Methods of search

The following databases were searched:

• Medline from 1966

• Embase from 1980

• BIDS ISI (Science Citation Index from 1981)

• The Cochrane Skin Group Trials Register

• The Cochrane Library, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials

• Mega Register of Controlled Trials on the Current Controlled Trials website and the National Research Register's MRC Clinical Trials Directory.

The search strategy used to locate RCTs included the search terms 1-29, as given in the Cochrane Handbook,22 Appendix 5c.2.

Search terms included: BCC, Basal cell carcinoma, basal cell cancer, nodular BCC, naevoid BCC, Gorlin syndrome, rodent ulcer, Jacob's ulcer, basal cell epithelioma, basalioma, non-melanoma skin cancer which include squamous cell carcinoma and BCC, NMSC.

Pharmaceutical companies were contacted where appropriate for reviews or unpublished trials.

QUESTIONS

What are the effective therapeutic interventions for BCC of the skin? How do the therapeutic interventions for BCC compare with each other? How do the cosmetic outcomes for these interventions compare? Are these interventions cost-effective?

The first-line treatment of BCC is often surgical excision. Numerous alternatives are available and include: curettage, cryosurgery, laser, excision with predetermined margins, excision under frozen section control, Mohs' micrographic surgery (the use of horizontal frozen sections and mapping to determine tumour clearance), radiotherapy, topical therapy, intralesional therapy, PDT (the application of a cream to induce photodamage to the tumour using various light sources), immunomodulators (agents used to stimulate the immune system and work on eradicating the tumour) and chemotherapy. Surgical treatment requires access to a minor operating theatre and most other treatments are carried out in specialist centres. Although there is wide variety in the treatment modalities used in the management of BCC, and the vast majority of the tumours are probably treated successfully, little research is available which accurately compares these different treatment modalities.

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