Early Detection of Desiccation and Curettage Failure in the Treatment of Basal Cell Carcinoma

Abstract

Background/Aims: Basal cell carcinoma (BCC) is a malignant neoplasm of keratinocytes. Electrodessication and curettage (ED&C) published cure rates vary widely, and the authors of this study are unaware of any previous literature which has attempted to rapidly identify treatment failures. Objective: To identify BCC ED&C failures by histologically analyzing the fragments produced by the third round of curettage. Methods: The monitoring of routine therapy of 862 cases of BCC that were treated by ED&C followed by the submission of cautery fragments of the third round of curettage for histological and immunohistochemical testing. Results: Of the 862 cases, 764 (89%) had no residual BCC seen in their curetting. Of these patients, zero recurrences (0%) were noted. Forty-eight of the 862 cases had residual BCC seen in their curetting and elected to receive no additional therapy. Eighteen (38%) had a recurrence detected. Fifty of the 862 cases had residual BCC seen in their curetting and elected for immediate re-excision. Thirty-five (70%) had histological evidence of residual BCC. Limitations: The study was performed at a single center with 2 years of follow-up. Conclusion: Pathological examination of curettage fragments in combination with immunohistochemistry testing appears to be beneficial in predicting which patients are likely to have recurrence of BCC after ED&C.