review of 10 published series of BCCs treated using curettage and electrodesiccation showed recurrence rates mostly in the 3%-7% range.
Among the advantages cited by the investigators of going with curettage alone were its simplicity, reduced equipment requirement, cost effectiveness, lack of electrical interference with implantable cardiac devices, the avoidance of potentially hazardous viral smoke plumes, and reduced rates of hypopigmentation and scarring.
This was a retrospective study. Its other significant limitation was that all 302 BCCs were treated by the same dermatologist: Dr. Mark J. Zalla, who Dr. Swanson considers to be a dermatologic surgeon of exceptional talent.
“I’m not Mark Zalla. Nobody else in this room is Mark Zalla, so we can’t necessarily extrapolate from this study what your outcomes are going to be. That said, I’ve adopted this technique, and most of my colleagues do not do electrodesiccation anymore. I take off several basal cell carcinomas per day with curettage, and it’s my sense that I don’t have higher recurrence rates and that it does heal better with less scarring,” Dr. Swanson said.
He reported having no financial conflicts of interest regarding his presentation. SDEF and this news organization are owned by the same parent company.