THE LONG-TERM efficacy of superficial curettage (SC) followed by imiquimod cream, 5%, compared with surgical excision (SE) in treating nodular basal cell carcinoma (nBCC) has been evaluated in a secondary analysis of the SCIN randomised clinical trial. The trial followed 145 patients over five years, with results indicating a significant difference in treatment success between the two approaches.
After five years, the probability of remaining free from treatment failure was 77.8% for patients who underwent SC followed by imiquimod and 98.2% for those who received SE. The hazard ratio for treatment failure was 15.93, with a confidence interval that did not exclude the prespecified noninferiority margin of 5.22. These findings suggest that while SC plus imiquimod may be an alternative treatment, it is significantly less effective than SE in ensuring long-term tumor-free survival.
The study enrolled patients with primary nBCC ranging from 4 to 20 mm in diameter. Participants were randomised to either SC plus imiquimod or SE between January 2016 and November 2017 at two outpatient dermatology departments in the Netherlands. The trial’s primary endpoint was the probability of remaining free from treatment failure at one year, while secondary outcomes included the five-year follow-up data, completed in September 2022.
Throughout the study, 15 treatment failures occurred in the SC plus imiquimod group, with five of these failures happening between one and five years after treatment. In contrast, only one treatment failure was recorded in the SE group. The competing risk analysis, which accounted for unrelated deaths, resulted in a subhazard ratio of 16.16, reinforcing the superior efficacy of SE over SC plus imiquimod.
These findings highlight the trade-offs between the two treatment options. While SC plus imiquimod offers a noninvasive approach, it carries a significantly higher risk of recurrence. Patients must be informed about these differences to make an educated choice regarding their treatment. SE remains the more reliable option for long-term success, but for those prioritising less invasive treatment, SC plus imiquimod may still be a viable, albeit less effective, alternative. The results of this study provide valuable guidance for both clinicians and patients in selecting the most appropriate therapy for nBCC.
Katie Wright, EMJ
Reference
Verkouteren BJA et al. Imiquimod cream preceded by superficial curettage vs surgical excision for nodular basal cell carcinoma: a secondary analysis of a randomized clinical trial. JAMA Dermatol. 2025;DOI:10.1001/jamadermatol.2024.5572.
