Surgical excision (SE) is significantly more effective than superficial curettage (SC) followed by imiquimod cream, 5%, in maintaining tumor-free survival for nodular basal cell carcinoma (nBCC) after five years, according to a new analysis in JAMA Dermatology.
Researchers conducting the secondary analysis of the SCIN randomized clinical trial evaluated 145 patients with histologically confirmed nBCC in the study and randomly assigned to either SC plus imiquimod (n = 73) or SE (n = 72) between January 2016 and November 2017.
Five-year tumor-free survival probability was 98.2% for SE (95% CI, 88.0% to 99.8%) vs. 77.8% (95% CI, 65.7% to 86.0%) for SC plus imiquimod. Of the 15 treatment failures observed in the SC plus imiquimod group, five occurred between one and five years post-treatment. One failure was recorded in the SE group. Relative risk of treatment failure for SC plus imiquimod was 15.93 (95% CI, 2.10 to 120.64).
"This secondary analysis of a randomized clinical trial found that although it cannot be concluded that SC plus imiquimod is noninferior to SE, SC plus imiquimod was substantially less effective at five years after treatment," the researchers concluded. "Most treatment failures occurred in the first year after treatment, and the probability of tumor-free survival 5 years after treatment with SC plus imiquimod was still 77.8%. The information in this trial can be used to counsel patients on the relative benefits and trade-offs of the different treatment options for nBCC."
Source: Verkouteren B, et al. JAMA Dermatology. 2025. Doi:10.1001/jamadermatol.2024.5572