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May 16, 2011

Assessing the Treatment of Nonmelanoma Skin Cancers

Author Affiliations

Author Affiliations: Departments of Dermatology and Immunology, University of Texas MD Anderson Cancer Center, Houston.


Copyright 2011 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2011

Arch Dermatol. 2011;147(5):605-606. doi:10.1001/archdermatol.2011.91

Nonmelanoma skin cancers (NMSCs), principally basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), are the most common human cancers. Accordingly, they are treated in a number of different ways. Unfortunately, there is a lack of high-quality randomized clinical trials comparing different techniques of treatment for NMSC. Recent Cochrane database reviews have focused on interventions for BCC,1 interventions for nonmetastatic cutaneous SCC,2 and a comparison between standard excision and Mohs micrographic surgery (MMS) for eyelid BCC.3 In all of these reviews, a few conclusions become clear. First, there are no high-quality randomized controlled studies comparing frequently used interventions for BCC and SCC. Most studies are case series or case-control studies, and many do not have very extensive follow-up. Second, interventions are hard to compare because they are typically used in very different clinical scenarios. It may be difficult to justify MMS for low-risk tumors and sites or standard excision for high-risk ones. Finally, in an age where cost control is a serious concern, it is difficult to compare the cost-effectiveness of these interventions given the lack of long-term follow-up, complication rates, patient satisfaction, and treatment-associated morbidity.

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