Morriston Hospital, Swansea Bay University Health Board, Swansea, UK.
University College London, London, UK.
Ann R Coll Surg Engl. 2021 Apr;103(4):263-271. doi: 10.1308/rcsann.2020.7020. Epub 2021 Feb 9.
Basal cell carcinoma is the most common cancer. Excisional surgery is associated with a high clearance rate, at the expense of significant functional and aesthetic morbidity, especially within the T-zone or for extensive lesions. We report five-year follow-up outcomes for carbon dioxide laser extirpation of cutaneous basal cell carcinoma, assisted by immediate methyl aminolevulinate photodynamic therapy and cost-benefit considerations.
Retrospective cohort database analysis of adult patients with biopsy-proven primary cutaneous basal cell carcinoma, completing five years of follow-up. Direct per-lesion cost was compared with conventional wide local excision. Patients with morphoeic basal cell carcinoma were excluded.
Treated lesions were up to 1% total body surface area and up to 3.8mm (1.38 ± 0.695cm, mean ± standard deviation) in biopsy-proven depth. At the five-year follow-up mark, 93.6% of treated areas remained free of recurrence. Nodular basal cell carcinoma was the most common subtype (41.5%). A mean tumour depth greater than 2 ± 0.872mm was significantly associated with recurrence (Mann-Whitney, = 0.0487). For a service delivered through the NHS at 2015 prices, we report a 43% saving, equating to a saving of £235 per basal cell carcinoma or a national annualised saving of £70 million by 2025 for the NHS.
Our results suggest that CO-assisted photodynamic therapy is non-inferior to excision but may offer better functional and cosmetic preservation at a fraction of the direct like for like cost of operative surgery. Investigation of this method by randomised controlled methodology is warranted.
基底细胞癌是最常见的癌症。切除术虽能提高清除率，但会导致严重的功能和美容损伤，尤其是在 T 区或广泛病变时。我们报告了二氧化碳激光切除皮肤基底细胞癌的 5 年随访结果，同时辅助即时的氨甲环酸光动力治疗，并考虑了成本效益比。
回顾性分析了经活检证实的原发性皮肤基底细胞癌成年患者的数据库，这些患者完成了 5 年的随访。直接按病变计算的成本与传统的广泛局部切除进行了比较。排除了形态基底细胞癌患者。
治疗的病变面积不超过 1%的体表面积，活检证实的深度不超过 3.8mm（1.38±0.695cm，平均值±标准偏差）。在 5 年的随访标记处，93.6%的治疗区域无复发。结节性基底细胞癌是最常见的亚型（41.5%）。平均肿瘤深度大于 2±0.872mm 与复发显著相关（Mann-Whitney，=0.0487）。按 2015 年价格计算，通过国民保健制度提供服务，我们报告节省了 43%，相当于每例基底细胞癌节省 235 英镑，到 2025 年，国民保健制度每年可节省 7 亿英镑。
我们的结果表明，CO2 辅助光动力疗法与切除术相比不劣效，但可能以手术操作直接相似成本的一小部分提供更好的功能和美容保存。通过随机对照方法对这种方法进行研究是合理的。
