Cryosurgery for basal cell carcinoma treated in primary care
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ORIGINAL ARTICLE
Cryosurgery for basal cell carcinoma treated in primary care David Buckley 1
&
Christa Marczuk 1 & Thomas Kennedy 1
Received: 25 September 2019 / Accepted: 24 January 2020 # Royal Academy of Medicine in Ireland 2020
Abstract Background Basal cell carcinoma (BCC) is a very common skin cancer in Caucasians. Although rarely life-threatening, it can be locally destructive and consumes a considerable amount of health expenditure. Treatments that are safe, cost-effective and can be carried out in primary care with a high cure rate and good cosmetic results for selected cases of BCC need to be explored. Aims This retrospective study was carried out to assess whether cryosurgery is a reasonable option for treating select cases of basal cell carcinomas (BCCs) in primary care under local anaesthetic by an expert cryosurgeon. Method The treatment and outcome of 184 consecutive, histologically diagnosed BCCs in 138 patients in one primary care setting over a 5-year period was analysed. Results One hundred (54%) BCCs were treated with cryosurgery, 57 (31%) treated by excision in primary care, 13 (7%) by photodynamic therapy (PDT), 12 (7%) by referral to plastic surgery mostly for flaps or grafts and 2 (1%) by imiquimod 5%. Conclusions Just over half of all BCCs in this survey were treated using cryosurgery (100 = 54%) and 79 were followed up for more than 5 years. The cure rate with cryosurgery was 95% after 5 years (95% CI, 0.8686–0.9837) with an excellent or good cosmetic outcome in 92%. Keywords Basal cell carcinoma . Cosmetic outcome . Cryosurgery . Cure rate . Primary care
Introduction Although patients rarely die of BCC and less than 0.5% metastasize [1, 2], they can cause considerable morbidity, affect patients’ quality of life and take up a large proportion of health expenditure. While plastic surgery (flaps or grafts) and Mohs micrographic surgery consistently give high cure rates, the availability and cost of care of these modalities usually restricts them to high-risk tumours [3, 4]. Simple elliptical excision and non-excision surgical options such as curettage and cautery, cryosurgery and topical treatments such as imiquimod 5%, when used in selected cases and by doctors experienced in their use, can have high cure rates, good cosmetic results and are low-cost options for many low and moderate-risk BCCs [5]. The 5-year cure rate when treating NMSCs with cryosurgery by experienced practitioners has been consistently over 92.5% [6–11]. Cryosurgery has many advantages over
* David Buckley [email protected] 1
The Ashe Street Clinic, Tralee, Co Kerry, Ireland
conventional excision surgery in particular with regard to treatment times, treating many BCCs simultaneously, tissue conserving, low-risk to underlying structures such as blood vessels, nerves and cartilage, managing patients on anticoagulants, cost of care and cryo-immuno-stimulation [12, 13].
Methods This is a retrospective study of the outcome of the treatment of 184 consecutive histologically proven BCCs in one multidisciplinary prim
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