Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Dermatology and Venereology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
J Eur Acad Dermatol Venereol. 2023 Nov;37(11):2370-2377. doi: 10.1111/jdv.19322. Epub 2023 Jul 21.
Cryosurgery is a common destructive treatment method for intraepidermal carcinoma (IEC) above the knee. Curettage alone is a simple, non-aggressive and inexpensive treatment method commonly used on benign skin lesions. However, only one study has assessed curettage for treatment of IEC.
We aimed to (1) compare the effectiveness of cryosurgery (standard method) to curettage (experimental method) for treatment of IEC in regard to overall clearance rates at 1-year follow-up, and (2) investigate whether wound healing times differed between the treatment groups.
In this randomized and controlled, non-inferiority trial, adult patients with one or more IEC with a diameter of 5-20 mm, located above the knee and suitable for destructive treatment were recruited from Sahlgrenska University Hospital (Gothenburg, Sweden). Lesions were randomized to treatment with either cryosurgery or curettage. Wound healing was assessed by a nurse after 4-6 weeks and through self-report forms. Overall clearance was assessed by a dermatologist after 1 year.
In total, 183 lesions in 147 patients were included, with 93 lesions randomized to cryosurgery and 90 to curettage. Eighty-eight (94.6%) of the lesions in the cryosurgery group and 71 (78.9%) in the curettage group showed an overall clearance at the 1-year follow-up visit (p = 0.002). The non-inferiority analysis was inconclusive. Curettage resulted in both shorter self-reported wound healing times (mean time 3.1 vs. 4.8 weeks, p < 0.001) and a larger proportion of healed wounds after 4-6 weeks (p < 0.001).
Cryosurgery and curettage both result in high clearance rates for treatment of IEC, but cryosurgery is significantly more effective. On the other hand, curettage may result in shorter wound healing times.
冷冻疗法是一种常见的破坏治疗方法，适用于膝上表皮内癌（IEC）。单纯刮除术是一种简单、非侵袭性和廉价的治疗方法，常用于良性皮肤病变。然而，只有一项研究评估了刮除术治疗 IEC 的效果。
我们旨在（1）比较冷冻疗法（标准方法）和刮除术（实验方法）治疗 IEC 的疗效，以 1 年随访时的总体清除率为指标，（2）研究治疗组的伤口愈合时间是否存在差异。
在这项随机对照、非劣效性试验中，我们招募了来自瑞典哥德堡 Sahlgrenska 大学医院的患有一个或多个直径为 5-20mm、位于膝上且适合破坏性治疗的 IEC 的成年患者。将病变随机分为冷冻疗法或刮除术治疗。在 4-6 周后和通过自我报告表格，由护士评估伤口愈合情况。在 1 年后，由皮肤科医生评估总体清除情况。
共纳入了 147 名患者的 183 个病变，其中 93 个病变随机分为冷冻组，90 个病变分为刮除组。冷冻组的 88（94.6%）个病变和刮除组的 71（78.9%）个病变在 1 年随访时显示出总体清除（p=0.002）。非劣效性分析不确定。刮除术不仅使自我报告的伤口愈合时间更短（平均时间为 3.1 周比 4.8 周，p<0.001），而且在 4-6 周后愈合的伤口比例也更大（p<0.001）。
冷冻疗法和刮除术都能有效治疗 IEC，但冷冻疗法的效果明显更好。另一方面，刮除术可能会导致伤口愈合时间更短。
