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Structured Abstract
Introduction:
Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are among the most common malignancies in the United States. There are many potential management strategies for BCCs and SCCs, and the choice of management strategy for an individual patient is not straightforward. We aimed to comprehensively collect information on the comparative effectiveness and safety of each currently used therapeutic strategy for both BCC and SCC.
Data sources:
We conducted literature searches in MEDLINE®, the Cochrane Central Trials Registry and Cochrane Database of Systematic Reviews, and Embase® up to March 2017. We also perused the reference lists of published relevant clinical practice guidelines and systematic reviews. We recorded information on recurrence, histologic clearance, clinical clearance, patient- or observer-rated cosmetic outcomes, adverse effects, quality of life, costs and resources, mental health, patient satisfaction, and mortality. We estimated intervention effects (differences in outcomes between treatments) and the mean frequency of the outcome with each treatment using network meta-analyses.
Results:
We identified 58 randomized controlled trials and 51 nonrandomized comparative studies comparing 21 interventions in 9 categories. Nearly all reported results for recurrence or cure rate outcomes and adverse events, and many reported results for cosmetic outcomes. Few studies reported results using validated instruments for quality of life, mental health, or patient satisfaction with treatment. Data were sparse, especially for analyses at the individual-intervention level. For BCCs, surgical interventions and radiation were associated with lower recurrence rates than interventions that destroy lesions with heat or cold and photodynamic therapy (PDT), and may have lower recurrence rates than curettage. Recurrence rates did not differ significantly between imiquimod and excision. The data were not sufficient to draw conclusions about the comparison of curettage with interventions that destroy lesions with heat or cold, or PDT versus other intervention categories. For SCC in situ, interventions that destroy the lesions with heat or cold and PDT were associated with lower recurrence rates than 5-fluorouracil. Data on the relative effect of thermal interventions versus PDT were not precise enough to draw conclusions.
Conclusions:
Based on sparse evidence, surgical and radiation treatments have lower recurrence rates than other modalities for the treatment of low-risk BCC, and PDT appears to have superior cosmetic outcomes. Large gaps remain in the literature regarding the comparison of individual interventions and SCC in situ, with very little or no information on immunocompromised patients, patients with limited life expectancy, and patients with specific lesion categories, including high-risk BCCs and invasive SCCs.
May 2019 update:
an addendum is located at the end of the main report, before the appendixes.
Contents
- Preface
- Key Informants
- Technical Expert Panel
- Peer Reviewers
- Evidence Summary
- Introduction
- Methods
- Results
- Discussion
- References
- Treatments for Basal Cell and Squamous Cell Carcinoma of the Skin: BCC Addendum
- Appendix A. Search Strategy
- Appendix B. Excluded Studies
- Appendix C. Design Details
- Appendix D. Baselines
- Appendix E. Arm Details
- Appendix F. Risk of Bias
- Appendix G. Summary Results From Unadjusted NRCS
- Appendix H. Adverse Events Reported
- Appendix I. Study-Level Results
Suggested citation:
Drucker A, Adam GP, Langberg V, Gazula A, Smith B, Moustafa F, Weinstock MA, Trikalinos TA. Treatments for Basal Cell and Squamous Cell Carcinoma of the Skin. Comparative Effectiveness Review No. 199. (Prepared by the Brown Evidence-based Practice Center under Contract No. 290-2015-00002-I.) AHRQ Publication No. 17(18)-EHC033-EF. Rockville, MD: Agency for Healthcare Research and Quality; December 2017. www.effectivehealthcare.ahrq.gov/reports/final.cfm.
This report is based on research conducted by the Brown Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2015-00002-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.
The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.
AHRQ or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, or reimbursement or coverage policies, may not be stated or implied. This report may periodically be assessed for the currency of conclusions. If an assessment is done, the resulting surveillance report describing the methodology and findings will be found on the Effective Health Care Program Web site at www.effectivehealthcare.ahrq.gov. Search on the title of the report.
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