Curettage (scrapping) and cryosurgery (liquid nitrogen cold spray) for superficial skin cancers…

For some thin cancers of the trunk and extremities, curettage followed by cryosurgery is effective.

Superficial basal and squamous cell carcinomas (BCCs and SCCs) usually occur on the trunk and extremities. As the name implies, these tumors grow sideways instead of down, so their area tends to be large while their tumor mass tends to be small. Surgical removal causes relatively large wounds. Especially on the legs, these heal slowly. These tumors do not invade vital tissues and are accessible to removal by curettage and destruction by cryosurgery. To determine the long-term cure rate associated with these methods in the treatment of superficial BCCs and SCCs, researchers prospectively followed 69 patients with 100 nonfacial, nonmelanoma skin cancers smaller than 2 mm in diameter that were treated in a dermatologist’s office. The primary endpoint was the number of patients who remained disease-free for 5 years.

All lesions were biopsied to confirm diagnosis; 83 were superficial BCCs, and 17 were superficial SCCs (including 11 SCCs in situ). Margin outlines of 4 mm were drawn around each tumor. All lesions were raked in multiple directions with a 2-mm curette until all friable tumor and epidermis were removed within the marked margins. After hemostasis was achieved with 20% aluminum chloride solution, each lesion was additionally treated with one freeze–thaw cycle of liquid nitrogen spray. Patients were evaluated at 1 and 5 years after treatment.

Treatments were well tolerated, and infections did not occur. Several mild-to-moderate hypertrophic scars developed over treatment sites on the chest, back, and shoulders. No tumors had recurred by 1 year. After 5 years, only one superficial BCC had recurred among 95 evaluable tumor sites. This occurred at the edge of the treated site, rather than at its depth.

Comment: This may be the first study to prospectively evaluate curettage followed by cryosurgery treatment of superficial nonfacial basal and squamous cell carcinomas. The results confirm the effectiveness of curettage followed by cryosurgery. The cryosurgical treatment was minimal, with a freeze time of only 10 to 20 seconds, creating a thin, palpable frozen disc at the skin surface. I like this form of treatment for selected thin cancers of the trunk and extremities. In my experience, it is effective, healing is faster than after curettage with electrodessication, and the scars seem less prominent. I am happy to see its success documented.

— Mark V. Dahl, MD

This entry was posted in BCC (basal cell carcinoma), cancer, SCC (squamous cell carcinoma). Bookmark the permalink.