Introduction: Superficial basal cell carcinomas (BCCs) may be treated using electrodesiccation and curettage (EDC) but aesthetically unpleasing scars can be a major disadvantage of this procedure. A hydroquinone/tretinoin-based skin health system is known to improve overall skin quality. In the treatment of photodamage, the system has been shown to significantly improve hyperpigmentation, tactile roughness, sallowness, laxity, wrinkling, and skin clarity. Tretinoin is also known to improve scar cosmesis. We sought to evaluate if scar cosmesis post-EDC can be improved through the use of the hydroquinone/tretinoin-based system before and after EDC.
Methods: Patients were eligible for enrollment if they had 1-3 biopsy-proven superficial BCCs on the trunk, each with a diameter of > 0.5 cm and < 2.5 cm. The patients were randomly assigned (1:1) to twice-daily treatment with either the hydroquinone/tretinoin-based system or standard treatment with a cleanser and healing ointment—with each regimen to be used for 3 weeks before and after EDC. (Post-EDC therapy began once each lesion reached ≥ 75% re-epithelialization.) A modified version of the validated Beausang scale was used to evaluate indices of scar cosmesis.
Results: Overall, 51 patients (with 59 lesions) enrolled in the study and 49 (96%) completed. Both patients who discontinued had received standard treatment and the discontinuations were due to malaise and voluntary withdrawal. At the end of the study, treatment success (i.e. an excellent or good wound appearance) according the investigator global assessments was reported in 72% of lesions receiving the hydroquinone/tretinoin system and 63% of lesions receiving standard treatment. Six masked expert graders reviewed the photos after the end of the study and they reported the mean incidence of treatment success to be 61% in lesions receiving the hydroquinone/tretinoin system and 29% in lesions receiving standard treatment. Overall, the proportion of lesions they reported as having achieved treatment success was significantly greater with the hydroquinone/tretinoin system than with standard treatment (P=.020). Both treatment regimens were similarly well tolerated.
Conclusions: The photographic assessments show that use of the hydroquinone/tretinoin skin care system adjunctively with EDC resulted in superior aesthetic results post-procedure compared with standard treatment.