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A systematic review of observational management of cutaneous basal cell carcinoma
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Goodall, R., Chicco, M., Wietek, N., Borsky, K., Harrison, C. and Rodrigues, Jeremy N. (2022) A systematic review of observational management of cutaneous basal cell carcinoma. Journal of Plastic, Reconstructive & Aesthetic Surgery, 75 (7). pp. 2277-2285. doi:10.1016/j.bjps.2022.04.056 ISSN 1748-6815.
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WRAP-systematic-review-observational-cutaneous-basal-cell-carcinoma-2022.pdf - Accepted Version - Requires a PDF viewer. Available under License Creative Commons Attribution Non-commercial No Derivatives 4.0. Download (252Kb) | Preview |
Official URL: http://dx.doi.org/10.1016/j.bjps.2022.04.056
Abstract
Background
Cutaneous basal cell carcinoma (BCC) is the commonest cancer in the United Kingdom and United States. Surgical excision is the most common treatment. This review summarises all published outcomes of observational/non-interventional management of cutaneous BCC.
Methods
This PRISMA-compliant systematic review searched MEDLINE, EMBASE and CENTRAL databases from inception-June 2021. All studies reporting outcomes of observational management for BCC were included.
Results
We identified 2529 titles, from which 4 full-text articles were eligible, reporting on 2298 individuals. Two studies were randomised controlled trials (RCTs) comparing histological clearance rates and adverse events following treatment with an inactive strategy (placebo cream) versus topical 5%-imiquimod (at different frequencies) for 6-12 weeks. Clearance rates ranged from 52-100% for imiquimod and 2-19% for placebo, with more adverse events associated with imiquimod. The other two studies used prospective cohort designs. One study assessed the natural history of BCCs managed expectantly in 39 individuals aged ≥80years. During the 15.8-month follow-up, 46.2% of lesions did not increase in size and 10.3% resolved. The remaining study compared treatment patterns of 1360 patients with non-melanoma skin cancer (NMSC) in individuals with or without limited life-expectancy (LLE). The LLE subgroup had a 5-year mortality rate of 43.3%, with no deaths attributed to NMSC. Only 3.3% of individuals with LLE underwent observational treatment. No study examined quality-of-life or cost-effectiveness.
Conclusion
There has been limited investigation of observational management of BCC, despite possible advantages of this strategy. Future RCTs should compare quality-of-life outcomes and utility-adjusted survival following interventional or observational management of BCC.
Item Type: | Journal Article | ||||||||||||
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Subjects: | R Medicine > RC Internal medicine | ||||||||||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Library of Congress Subject Headings (LCSH): | Basal cell carcinoma | ||||||||||||
Journal or Publication Title: | Journal of Plastic, Reconstructive & Aesthetic Surgery | ||||||||||||
Publisher: | Elsevier Inc. | ||||||||||||
ISSN: | 1748-6815 | ||||||||||||
Official Date: | 1 July 2022 | ||||||||||||
Dates: |
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Volume: | 75 | ||||||||||||
Number: | 7 | ||||||||||||
Page Range: | pp. 2277-2285 | ||||||||||||
DOI: | 10.1016/j.bjps.2022.04.056 | ||||||||||||
Status: | Peer Reviewed | ||||||||||||
Publication Status: | Published | ||||||||||||
Access rights to Published version: | Restricted or Subscription Access | ||||||||||||
Date of first compliant deposit: | 4 May 2022 | ||||||||||||
Date of first compliant Open Access: | 29 April 2023 | ||||||||||||
RIOXX Funder/Project Grant: |
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