We have read with interest the review by Aguayo-Leiva et al1 on surgical vs nonsurgical treatment of basal cell carcinoma, recently published in Actas Dermo-Sifiliográficas (October 2010). We would like to comment on some of their statements in the light of our experience:

• 1.

  In their conclusions, the authors state: “Despite there being few studies that compare surgical and nonsurgical therapies for BCC [basal cell carcinoma], it is clear that surgery is associated with the lowest recurrence rates.” We do not agree that this statement is “clear.” It is true that surgical excision is generally regarded as the preferred treatment for BCC, but there is still no scientific evidence to support or refute this view.2 As Thissen2 pointed out in an excellent meta-analysis, it is not possible to compare the relative risk of recurrence after surgical and nonsurgical treatment of BCCs because of lack of uniformity in the selection of the BCCs and because of differences in the technique, in the experience of the dermatologist or surgeon performing the treatment, in the statistical analysis, and in reporting of the results in the literature. This is still a subject of debate. It is not yet possible to establish general guidelines based on evidence rather than on opinions, however “clear” these opinions may be.

• 2.

  We agree with the authors that curettage-electrodesiccation (CE) of BCCs “is a simple and cheap technique that achieves good functional and cosmetic results.” In their review the authors repeat the data of Silverman3 published in 1991 and claim that this technique is only recommended in BCCs that “have a diameter less than 1cm [...] and are located in a low-risk area.”1 We were surprised that they did not include in their review the article that we published recently in the “blue journal” (Journal of the American Academy of Dermatology),4 which does not agree with this recommendation.

We performed a follow-up study on 257 patients with BCCs (primary, nonsclerosing, and histologically confirmed), who were treated with CE at the Hospital Universitario Central de Asturias, Oviedo in a department specializing in this technique. Eighty-one BCCs with a diameter between 4 and 15mm were located in medium-risk areas and 176 BCCs with a diameter between 4 and 10mm in high-risk areas, according to the standard classification.3 Altogether, 105 BCCs were located in the nasal and paranasal region or in the nasolabial fold, 48 on the eyelid or canthus, 12 in the perioral region, 11 on the ear, 48 on the forehead and temples, 14 in the periauricular region, and 19 on the cheek and in the malar region. The mean (SD) follow-up was 5.34 (1.33) years. The outcomes were analyzed rigorously by calculating the life table and plotting the Kaplan-Meier curves. In summary, we observed only 3 recurrences of BCC treated with CE: 1 on the nose, 1 on the eyelid, and 1 in the periauricular region. The 5-year cumulative nonrecurrence rate of BCCs treated with CE was 98.89% (SD, 0.70; 95% CI, 97.40%-100%). That is, the recurrence of primary and nonsclerosing BCCs in medium- and high-risk areas was observed only in 1.20%. Previously published articles have reported a cure rate of more than 95% for BCC treated with CE when it is performed by experts and suitable selection criteria are applied.4 In summary, our experience is that CE can be a very effective and inexpensive technique for treating BCC, not only on low-risk areas but also on medium- and high-risk areas if: a) it is performed by experts; and b) suitable selection is performed (primary, nonfibrosing BCC with the diameters stated above). As with any other procedure, proper training is a crucial factor in its effectiveness and should always be borne in mind in the comparison of results between different techniques.