Histologic subtype of treatment failures after noninvasive therapy for superficial basal cell carcinoma: An observational study

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Abstract

Background: There have been concerns that recurrences after noninvasive therapy for basal cell carcinoma (BCC) transform into a "more aggressive'' histologic subtype.

Objective: We sought to evaluate the proportion of patients with a nonsuperficial treatment failure after noninvasive therapy for superficial BCC.

Methods: An observational study was performed using data from a single blind, noninferiority, randomized controlled trial (March 2008-August 2010) with 5-year follow-up in patients with primary superficial BCC treated with methylaminolevulinate-photodynamic therapy, 5-fluorouracil, or imiquimod. Data were used from 166 adults with a histologically confirmed treatment failure.

Results: A nonsuperficial subtype was found in 64 of 166 treatment failures (38.6%). Proportions with a more aggressive subtype than the primary tumor were 51.3% (38/74) for early and 28.3% (26/92) for later treatment failures (P = .003). The proportion of more aggressive early failures was significantly lower after imiquimod (26.3%) compared with methylaminolevulinate-photodynamic therapy (54.8%, P = .086) and 5-fluorouracil (66.7%, P = .011).

Limitations: There was limited information on the exact time of occurrence of treatment failures.

Conclusion: More aggressive treatment failure recurrences after noninvasive therapy for superficial BCC occur most often within the first 3 months posttreatment, probably indicating underdiagnosis of more aggressive components in the primary tumor rather than transformation.

Original languageEnglish
Pages (from-to)1022-1028
Number of pages7
JournalJournal of the American Academy of Dermatology
Volume80
Issue number4
DOIs
Publication statusPublished - Apr 2019

Keywords

  • 5-fluorouracil
  • basal cell carcinoma
  • histologic subtype
  • imiquimod
  • MAL-PDT
  • misclassification
  • noninvasive therapy
  • sampling error
  • superficial
  • transformation
  • IMIQUIMOD 5-PERCENT CREAM
  • PHOTODYNAMIC THERAPY
  • PUNCH BIOPSY
  • TOPICAL IMIQUIMOD
  • SURGICAL EXCISION
  • CONFOCAL MICROSCOPY
  • DIAGNOSTIC-ACCURACY
  • EUROPEAN GUIDELINES
  • NON-INFERIORITY
  • SINGLE-BLIND

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