Curettage and Imiquimod Less Effective Than Surgery for nBCC

TOPLINE:

In a randomized trial, recurrence was higher after superficial curettage (SC) plus imiquimod cream than surgical excision (SE) in patients with nodular basal cell carcinoma (nBCC).

METHODOLOGY:

• In this secondary analysis of the SCIN trial, researchers evaluated 145 patients (53.1% men; median age, 68 years) with histologically confirmed primary nBCC 4-20 mm in size, from two outpatient dermatology departments in the Netherlands between January 2016 and November 2017.
• Participants were randomly assigned to receive either SC followed by imiquimod cream, 5% (n = 73) or SE (n = 72).
• The main outcome was the 5-year probability of remaining free from treatment failure (defined as histologically confirmed BCC in a clinically suspect area within 10 mm of the scar).
• Secondary outcomes were cosmetic outcomes of the scar and long-term patient satisfaction with treatment.

TAKEAWAY:

• At 5 years posttreatment, the probability of remaining free from treatment failure was 77.8% for the SC plus imiquimod group compared with 98.2% for the SE group (relative risk, 15.93; 95% CI, 2.10-120.64). The CI did not exclude the noninferiority margin of 5.22.
• Of the 15 treatment failures in the SC plus imiquimod group, 10 occurred within the first year, while only one failure was observed in the SE group overall. Twenty deaths (11 in the SC plus imiquimod group and 9 in the SE group) were also reported during the follow-up, but none was related to BCC.
• Physicians rated cosmetic outcomes higher for SC plus imiquimod, although patient-reported outcomes were similar between the two groups.
• Slightly more patients in the SC plus imiquimod group reported willingness to repeat or recommend the treatment and were satisfied with the cosmetic result, although these differences were not statistically significant.

IN PRACTICE:

“In this secondary analysis of a randomized clinical trial, it could not be concluded that SC plus imiquimod is noninferior to SE, but SC plus imiquimod was substantially less effective than SE,” the authors wrote. “The information in this trial can be used to counsel patients on the relative benefits and trade-offs of the different treatment options for nBCC,” they added.

SOURCE:

The study was led by Babette J.A. Verkouteren, PhD, Department of Dermatology, Maastricht University Medical Centre, Maastricht, the Netherlands. It was published online on January 29 in JAMA Dermatology.

LIMITATIONS:

About 24% of patients were lost to follow-up, and because of the evident differences in procedures and resulting scarring, investigators, patients, and treating physicians could not be blinded to the allocated treatment.

DISCLOSURES:

The authors did not report any study funding source. Authors received personal fees and speaking fees from pharmaceutical companies outside this work. One author received a supply of imiquimod cream from Viatris during the study.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.