A retrospective study has been undertaken of all head and neck basal cell cancers treated at the Royal Free Hospital between 1976 and 1980 inclusive. Four methods of treatment were used during the period: simple excision with primary closure (n = 43), skin grafting or trans-position flap (n = 19), radiotherapy (n = 99), and cryosurgical ablation (n = 34). The methods were compared by observing the immediate results, the subsequent tumour recurrence rate and the length of follow-up. Statistical comparison of tumour recurrence rate showed no significant difference between treatment groups. Radiotherapy had the lowest recurrence rate (2%), but required an average of 9 out-patient treatment attendances. Excision with primary closure carried the highest recurrence rate (9.3%), whilst excision with defect closure by flap or graft, which needed a mean in-patient stay of 8.2 days, and cryosurgical treatment had similar recurrence rates of 5 to 6%. Comparing the modes of treatment, cryosurgery was quickest to perform, required no hospitalization and less than 2 out-patient treatment sessions per patient and gave the best cosmetic result. It appears to be a safe technique for treating basal cell cancers and may prove to be the most cost effective method.
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