ABSTRACT
BACKGROUND: The incidence of multiple facial basal cell carcinomas (BCCs) is increasing. OBJECTIVE: Comparison of cosmetic results after cryosurgery and excision for primary BCCs. METHODS: Cosmetic results after cryosurgery and excision (prospective randomized study) of primary BCCs in the head/neck area were assessed by five independent professional observers and by the patients. RESULTS: Ninety-six BCCs were treated either with surgical excision (n = 48) or cryosurgery (n = 48). Clinical professionals evaluated the cosmetic results after surgery as significantly better. The beautician had no preference for either therapy. The patient had a significant preference for excision. Localization and size of the tumor did not modify this general preference for excision. The male dermatologist, however, had a tendency to evaluate results in the cheek, periauricular, and neck area as inferior to those in the rest of the face, regardless of which therapy was given. CONCLUSION: In general, cosmetic results after excision are better than after cryosurgery.
Subject(s)
Carcinoma, Basal Cell/surgery , Cryosurgery , Head and Neck Neoplasms/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Cosmetic Techniques , Female , Humans , Male , Middle Aged , Prospective Studies , Treatment OutcomeABSTRACT
OBJECTIVE: To determine the policy of dermatologists practising in the Netherlands in the treatment of basal cell carcinoma. DESIGN: Written enquiry. SETTING: Catharina Hospital, Eindhoven, the Netherlands. METHOD: All 293 dermatologists practising in the Netherlands were sent a questionnaire in May 1996 containing 15 questions about diagnosis and treatment of basal cell carcinoma. RESULTS: Eighteen forms dropped off because of termination of the practice or joint completion in group practices. The response was 76% (208/275). The diagnosis was made usually on the basis of histological examination (71% of the respondents; 84% in a tumour recurrence). Excision was the preferred treatment for all subtypes of basal cell carcinoma; second choices were cryosurgery or curettage/electrocoagulation. Roentgen contact therapy has been practically abandoned. New methods such as photodynamic therapy and immunotherapy are being used only sporadically on an experimental basis. Most dermatologists regarded tumour recurrences as a bigger problem than primary tumours. They attempt to reduce the percentage of recurrences by giving advice about risk factors (sunlight). CONCLUSION: Too little use is being made of diagnostic biopsy to enable an optimal choice of therapy of basal cell carcinomas, especially in cases of recurrence tumours.
Subject(s)
Carcinoma, Basal Cell/diagnosis , Carcinoma, Basal Cell/therapy , Dermatology/statistics & numerical data , Practice Patterns, Physicians'/statistics & numerical data , Skin Neoplasms/diagnosis , Skin Neoplasms/therapy , Female , Health Care Surveys , Humans , Male , Neoplasm Recurrence, Local/prevention & control , Neoplasms, Second Primary/therapy , Netherlands , Patient Education as Topic/statistics & numerical data , Surveys and QuestionnairesABSTRACT
Three patients, two men aged 54 and 72 years, respectively, and a woman aged 52 years, were treated successfully for (recurrence of a) keratoacanthoma with methotrexate. Since the sixties 11 patients with recurrent keratoacanthoma treated with methotrexate have been described. Dose schedules were widely different and dosages were in general high, resulting in more or less severe side effects. The patients now presented were treated according to the Weinstein schedule, with small doses and during a short period, which minimises the adverse effects.
