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Carcinoma, Basal CellB-OSSNCT02285790

One-stop-shop Study for Treatment of Basal Cell Carcinoma Using Reflectance Confocal Microscopy

A study testing Reflectance confocal microscopy, Punch biopsy and Surgical excision in people with Carcinoma, Basal Cell, run by Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA) at 2 sites in Netherlands.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The purpose of this study is to assess the efficacy and safety of the one-stop-shop concept, using real-time in vivo reflectance confocal microscopy as diagnostic tool, prior to surgical management of new primary basal cell carcinoma Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Carcinoma, Basal Cell
What is being tested?
Reflectance confocal microscopy, Punch biopsy and Surgical excision
Could I receive a placebo?
No, everyone receives an active treatment
How many people
100 participants
Where
2 sitesNetherlands
Study dates
Jan 2015to Apr 2016
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 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patients with clinically suspected new primary BCC as assessed by an experienced board certified dermatologist
  • Patients seen at the outpatient clinic before 12h00 AM will be eligible to participate
  • Patient is willing and able to give written informed consent
  • BCC lesion is suitable for conventional surgical excision under local anesthetics
  • BCC lesion is present since at least 1 month

Who cannot join

  • BCC lesion in a high-risk location of the face (H-zone and ears)
  • Contra-indication for conventional surgical excision (primary surgical closure seems not achievable)
  • Recurrent BCC lesion (BCC that has been previously unsuccessfully treated) Macroscopic ulcerating BCC lesions (not feasible for RCM analysis due to technical reasons)
  • Patients with basal cell nevus syndrome
  • Patients treated with hedgehog inhibitor medication
  • Patients with a history of hypersensitivity to and/ or a history of allergy to local anesthesia
  • Unavailability within the following 6 weeks (for example due to holiday or sports)
  • Patients not competent to understand the procedures involved

Trial locations and contacts

2 sites in 1 country.

Netherlands2 sites
  • Dutch Cancer Institute

    Amsterdam, North Holland, 1066CX

  • Academic_Medical_Center

    Amsterdam, North Holland, 1105AZ

Other trials in Netherlands

About this study

Official title: Treatment of Basal Cell Carcinoma Using a One-stop-shop With Reflectance Confocal Microscopy: a Randomized Controlled Multicenter Trial

The purpose of this study is to assess the efficacy and safety of the one-stop-shop concept, using real-time in vivo reflectance confocal microscopy as diagnostic tool, prior to surgical management of new primary basal cell carcinoma

Read the detailed description

Basal cell carcinoma (BCC) is the most common cancer diagnosed in white populations worldwide. The rising incidence of BCCs is becoming a major worldwide public health problem (1,11). Between 1973 and 2009, the European standardized rate quadrupled from 40 to 165 per 100,000 person-years for men and from 34 to 157 for women, most probably as a result of more intensive UV exposure (12). This is supported by previous published epidemiological literature indicating that ultraviolet radiation is an important risk factor for BCC with a significant increase among outdoor workers (13,14). Despite the low mortality from BCC, multiple and recurring tumors confer a high morbidity and considerable burden for health care providers and health budgets. Although BCC does not seem to have a high effect on patients' quality of life, patients suffering from BCC are definitely interested in efficacy, low recurrence rates and cosmetic outcome of their therapies.(15). Meanwhile resources available at hospitals have not increased proportionally and therefore optimizing effectiveness of present treatment modalities in daily dermatologic practice is mandatory (16).

Clinically, BCC are characterized by small, translucent, or pearly papules, with raised teleangiectatic edges (17) . Most of the BCC occur in sun-exposed skin of the head and neck area (18,19). Sensitivity and positive predictive value for the clinical diagnosing of BCC by dermatologists has been reported to be 95.4% and 85.9%, respectively (20). However, dividing between BCC subtypes is not always possible upon clinical assessment. To date, histological analysis of punch biopsy remains the golden standard to confirm the clinical diagnosis of BCCs and dividing between the following subtypes: nodular (nBCC), micronodular (mnBCC), infiltrating (iBCC) and superficial (sBCC) (10). Of those, nBCC and sBCC have a less aggressive growth pattern in comparison to mnBCC and iBCC. Additionally, mixed type BCC (mtBCC) can be defined as a combination of subtypes and are frequently composed of aggressive subtypes (21). Surgical excision remains the standard of treatment, with Mohs micrographic surgery typically utilized for high-risk lesions (22). Based upon the histological growth pattern, BCC are surgically removed with a margin of either 3mm (nBCC and sBCC) or 5mm (mnBCC, iBCC) in accordance with current Dutch guidelines (10).

Due to the rising incidence of BCC there is a need for more efficient, non-invasive methods to diagnose BCCs. The use of real-time in vivo reflectance confocal microscopy (RCM) to diagnose BCCs has proven successful to address this need. Various studies have demonstrated that RCM is safe and accurate (sensitivity and specificity) to diagnose BCCs(2-6). Reported sensitivity and specificity for RCM in diagnosing BCC range from 83%-100% and 79%-97%, respectively (7). Furthermore, Peppelman et al. and Longo et al. recently reported on RCM features that might divide between nodular, micronodular, superficial and infiltrative subtypes of BCC (8,9).

In 2012, van der Geer et al reported on the feasibility of a one-stop-shop (OSS) concept for the treatment of skin cancer patients (23). One-stop-shop implies that at the day of the initial outpatient clinic consultation, diagnosis and treatment plan both take place. In their study, pre-operative frozen section histology was used to confirm BCC diagnosis and subtype. The mean throughput time was 4 hours and 7 min, no complications were observed, and patient satisfaction was high (23). Incorporating RCM as non-invasive diagnostic tool in a BCC OSS concept for lesions suitable for conventional surgical excision might further reduce time between clinical diagnosis and treatment, administrative workload and costs.

The aim of our study is to assess the efficacy and safety of the one-stop-shop concept, using real-time in vivo reflectance confocal microscopy (Vivascope 1500; Lucid Technologies, Henrietta, NY, USA) as diagnostic tool, prior to surgical management of new primary BCCs, of all subtypes, in the general population.

Being tested
Reflectance confocal microscopy, Punch biopsy, Surgical excision
Medical subject headings
Carcinoma, Basal Cell

What participants receive

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

  • Reflectance confocal microscopyDevice

    Also called Confocal microscopy, Vivascope 1500

  • Punch biopsyProcedure or surgery

    Also called Biopsy

  • Surgical excisionProcedure or surgery

    Also called Surgical removal, Surgery

    Excision of the suspected basal cell carcinoma lesion under local anesthetics

Study groups in NCT02285790
Study groupRoleWhat they receive
RCM-OSS procedureExperimentalThe Vivascope 1500 will be used (CE certified, Lucid Technologies, Henrietta, NY, USA). Reflectance confocal microscopy (RCM) imaging will be performed for intended use only and interpreted on the Vivascope workstation by two investigators independently at both study locations. The investigators will be blinded to the results of the reference standard. After RCM imaging subjects will receive OSS surgical excision according to subtype. Clinically suspected primary BCCs that are not confirmed by RCM will also receive surgical treatment with a margin of 3mm.
Receives: Device: Reflectance confocal microscopy; Procedure: Surgical excision
Standard of care procedureActive comparatorClinical suspected primary BCCs, of all subtypes, will be diagnosed by conventional 3mm punch biopsy of the most elevated part of the lesion. Punch biopsies will be performed under local anesthetics using 1% xylocaine/adrenaline. HE stained sections of the punch biopsies will be evaluated by an experienced board certified pathologist. Subjects will receive surgical excision according to subtype within 6 weeks after punch biopsy has been performed. Clinically suspected new primary BCCs that are not confirmed by punch biopsy will also receive surgical treatment with a margin of 3mm.
Receives: Procedure: Punch biopsy; Procedure: Surgical excision

What is being measured

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

  1. Comparison between one stop shop using reflectance confocal microscopy in the surgical treatment of BCC and current standard of care using punch biopsy, by assessing incomplete surgical excision on the final pathology report.

    Assessment will be performed by an experienced board certified pathologist. The number of incomplete excisions will be compared between study- and control group.

    Measured: Within the first week after surgical excision of suspected BCC lesion

Secondary outcomes (2)
  1. Comparison of the diagnostic accuracy (sensitivity and specificity) between RCM and punch biopsy in both diagnosing and subtyping BCCs

    Sensitivity and specificity of RCM for diagnosing and subtyping BCC, will be separately analyzed by comparing RCM diagnosis and subtype with final pathology reports of the study group. This will be performed by using unidentifiable saved RCM images of all included lesions of the study group.

    Measured: Within the first week after surgical excision of suspected BCC lesion

  2. Comparison of patient satisfaction between study group and standard of care (control) group by using a standardized web-based questionnaire for patient reported outcome in the management of skin diseases (www.huidvragen.info)

    An adjusted version of this web-based questionnaire has previously been published to assess patient satisfaction among patients suffering from psoriasis (van Cranenburgh OD et al. Satisfaction with treatment among patients with psoriasis: a web-based survey study. Br J Dermatol. 2013 Aug;169(2):398-405). The outcome of the questionnaire will be compared between study- and control group.

    Measured: As assessed at the post-operative visit 3 months after surgical excision

Timeline

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

  1. First posted7 Nov 2014 (estimated)
  2. Study startJan 2015
  3. Primary completionOct 2015
  4. Study completionApr 2016

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
100 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02285790
Sponsor's protocol ID
B-OSS 2014_244
Acronym
B-OSS
Status last verified
Apr 2016
First submitted
1 Nov 2014
Last updated
13 Apr 2016
Results posted
No
Data monitoring committee
No

Publications

  • Lomas A, Leonardi-Bee J, Bath-Hextall F. A systematic review of worldwide incidence of nonmelanoma skin cancer. Br J Dermatol. 2012 May;166(5):1069-80. doi: 10.1111/j.1365-2133.2012.10830.x.

    PubMed 22251204
  • Sauermann K, Gambichler T, Wilmert M, Rotterdam S, Stucker M, Altmeyer P, Hoffmann K. Investigation of basal cell carcinoma [correction of carcionoma] by confocal laser scanning microscopy in vivo. Skin Res Technol. 2002 Aug;8(3):141-7. doi: 10.1034/j.1600-0846.2002.20345.x.

    PubMed 12236882
  • Gonzalez S, Tannous Z. Real-time, in vivo confocal reflectance microscopy of basal cell carcinoma. J Am Acad Dermatol. 2002 Dec;47(6):869-74. doi: 10.1067/mjd.2002.124690.

    PubMed 12451371
  • van der Geer S, Reijers HA, van Tuijl HF, de Vries H, Krekels GA. Need for a new skin cancer management strategy. Arch Dermatol. 2010 Mar;146(3):332-6. doi: 10.1001/archdermatol.2010.1.

    PubMed 20231509
  • van der Geer S, Frunt M, Romero HL, Dellaert NP, Jansen-Vullers MH, Demeyere TB, Neumann HA, Krekels GA. One-stop-shop treatment for basal cell carcinoma, part of a new disease management strategy. J Eur Acad Dermatol Venereol. 2012 Sep;26(9):1154-7. doi: 10.1111/j.1468-3083.2011.04184.x. Epub 2011 Jul 19.

    PubMed 21771105
  • van Cranenburgh OD, de Korte J, Sprangers MA, de Rie MA, Smets EM. Satisfaction with treatment among patients with psoriasis: a web-based survey study. Br J Dermatol. 2013 Aug;169(2):398-405. doi: 10.1111/bjd.12372.

    PubMed 23565643
  • Kadouch DJ, Wolkerstorfer A, Elshot Y, Zupan-Kajcovski B, Crijns MB, Starink MV, Bekkenk MW, van der Wal AC, Spuls PI, de Rie MA. Treatment of Basal Cell Carcinoma Using a One-Stop-Shop With Reflectance Confocal Microscopy: Study Design and Protocol of a Randomized Controlled Multicenter Trial. JMIR Res Protoc. 2015 Sep 10;4(3):e109. doi: 10.2196/resprot.4303.

    PubMed 26362616

Questions about this trial

What is this clinical trial studying?

A study testing Reflectance confocal microscopy, Punch biopsy and Surgical excision in people with Carcinoma, Basal Cell, run by Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA) at 2 sites in Netherlands.

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 5 inclusion and 8 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: finished, as of the sponsor's last update on 13 Apr 2016. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in Netherlands. 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?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

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?

Comparison between one stop shop using reflectance confocal microscopy in the surgical treatment of BCC and current standard of care using punch biopsy, by assessing incomplete surgical excision on the final pathology report. (time frame: Within the first week after surgical excision of suspected BCC lesion). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02285790, which also lists 7 linked publications.

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 13 Apr 2016.

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