Does inflammation contribute to the eradication of basal cell carcinoma following curettage and electrodesiccation?

BACKGROUND. Curettage and electrodesiccation (C and D) is probably the technique most frequently utilized by dermatologists to treat basal cell carcinomas (BCC). From histologic studies, it appears C and 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 and D is significantly less than this histologically observed residual tumor frequency immediately following C and 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 and D clears residual tumor. OBJECTIVE. To test the hypothesis that inflammation developing after C and D clears residual tumor not mechanically removed by the procedure. METHODS. The frequency of residual BCC detected histologically immediately following C and D was compared with the frequency 1 month after the C and D, an amount of time in which an effect (if any) of inflammation could occur. RESULTS. Twenty-two of 29 primary BCC <1 cm treated by C and D were tumor free immediately following the procedure (clearance rate, 75.9%). Eleven of 14 primary BCC <1 cm treated by C and 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 and D revealed size is a significant variable for clearance rates. Eleven primary BCC >1 cm but <2 cm were examined histologically immediately following C and 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 and 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 and D; one of these was tumor free when excised. CONCLUSION. For primary BCC <1 cm, no evidence was found that inflammation occurring over 1 month following C and D clears residual tumor. It was also noted that C and D fails to completely remove tumor in a large majority of primary BCC >1 cm, and in recurrent BCC.