Surgery may be the most effective treatment for patients with dermatomyositis squamous cell carcinoma (cSCC) in situ compared with other available treatment options, according to study results published in Journal of the European Academy of Dermatology & Venereology.
The finding comes from a systematic review and meta-analysis of the effectiveness of different interventions for cSCC in situ, also known as Bowen’s disease.
Investigators searched Medline, Embase and the Cochrane Library’s CENTRAL databases to identify relevant studies up to 12 June 2024. Outcome data on lesion clearance rate (LCR), participant clearance rate (PCR), lesion recurrence rate (LRR) and participant recurrence rate (PRR) were extracted and summarized.
A random-effects meta-analysis of proportions was conducted for each outcome with a generalized linear mixed model. The analysis included 71 studies.
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[C]Clinicians must carefully consider individual needs, patient characteristics, lesion locations, patient preferences, and any comorbidities when selecting the appropriate treatment.
The pooled LCR from 27 good-quality study arms was 0.78 (95% CI, 0.71-0.84; I2 =86%). The highest LCR of 0.97 (95% CI, 0.90-0.99) occurred in patients treated with surgery, followed by those treated with CO2 laser + dermabrasion + 5-fluorouracil (5-FU) combination therapy 5% (0.97; 95% CI, 0.82-1.0). When all studies were included in the analysis, the highest LCR occurred with surgery (0.98; 95% CI, 0.90-1.0; I2 =88%), followed by CO2 laser + dermabrasion + 5-FU 5% combination therapy (0.97; 95% CI, 0.82-1.0).
For PCR in 13 good-quality study arms, the pooled rate was 0.72 (95% CI, 0.50-0.87; I2 =85%). The highest PCR was for surgery (0.97, 95% CI, 0.90–0.99), followed by CO2 laser + dermabrasion + 5-FU 5% combination therapy (0.97; 95% CI, 0.82-1.0). When all studies were included, surgery was the most favorable treatment (1.0; 95% CI, 0.95-1.0; I2 =66%), with the worst PCR occurring for placebo (0.06; 95% CI, 0.00-0.46; I2 =46%).
For LRR, 21 good-quality study arms yielded a pooled rate of 0.13 (95% CI, 0.09-0.17; I2 =58%). The lowest LRR was 0.04 (95% CI, 0.00-0.18) for CO2 laser + dermabrasion + 5% 5-FU combination therapy, followed by 0.07 (95% CI, 0.03-0.16; I2 =0%) for photodynamic laser therapy + methyl aminolevulinate (PDT). Based on all studies, surgery was the superior treatment modality for LRR (0.04; 95% CI, 0.02-0.07; I2 =49%).
Regarding PRR, 5-aminolevulinic acid PDT was associated with the lowest PRR (0.00; 95% CI, 0.00-0.13) in all studies. Only PRR in patients undergoing surgery was significantly different compared to cryotherapy (P <.001).
The researchers noted that data on PRR are limited and that there is a general lack of high-quality data on the treatment of cSCC in situ. These classifications should be interpreted with caution due to overlapping confidence intervals, different sample sizes, and high heterogeneity. Also, the analysis did not include assessment of adverse events, and the single-arm design prevents direct comparison of treatments.
“[C]”Physicians should carefully consider individual needs, patient characteristics, lesion locations, patient preferences, and any comorbidities when choosing the appropriate treatment,” the researchers said.
Disclosure: Some of the study authors declared affiliations with biotechnology, pharmaceutical, and/or device companies. See the original report for a complete list of the authors’ disclosures.
