Histologic subtype of treatment failures after noninvasive therapy for superficial basal cell carcinoma: An
Lieke C J van Delft1, Patty J Nelemans2, Maud H E Jansen1
1Department of Dermatology, Maastricht University Medical Center+, Maastricht, the Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, the Netherlands.
Background:
There have been concerns that recurrences after noninvasive therapy for basal cell carcinoma (BCC) transform into a "more aggressive" histologic subtype.
Objective:
We sought to evaluate the proportion of patients with a nonsuperficial treatment failure after noninvasive therapy for superficial BCC.
Methods:
An observational study was performed using data from a single blind, noninferiority, randomized controlled trial (March 2008-August 2010) with 5-year follow-up in patients with primary superficial BCC treated with methylaminolevulinate-photodynamic therapy, 5-fluorouracil, or imiquimod. Data were used from 166 adults with a histologically confirmed treatment failure.
Results:
A nonsuperficial subtype was found in 64 of 166 treatment failures (38.6%). Proportions with a more aggressive subtype than the primary tumor were 51.3% (38/74) for early and 28.3% (26/92) for later treatment failures (P = .003). The proportion of more aggressive early failures was significantly lower after imiquimod (26.3%) compared with methylaminolevulinate-photodynamic therapy (54.8%, P = .086) and 5-fluorouracil (66.7%, P = .011).
Limitations:
There was limited information on the exact time of occurrence of treatment failures.
Conclusion:
More aggressive treatment failure recurrences after noninvasive therapy for superficial BCC occur most often within the first 3 months posttreatment, probably indicating underdiagnosis of more aggressive components in the primary tumor rather than transformation.
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