A Cochrane review included 27 studies. Only one RCT (n=347) of surgery versus radiotherapy had primary outcome data at four years, showing significantly more persistent tumours and recurrences in the radiotherapy group as compared to the surgery group (RR 0.09, 95% CI 0.01 to 0.69). One study found no significant difference for recurrence at 30 months when Moh's micrographic surgery was compared to surgery for high risk facial BCCs (RR 0.64, 95% CI 0.16 to 2.64). One study of methylaminolevulinate photodynamic therapy (MAL PDT) versus cryotherapy found no significant difference in recurrences in the MAL PDT group when compared to cryotherapy at one year (RR 0.50, 95% CI 0.22 to 1.12). Cryotherapy showed no significant difference in recurrences at one year when compared to surgery on one study (n=96). When radiotherapy was compared to cryotherapy there were significantly fewer recurrences at one year in the radiotherapy group (RR 0.11, 95% CI 0.03 to 0.43; 1 trial, n=93). No data were available for recurrence at three to five years or early treatment failure within six months. Short-term studies suggest a success rate of 87 to 88% for imiquimod in the treatment of superficial BCC using a once-daily regimen for 6 weeks and a 76% treatment response when treating nodular BCC for 12 weeks, when measured histologically.
A systematic review including 18 patient series with a total of 9 930 subjects was abstracted in DARE. The authors state that the real recurrence rate will be somewhere between the estimated weighted strict and raw recurrence rates.
The authors conclude that Mohs micrographic surgery should be used mainly for larger, morphea-type basal cell carcinomas located in danger zones.