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Presented by Robert S. Stern, M.D. at the September 10, 2003 meeting of the Dermatologic and Ophthalmic Drugs Advisory

Presented by Robert S. Stern, M.D. at the September 10, 2003 meeting of the Dermatologic and Ophthalmic Drugs Advisory Committee. Recurrence Rates in Primary Basal Cell Carcinoma According to Treatment Modality. Jean C. Lee, Harvard Medical Student.

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Presented by Robert S. Stern, M.D. at the September 10, 2003 meeting of the Dermatologic and Ophthalmic Drugs Advisory

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  1. Presented by Robert S. Stern, M.D. at the September 10, 2003 meeting of the Dermatologic and Ophthalmic Drugs Advisory Committee

  2. Recurrence Rates in Primary Basal Cell Carcinoma According to Treatment Modality Jean C. Lee, Harvard Medical Student

  3. Usually reserved for small (<2cm), well-defined tumors on low risk areas, performed with 4-5 mm margins • Reserved for high risk tumors, including: • Size 5-10mm in H zone of face, >10 mm on rest of face, or > 20 mm on body • Tumors with no distinct margins • High risk histology (morpheaform or infiltrative BCC) • Persistently recurrent tumors Usually reserved for tumors < 1 cm on cosmetically less sensitive areas Usually for low risk lesions on trunk or extremities Treatment Modalities for Basal Cell Carcinoma • Surgical Excision • Cryosurgery • Curettage and Electrodesiccation • Mohs' Micrographic Surgery

  4. Predictors of BCC Recurrence • Size of tumor • Clinically indistinct margins • Location (embryonic fusion planes provide little resistance to tumor growth) • Histologic type (morpheaform, micronodular, sclerosing, or mixed type) • Perineural invasion • Recurrent tumor • Previously irradiated tumor • Skill of the operator

  5. Defining Recurrence Rates • Raw recurrence rate: total number of recurrences divided by the total number of tumors treated • Strict recurrence rate: total number of patients with recurrence divided by number of treated patients observed for at least 5 years • Life table cumulative 5 year recurrence rate: Adjusts recurrence rates for the number of patients lost to follow-up each year

  6. BCC recurrence rates for Mohs’ Surgery Data from Thissen M et al. “A Systematic Review of Treatment Modalities for Primary Basal Cell Carcinomas”, Archives of Dermatology 1999;135(10):1177-1183.” * Represents raw recurrence rate **Represents total number of tumors, not number of patients

  7. BCC recurrence rates for Surgical Excision *Represents raw recurrence rate **Represents total number of tumors, not number of patients

  8. BCC recurrence rates for Cryosurgery * Represents raw recurrence rate **Represents total number of tumors, not number of patients

  9. BCC recurrence rates for Curettage and Electrodesiccation

  10. Summary • The range of recurrence rates appear to be similar for most physical modalities, including surgical excision, cryosurgery, curettage and electrodesiccation, curettage and cryosurgery, and curettage alone. • For follow-up period of 3-4 years, this rate falls between 3 to 5% • For a follow-up period of 5 years or more, this rate is about double, approximately 5 to 12% • Recurrence rates for tumors treated by Moh’s Micrographic Surgery appear to be lower at all points in time and averages between 1-2%.

  11. Conclusions • The key predictors of tumor recurrence are size and site of the lesion, histology of tumor, and skill of the operator • All of the non-Mohs' modalities have roughly equal and excellent cure rates for BCC without high-risk prognostic factors • There is an increased risk of BCC recurrence regardless of treatment modality with increasing time. This underscores the importance of long term follow-up for evaluating the effectiveness of a therapy.

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