Histological and immunohistochemical evaluation of basal cell carcinoma following curettage and electrodessication.

BACKGROUND

Basal cell carcinoma (BCC) is the most frequent non-melanoma skin cancer. Curettage and electrosurgery is probably the method most commonly used by dermatologists for the treatment of small and low risk BCCs. However, one is unable to determine the persistence of any residual tumor. This study was carried out in order to demonstrate the presence of such tumoral cells after curettage and electrofulguration.

METHODS

20 primary BCC outpatients were studied at the Dermatology Service of Getúlio Vargas Hospital in the city of Teresina--State of Piauí--Brazil, with lesions of up to 1 cm in diameter on the face, and up to 1.5 cm elsewhere, and with no clinical signs of sclerosing and micronodular forms. Patients were anesthetized with 2% lidocaine with vasoconstrion and the lesions were curetted. Electrofulguration was conducted throughout the curetted area and 1 millimeter beyond. After two curettage and electrofulguration cycles, an incision around the resultant ulcer was made 2 mm beyond the visible bloody borders and in the base to the middle of subcutaneous fat. Two straight incisions were also carried out intersecting the lesion center, dividing it into quadrants. Each quadrant was incised and then fixed with 10% formalin. The quadrants and the fragments resulting from the curettage were in paraffin and histopathologically tested through hematoxylin/eosin stains and immunohistochemistry with Ber-EP4 marker.

RESULTS

There was evidence of persistent BCC in 5 of the 20 sites treated (25%): four (20%) in one quadrant and one (5%) in all four quadrants. 70-100% of tumor cells expressed Ber-EP4 in all 20 BCCs.

CONCLUSIONS

The persistence of tumoral residues after 2 curettage and electrofulguration cycles for basal cell carcinoma was found in 5 sites treated (25%). Despite the small cohort, such findings are very similar to those of other studies that applied curettage and electrocoagulation and indicated the probability of 25% of tumoral persistence.