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Carcinoma, Basal CellNCT00515970

Curettage Versus Excision in Nodular and Superficial Basal Cell Carcinomas

A study testing Curettage, Deep excision and Shave excision in people with Carcinoma, Basal Cell, run by University Hospital Tuebingen at 1 site in Germany.

Suspended

Paused. Enrolment is on hold for now and may resume.

Official record
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Trial summary

Basal cell carcinoma (BCC) is the most frequent skin cancer. Uncontrolled growth destroys local anatomic structures. There are various treatment alternatives with different recurrence rates and expenses. After surgical excision, the recurrence rate is in between 3 and 4% and the procedure is relatively expensive. Read more about this study

Who is it for?
Any age
Conditions the study is for
Carcinoma, Basal Cell
What is being tested?
Curettage, Deep excision and Shave excision
Could I receive a placebo?
No, everyone receives an active treatment
How many people
400 participants
Where
1 siteGermany
Study dates
Dec 2007to Dec 2014
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages Any age
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • Clinical or histologic diagnosis of BCC
  • Patient Dependent Exclusion Criteria:
  • > 5 BCCs at presentation
  • Immunosuppressive drugs
  • Pregnancy
  • Disability to give informed consent
Show all 19Show fewer
  • Synchronous participation in other studies
  • Progeroid syndromes
  • Other malignant tumors, except for BCC and squamous cell carcinoma, or monoclonal neoplasms of the hematopoietic or immune system
  • Critical illness precluding sufficient follow-up visits
  • Tumor Exclusion Criteria:
  • Recurrent BCC
  • Nodular BCC with an exophytic part of > 1.5 mm above skin level
  • Nodular BCC with a diameter of > 10 mm
  • Superficial BCC with a diameter of > 20 mm
  • Ulceration
  • Scarring
  • Blurred margins
  • Histopathologic evidence of a tumor type different from nodular or superficial BCC

Who cannot join

None listed.

Trial locations and contacts

1 site in 1 country.

Germany1 site
  • Department of Dermatology, Eberhard Karls University

    Tübingen, Baden-Wurttemberg, 72076

Other trials in Germany

About this study

Official title: Prospective Randomized Trial: Curettage Versus Excision in Nodular and Superficial Basal Cell Carcinomas

Basal cell carcinoma (BCC) is the most frequent skin cancer. Uncontrolled growth destroys local anatomic structures. There are various treatment alternatives with different recurrence rates and expenses. After surgical excision, the recurrence rate is in between 3 and 4% and the procedure is relatively expensive. Photodynamic therapy as well as imiquimod 5% are expensive therapies with high recurrence rates, that lack histologic evidence of BCC. Cryosurgery and curettage are inexpensive, although the recurrence rates are higher than after surgical excision.

This prospective, randomized trial compares recurrence rates, cosmetic outcome, and surgery-related complications after curettage versus surgical excision in nodular and superficial BCC. About 600 tumors will be included. One half is treated by curettage, the other half by surgical excision. The follow-up period is four years. If the difference between recurrence rates is ≤7% and the cosmetic outcome as well as the surgery-related complications are not worse after curettage, surgical excision must be considered an overtreatment.

Read the detailed description
  1. First presentation of a patient with clinical or histopathological diagnosis of BCC
  2. Study patient number, first and surname, date of birth and gender are listed in a distinct file.
  3. Informed consent
  4. Whole body screening for skin cancer
  5. In- or exclusion of the patient. If the patient is excluded, no more data are obtained.
  6. Recording of the following features in an electronic file:
  7. Number of BCCs
  8. Anatomic location
  • Lip
  • Eyelid
  • Ear
  • Nose
  • Other parts of the face
  • Scalp or neck
  • Trunk
  • Arm, hand, or shoulder
  • Leg, foot, or hip
  1. Position
  • Ventral or dorsal. If the tumor is located at the lateral margin of ventral and dorsal, it is considered ventral.
  • Right, left, midline
  • Distinct BCCs are numbered. To ensure future distinction of different tumors, numbering starts with the most up-right-ventral tumor and ends with the most down-left-dorsal one. Numbering continues with BCCs that appear later during the period of recruitment.
  1. Diameter in mm
  2. In- or exclusion of the tumor
  3. Photographs of the included BCCs
  4. Randomization is performed by the Department of Biostatistics (distance to the Department of Dermatology = 1.7 km) with envelopes containing the assigned study arm. The study physician calls one of four staff members of the Department of Biostatistics and asks for randomization. The envelopes are not opened unless the electronic data file is completed by the study physician.
  5. Disinfection
  6. Local anesthesia
  7. Surgery
  8. Dressing
  9. If histopathology discovers another BCC type than nodular or superficial or even another tumor than BCC, then the tumor is excluded.
  10. Follow-up visit 3 and 6 months (+/- 30 days) after the operation. In BCCs that had to be operated in >1 step, the day of the follow-up visit refers to the initial operation.
  11. In case of clinical suspicion of recurrence of BCC a punch biopsy is taken. If the biopsy confirms recurrence, the endpoint is achieved.
  12. If BCCs must be added to a patient during the recruitment period, follow-up visits always refer to the latest BCC.
  13. If the patient visits our department not within the defined follow-up period, the appointment is not recorded (except confirmation of recurrence).
  14. Patients who provide no feedback receive phone calls.
  15. If a patient or a private practitioner suspect a recurrence of BCC beyond a defined follow-up period, of course, the patient is invited as early as possible to our department, where a biopsy will be taken.
  16. The patient receives a letter containing a list of the BCCs treated within the study. The private practitioner is to be visited with the list after 12, 24, and 36 months (+/- 30 days) referring to the last operation within the recruitment period. The letter contains a questionnaire about scar size and suspicion of recurrence of BCC. The practitioner or the patient return the questionnaire with the answers to our department. If recurrence is suspected we take a biopsy.
  17. When follow-up is closed for an individual patient, the reason is recorded:
  18. Planned end of follow-up after 48 months.
  19. Patient has moved.
  20. Death (date of death).
  21. Consent withdrawn.
  22. Patient has become meanwhile so ill or high-maintenance that no more follow-up visits can be planned.
  23. Recurrence of all of the patient's BCCs.
  24. Statistic evaluation is based on an intention-to-treat-analysis.
  25. The trial is designed to prove the equivalence of treatment modalities. A statistic test is used for evaluation, including the Kaplan-Meier-method. When all 4 study arms contain 116 BCCs, a 2-group-test on the equivalence of ratios with a 1-sided significance level of 0.05 will have a power of 80% to disprove the null hypothesis. The null hypothesis is that standard and test method are not equivalent (ratio difference delta T - delta S ≥ 0.15). Then the alternative hypothesis is more probable, meaning that the ratios in both groups are equivalent supposed that the expected ratio difference is 0.07 and the ratio within the standard group is 0.03 (according to an expected recurrence rate of 3% in the surgical excision study arm).
Being tested
Curettage, Deep excision, Shave excision
Keywords
Carcinoma, Basal Cell, Curettage, Excision, Recurrence, Complication, Esthetic outcome
Medical subject headings
Carcinoma, Basal Cell, Recurrence

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • CurettageProcedure or surgery

    Curettage without subcutaneous tissue using a 7 mm ring curette and the "fountain-pen technique" (http://www.biopsypunch.com/kuerettagetechnik.htm; accessed on March 13, 2008). The curette is held between the thumb, index and middle finger. This method of holding enables precise guiding of the instrument, so that the piece of tissue can be removed in one well-targeted incision. After macroscopically complete removal, a safety margin is removed with the curette. It is used for histology to distinguish between R0 (excision margin without tumor cells) and R1 resection (excision margin containing tumor cells). Preparation with paraffin. Parallel, vertical sections for histologic diagnosis. Hematoxylin-eosin staining. Measurement of tumor thickness in mm.

  • Deep excisionProcedure or surgery

    12 o'clock mark. Excision with a scalpel down to the subcutaneous level. Plastic reconstruction. Three vertical, parallel bread loaf sections for histology. Preparation with paraffin. Staining with hematoxylin-eosin. Histologic diagnosis including report of tumor thickness in mm. Comment on complete removal (R0 versus R1). In case of R1 excision directed reoperations are performed until R0 is achieved.

  • Shave excisionProcedure or surgery

    Shave excision with a safety margin, using a scalpel. Wound healing by secondary intention. Preparation with paraffin. Parallel vertical bread loaf sections for histology. Staining with hematoxylin-eosin. Histologic diagnosis. Comment on complete removal (R0 versus R1). In case of R1 excision a reoperation is performed until R0 is achieved.

  • CurettageProcedure or surgery

    Curettage with a 7 mm ring curette with the "potato-peeler technique" (http://www.biopsypunch.com/kuerettagetechnik.htm; accessed on March 13, 2008). The handle of the curette is held in the distal inter-digital fold of the index finger, and supported by the other fingers of the curetting hand. The thumbs serve to provide a stable base. This technique makes it possible to guide the instrument, applying greater pressure, but accuracy is reduced. After macroscopically complete removal, a safety margin is removed with the curette. It is used for histology to distinguish between R0 (excision margin without tumor cells) and R1 resection (excision margin containing tumor cells). Preparation with paraffin. Parallel, vertical sections for histologic diagnosis. Hematoxylin-eosin staining.

Study groups in NCT00515970
Study groupRoleWhat they receive
1ExperimentalClinical or histologic diagnosis of nodular BCC
Receives: Procedure: Curettage
2Active comparatorClinical or histologic diagnosis of nodular BCC
Receives: Procedure: Deep excision
3ExperimentalClinical or histologic diagnosis of superficial BCC
Receives: Procedure: Curettage
4Active comparatorClinical or histologic diagnosis of superficial BCC
Receives: Procedure: Shave excision

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Recurrence of BCC, confirmed by biopsy

    Measured: 4 years after surgery

Secondary outcomes (12)
  1. Secondary hemorrhage as remembered by the patient

    Measured: 3 months (plus or minus 30 days) after surgery

  2. Wound infection as remembered by the patient

    Measured: 3 months (plus or minus 30 days) after surgery

  3. Hypesthesia after surgery

    Measured: 3 months (plus or minus 30 days) after surgery

  4. Keloid

    Measured: 3 months (plus or minus 30 days) after surgery

  5. Functional impairment or disfigurement by the scar. Keloid is always a disfiguring scar. If the scar is recognized as keloid, the measure "disfigurement" cannot be used here.

    Measured: 3 months (plus or minus 30 days) after surgery

  6. Subjective assessment of the esthetic outcome of the scar on a scale of excellent, good, satisfying, moderate, unfavorable; done by the patient

    Measured: 3, 6, 12, 24, 36, and 48 months (plus or minus 30 days) after surgery

  7. Subjective assessment of the esthetic outcome of the scar on a scale of excellent, good, satisfying, moderate, unfavorable; done by the study physician

    Measured: 3, 6, 12, and 48 months (plus or minus 30 days) after surgery

  8. Subjective assessment of the esthetic outcome of the scar on a scale of excellent, good, satisfying, moderate, unfavorable; done by a private practitioner

    Measured: 12, 24, and 36 months (plus or minus 30 days) after surgery

  9. Scar length in mm

    Measured: 6 and 48 months (plus or minus 30 days) after surgery

  10. Scar width in mm, perpendicular to its length

    Measured: 6 and 48 months (plus or minus 30 days) after surgery

  11. Color of the scar: hyperpigmented, hypopigmented, or erythematous

    Measured: 6 and 48 months (plus or minus 30 days) after surgery

  12. Level of the scar: atrophic, skin level, hypertrophic, or keloid

    Measured: 6 and 48 months (plus or minus 30 days) after surgery

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted14 Aug 2007 (estimated)
  2. Study startDec 2007
  3. Primary completionDec 2014 (estimated)
  4. Study completionDec 2014 (estimated)

Why it stopped: Problems with the electronic data collection program

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
400 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00515970
Sponsor's protocol ID
E.03.26007.1
Status last verified
Jun 2010
First submitted
13 Aug 2007
Last updated
15 Jun 2010
Results posted
No
Data monitoring committee
Yes

Questions about this trial

What is this clinical trial studying?

A study testing Curettage, Deep excision and Shave excision in people with Carcinoma, Basal Cell, run by University Hospital Tuebingen at 1 site in Germany.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 19 inclusion and 0 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: paused, as of the sponsor's last update on 15 Jun 2010. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Germany. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Recurrence of BCC, confirmed by biopsy (time frame: 4 years after surgery). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 15 Jun 2010.

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