Tazarotene, dermoscopy effective for sBCC

September 1, 2004

Washington, D.C. - Topical application of tazarotene 0.1 percent gel for up to 20 weeks, with treatment efficacy monitored using dermoscopy, can be an effective treatment regimen for patients with superficial basal cell carcinoma (sBCC), according to Claudia Cotellessa, M.D., a dermatologist at the University of L'Aquila, Italy. Surgical excision and Mohs micrographic surgery are the standard treatments for basal cell carcinoma. However, a surgical approach may not be the best choice for all patients with sBCC, says Dr. Cotellessa.

Washington, D.C. - Topical application of tazarotene 0.1 percent gel for up to 20 weeks, with treatment efficacy monitored using dermoscopy, can be an effective treatment regimen for patients with superficial basal cell carcinoma (sBCC), according to Claudia Cotellessa, M.D., a dermatologist at the University of L'Aquila, Italy.

Surgical excision and Mohs micrographic surgery are the standard treatments for basal cell carcinoma. However, a surgical approach may not be the best choice for all patients with sBCC, says Dr. Cotellessa.

"A medical approach, using 5-FU, intralesional alpha-interferon or bleomycin, or a topical treatment such as imiquimod or tazarotene, may be preferred for patients with recurrent or multiple superficial BCCs," says Dr. Cotellessa.

"Dermoscopy allows us to visualize structures that are not visible with the naked eye, and is an adjunctive method to clinical evaluation," says Dr. Cotellessa. "We monitored all BCC-specific features, such as arborizing vessels, leaf-like areas, large blue-gray ovoid nests, multiple blue-gray globules, ulceration and spoke wheel areas."

Thirty patients (16 male, 14 female) with a total of 41 sBCC lesions enrolled in the study from June 1998 to December 2001. The patients had a mean age of 62.5 years (range: 28 to 85 years). Forty-one superficial lesions were distributed on the trunk (21), face (12) and extremities (eight).

Patients applied topical tazarotene 0.1 percent gel once a day for a maximum period of 20 weeks. Lesions were evaluated by dermoscopic examination at baseline and once a month during treatment. Treatment efficacy was scored using a four-point system to evaluate the change from baseline: 1) complete response, defined as complete clinical disappearance of the lesion and the absence of all sBCC-specific dermoscopic criteria; 2) partial response, defined as more than 40 percent reduction in tumor size together with a reduction in the number or size of sBCC-specific dermoscopic criteria; 3)no response, defined as minimal reduction (less than 40 percent) in tumor size together with minimal or no change in sBCC-specific dermoscopic criteria; and 4)worsening, defined as an increase in tumor size together with an increase in the number or size of sBCC-specific criteria or the presence of additional sBCC-specific dermoscopic criteria.

Results After four to 20 weeks of treatment, 24 of the 41 lesions (58.5 percent) showed complete response, 13 (31.7 percent) showed partial response, three (7.3 percent) showed no response and one (2.5 percent) showed worsening. Dermoscopic evaluation of all successfully treated lesions showed a gradual decrease in sBCC-specific dermoscopic features during treatment, with response first seen in reduced size and number of arborizing vessels and leaf-life areas. There was gradual disappearance of additional sBCC-specific dermoscopic features with longer treatment, notably ovoid nests and blue-gray globules. In sBCC lesions that showed a complete clinical and dermoscopic response, complete surgical excision was performed to verify the absence of residual neoplastic cells.

Ulceration and crusting appeared during treatment in six of 12 successfully treated lesions that were not ulcerated at baseline, possibly indicating therapeutic response to tazarotene. Adverse effects of topical application of tazarotene 0.1 percent gel were reported for 10 lesions (24.4 percent) and consisted of erythema, burning and itching. None of the patients discontinued treatment due to adverse effects.

Disclosure: Dr. Cotellessa reports no conflicts of interest.