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Comparison of Cosmesis With Four Treatments for Basal and Squamous Cell Carcinomas

By: Lauren Harrison, MS
Posted: Tuesday, October 8, 2019

Brachytherapy and Mohs micrographic surgery have improved cosmesis compared with external-beam radiation therapy or conventional excision of T1–T2N0 basal cell and squamous cell carcinomas of the skin. Nicholas G. Zaorsky, MD, MS, of Penn State College of Medicine in Pennsylvania, published the results of a meta-analysis conducted with colleagues in Cancer.

“Based on our analysis, it appears that radiation can be a good alternative treatment to surgery,” said Dr. Zaorsky in an institutional press release. “It shouldn’t necessarily be thought of as something that’s an antiquated treatment that will result in a high chance of the cancer coming back or having unfavorable cosmetic outcomes.”

Researchers used a combination of Population, Intervention, Control, Outcome, Study Design (PICOS), Preferred Reporting Items for Systemic Reviews and Meta-analyses (PRISMA), and Meta-analyses of Observational Studies in Epidemiology (MOOSE) methods to identify studies published on PubMed that treated patients with T1–T2N0 basal or squamous cell carcinomas. Patients in the included studies were treated with conventional excision, brachytherapy, Mohs micrographic surgery, or external-beam radiation therapy, and cosmesis was reported on a scale of “good,” “fair,” or “poor.”

A total of 24 conventional excisions, 13 Mohs micrographic surgeries, 19 external-beam radiation therapies, and 7 brachytherapy studies were included in the analysis, accounting for treatment of 21,371 patients. The summary effect size for “good” cosmesis was 81% for conventional excision, 74.6% for excisional-beam radiation therapy, and 97.6% for brachytherapy. The only Mohs micrographic surgery study that included cosmesis reported 96% “good” cosmesis. Brachytherapy had improved “good” cosmesis compared with external-beam radiation therapy, but it had similar results to conventional excision and Mohs micrographic surgery. Overall, brachytherapy and Mohs surgery had more “good” and “fair” ratings than the other therapies. The 1-year recurrence rates for all therapies was less than 2%.

Disclosure: The study authors reported no conflicts of interest.



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