Does inflammation contribute to the eradication of basal cell carcinoma following curettage and electrodesiccation?
BACKGROUND
Curettage and electrodesiccation (C&D) is probably the technique most frequently utilized by dermatologists to treat basal cell carcinomas (BCC). From histologic studies, it appears C&D does not completely mechanically remove all nests of BCC in a substantial number of cases. Nevertheless, the reported 5-year reoccurrence rate following C&D is significantly less than this histologically observed residual tumor frequency immediately following C&D. Among the multiple possibilities that exist to explain why these residual nests do not appear as recurrent tumor more frequently is the theory that inflammation developing after C&D clears residual tumor.


OBJECTIVE
To test the hypothesis that inflammation developing after C&D clears residual tumor not mechanically removed by the procedure.


METHODS
The frequency of residual BCC detected histologically immediately following C&D was compared with the frequency 1 month after the C&D, an amount of time in which an effect (if any) of inflammation could occur.


RESULTS
Twenty-two of 29 primary BCC < 1 cm treated by C&D were tumor free immediately following the procedure (clearance rate, 75.9%). Eleven of 14 primary BCC < 1 cm treated by C&D then allowed to granulate 1 month before excision and histologic analysis were tumor free, for a clearance rate of 78.6%. Examination of larger tumors immediately following C&D revealed size is a significant variable for clearance rates. Eleven primary BCC > 1 cm but < 2 cm were examined histologically immediately following C&D; only three were tumor free for a clearance rate of 27.3%. Only one of five tumors > 2 cm thus treated was tumor free, for a clearance rate of 20%. Nine recurrent BCC of various sizes were treated by C&D and immediately examined histologically. Two were tumor free for a clearance rate of 22.2%. Two recurrent BCC were allowed to heal 1 month following C&D; one of these was tumor free when excised.


CONCLUSIONS
For primary BCC < 1 cm, no evidence was found that inflammation occurring over 1 month following C&D clears residual tumor. It was also noted that C&D fails to completely remove tumor in a large majority of primary BCC > 1 cm, and in recurrent BCC.
Spencer
J M
JM
Division of Dermatology, University of Tennessee, Memphis, USA.
Tannenbaum
A
A
Sloan
L
L
Amonette
R A
RA
D000368:Aged; D000369:Aged, 80 and over; D002280:Basal Cell Carcinoma / Q000473:pathology / Q000601:surgery*; D002921:Cicatrix / Q000473:pathology; D003475:Curettage; D003872:Dermatitis / Q000473:pathology*; D062109:Dermatologic Surgical Procedures; D004598:Electrosurgery; D005260:Female; D005500:Follow-Up Studies; D006097:Granulation Tissue / Q000473:pathology; D006801:Humans; D007249:Inflammation; D008297:Male; D008867:Microtomy; D008875:Middle Aged; D015580:Mohs Surgery; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery; D018365:Neoplasm, Residual; D012867:Skin / Q000473:pathology*; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D014945:Wound Healing