Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, London, UK.
Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, UK.
Br J Dermatol. 2021 Sep;185(3):499-511. doi: 10.1111/bjd.19809. Epub 2021 May 5.
Basal cell carcinoma (BCC) is the most common cancer affecting white-skinned individuals, and the worldwide incidence is increasing. Although rarely fatal, BCC is associated with significant morbidity and costs.
To assess the effects of interventions for primary BCC in immunocompetent adults.
We updated our searches of the following databases to November 2019: Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL and LILACS. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation method. We used standard methodological procedures expected by Cochrane.
We included 52 randomized controlled trials with 6990 participants (median age 65 years; range 20-95). Mean study duration was 13 months (range 6 weeks-10 years). Ninety-two per cent (n = 48/52) of studies exclusively included histologically low-risk BCC (nodular and superficial subtypes). The certainty of evidence was predominantly low or moderate for the outcomes of interest. Overall, surgical interventions have the lowest recurrence rates, and there may be slightly fewer recurrences with Mohs micrographic surgery over surgical excision for primary, facial BCC (high-risk histological subtype or located in the 'H-zone' or both) (low-certainty evidence). Nonsurgical treatments, when used for low-risk BCC, are less effective than surgical treatments, but recurrence rates are acceptable and cosmetic outcomes are probably superior.
Surgical interventions have lower recurrence rates and remain the gold standard for high-risk BCC. Of the nonsurgical treatments, topical imiquimod has the best evidence to support its efficacy for low-risk BCC. Priorities for future research include agreement on core outcome measures and studies with longer follow-up.
基底细胞癌（BCC）是白人中最常见的癌症，全球发病率正在上升。虽然 BCC 很少致命，但它与显著的发病率和成本有关。
评估免疫功能正常的成年人原发性 BCC 的干预措施的效果。
我们更新了对以下数据库的搜索，截至 2019 年 11 月：Cochrane 皮肤组专业登记处、CENTRAL、MEDLINE、Embase、CINAHL 和 LILACS。使用推荐评估、制定和评估方法评估证据的确定性。我们使用了 Cochrane 预期的标准方法程序。
我们纳入了 52 项随机对照试验，共 6990 名参与者（中位年龄 65 岁；范围 20-95 岁）。平均研究持续时间为 13 个月（范围 6 周-10 年）。92%（n=48/52）的研究仅包括组织学低风险 BCC（结节和浅表亚型）。对于感兴趣的结局，证据的确定性主要为低或中。总体而言，手术干预的复发率最低，对于原发性面部 BCC（高风险组织学亚型或位于“H 区”或两者），Mohs 显微外科手术可能比手术切除的复发率略低（低确定性证据）。对于低风险 BCC，非手术治疗的效果不如手术治疗，但复发率可以接受，美容效果可能更好。
手术干预的复发率较低，仍然是高风险 BCC 的金标准。在非手术治疗中，外用咪喹莫特治疗低风险 BCC 的证据最好。未来研究的重点包括对核心结局测量的一致意见和具有更长随访时间的研究。
