Spencer J M, Tannenbaum A, Sloan L, Amonette R A
Division of Dermatology, University of Tennessee, Memphis, USA.
Dermatol Surg. 1997 Aug;23(8):625-30; discussion 630-1. doi: 10.1111/j.1524-4725.1997.tb00379.x.
Curettage and electrodesiccation (C&D) is probably the technique most frequently utilized by dermatologists to treat basal cell carcinomas (BCC). From histologic studies, it appears C&D does not completely mechanically remove all nests of BCC in a substantial number of cases. Nevertheless, the reported 5-year reoccurrence rate following C&D is significantly less than this histologically observed residual tumor frequency immediately following C&D. Among the multiple possibilities that exist to explain why these residual nests do not appear as recurrent tumor more frequently is the theory that inflammation developing after C&D clears residual tumor.
To test the hypothesis that inflammation developing after C&D clears residual tumor not mechanically removed by the procedure.
The frequency of residual BCC detected histologically immediately following C&D was compared with the frequency 1 month after the C&D, an amount of time in which an effect (if any) of inflammation could occur.
Twenty-two of 29 primary BCC < 1 cm treated by C&D were tumor free immediately following the procedure (clearance rate, 75.9%). Eleven of 14 primary BCC < 1 cm treated by C&D then allowed to granulate 1 month before excision and histologic analysis were tumor free, for a clearance rate of 78.6%. Examination of larger tumors immediately following C&D revealed size is a significant variable for clearance rates. Eleven primary BCC > 1 cm but < 2 cm were examined histologically immediately following C&D; only three were tumor free for a clearance rate of 27.3%. Only one of five tumors > 2 cm thus treated was tumor free, for a clearance rate of 20%. Nine recurrent BCC of various sizes were treated by C&D and immediately examined histologically. Two were tumor free for a clearance rate of 22.2%. Two recurrent BCC were allowed to heal 1 month following C&D; one of these was tumor free when excised.
For primary BCC < 1 cm, no evidence was found that inflammation occurring over 1 month following C&D clears residual tumor. It was also noted that C&D fails to completely remove tumor in a large majority of primary BCC > 1 cm, and in recurrent BCC.
刮除术与电干燥法（C&D）可能是皮肤科医生治疗基底细胞癌（BCC）最常用的技术。从组织学研究来看，在大量病例中，C&D似乎并未完全机械性地清除所有基底细胞癌巢。然而，报告显示C&D后的5年复发率显著低于C&D后立即通过组织学观察到的残留肿瘤频率。在多种可能解释为何这些残留巢不更频繁地表现为复发性肿瘤的原因中，有一种理论认为C&D后发生的炎症清除了残留肿瘤。
检验C&D后发生的炎症清除了该手术未机械性清除的残留肿瘤这一假设。
将C&D后立即通过组织学检测到的残留基底细胞癌频率与C&D后1个月的频率进行比较，这是炎症可能产生影响（若有）的一段时间。
29例直径<1 cm的原发性基底细胞癌经C&D治疗后，22例术后立即无肿瘤（清除率75.9%）。14例直径<1 cm的原发性基底细胞癌经C&D治疗后，在切除及组织学分析前让其肉芽形成1个月，其中11例无肿瘤，清除率为78.6%。C&D后立即对较大肿瘤进行检查发现，肿瘤大小是清除率的一个显著变量。11例直径>1 cm但<2 cm的原发性基底细胞癌在C&D后立即进行组织学检查；只有3例无肿瘤，清除率为27.3%。如此治疗的5例直径>2 cm的肿瘤中只有1例无肿瘤，清除率为20%。9例不同大小的复发性基底细胞癌经C&D治疗后立即进行组织学检查。2例无肿瘤，清除率为22.2%。2例复发性基底细胞癌在C&D后让其愈合1个月；其中1例切除时无肿瘤。
对于直径<1 cm的原发性基底细胞癌，未发现有证据表明C&D后1个月内发生的炎症清除了残留肿瘤。还注意到，在大多数直径>1 cm的原发性基底细胞癌以及复发性基底细胞癌中，C&D未能完全清除肿瘤。
