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J Invest Dermatol. 2017 Mar;137(3):614-619. doi: 10.1016/j.jid.2016.10.019. Epub 2016 Dec 5.

Surgery Versus 5% Imiquimod for Nodular and Superficial Basal Cell Carcinoma: 5-Year Results of the SINS Randomized Controlled Trial.

Author information

1
Centre for Evidence Based Dermatology, University of Nottingham, Nottingham, UK. Electronic address: Hywel.williams@nottingham.ac.uk.
2
Centre for Evidence Based Dermatology, University of Nottingham, Nottingham, UK; School of Health Sciences University of Nottingham, Nottingham, UK.
3
Centre for Evidence Based Dermatology, University of Nottingham, Nottingham, UK; NIHR Nottingham Hearing Biomedical Research Unit, University of Nottingham, Nottingham, UK.
4
School of Medicine, University of Nottingham, Nottingham, UK.
5
Department of Dermatology, Chesterfield Royal Hospital NHS Foundation Trust, Chesterfield, UK.
6
Department of Dermatology, Nottingham University Hospitals NHS Trust, Nottingham, UK.

Abstract

We previously reported modest clinical 3-year benefit for topical imiquimod compared with surgery for superficial or nodular basal cell carcinoma at low-risk sites in our noninferiority randomized controlled SINS trial. Here we report 5-year data. Participants were randomized to imiquimod 5% cream once daily (superficial basal cell carcinoma, 6 weeks; nodular basal cell carcinoma, 12 weeks) or excisional surgery (4-mm margin). The primary outcome was clinical absence of initial failure or signs of recurrence at the 3-year dermatology review. Five-year success was defined as 3-year success plus absence of recurrences identified through hospital, histopathology, and general practitioner records. Of 501 participants randomized, 401 contributed to the modified intention-to-treat analyses at year 3 (primary outcome), 383 (96%) of whom had data at year 5. Five-year success rates for imiquimod were 82.5% (170/206) compared with 97.7% (173/177) for surgery (relative risk of imiquimod success = 0.84, 95% confidence interval = 0.77-0.91, P < 0.001). These were comparable to year 3 success rates of 83.6% (178/213) and 98.4% (185/188) for imiquimod and surgery, respectively. Most imiquimod treatment failures occurred in year 1. Although surgery is clearly superior to imiquimod, this study shows sustained benefit for lesions that respond early to topical imiquimod.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT00066872.

Comment in

PMID:
27932240
DOI:
10.1016/j.jid.2016.10.019
[Indexed for MEDLINE]
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