Re: Evidence-based review of the use of cryosurgery in treatment of basal cell carcinoma.

BACKGROUND Cryosurgery has been used to treat basal cell carcinoma (BCC), and it has many technical advantages over other methods. It is therefore important to establish its efficacy as a treatment for BCC. OBJECTIVE To review systematically the body of literature reporting on the efficacy of cryosurgery of BCC in terms of recurrence rates and cosmetic results. METHODS A review is given of MEDLINE, EMBASE, CancerLit, and the Cochrane Database of Systematic Reviews for studies that examined cyosurgery in treatment of BCC patients. RESULTS We found 13 noncontrolled prospective studies and 4 randomized clinical trials comparing cryosurgery to other methods of treatment for BCC. Because of the inability to double blind or placebo control treatment of BCC, none of the studies met criteria for A and B grade evidence, as defined by Sackett. Therefore, all studies were assigned grade C. CONCLUSIONS According to the best evidence, recurrence rates of BCC treated with cryosurgery are low (less than 10%). Except in one study, recurrence rates are calculated based on clinical, rather than histologic diagnosis, which may cause the rates to appear somewhat lower than they actually are, especially with a short follow-up period. Cosmetic results of cryosurgery treatment reported in literature are described as good by most investigators. Overall, there are sufficient data to consider cryosurgery as a reasonable treatment for BCC. There are no good studies, however, comparing cryosurgery with other modalities, particularly with Mohs surgery, excision, or electrodessication and curretage so that no conclusion can be made whether cryosurgery is as efficacious as other methods. Also, there is no evidence on whether curetting the lesions before cryosurgery affects the efficacy of treatment.