{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T11:04:23Z","timestamp":1793963063587,"version":"4.8.0"},"reference-count":12,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Dermatol"],"published-print":{"date-parts":[[2025,3,1]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Interest in noninvasive treatment of basal cell carcinoma (BCC) has been increasing. For superficial BCC, it has been demonstrated that imiquimod cream, 5%, has high long-term efficacy, but for nodular BCC (nBCC), long-term evidence is sparse.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To evaluate whether superficial curettage (SC) followed by imiquimod cream, 5%, is noninferior to surgical excision (SE) in nBCC after 5 years of treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>In this secondary analysis of the noninferiority Surgery Versus Combined Treatment With Curettage and Imiquimod for Nodular Basal Cell Carcinoma (SCIN) randomized clinical trial, patients with a primary nBCC of 4 to 20 mm were assigned to either SC plus imiquimod, 5%, or SE between January 1, 2016, to November 30, 2017, at 2 outpatient dermatology departments in the Netherlands. The primary outcome of the SCIN trial was the 1-year probability of remaining free from treatment failure; the prespecified secondary trial outcomes were the probability after 5 years of follow-up, completed September 7, 2022. Both an intention-to-treat analysis and per-protocol analysis were planned.<\/jats:p><\/jats:sec><jats:sec><jats:title>Intervention<\/jats:title><jats:p>SC plus imiquimod vs SE.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>The 5-year probability of remaining free from treatment failure (ie, freedom from recurrence; with 95% CI) was estimated with Kaplan-Meier analysis using data on treatment response from 3 planned follow-up visits at 3 months and 1 and 5 years after the end-of-treatment date. Additional analyses accounting for death as competing risk were also performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 145 patients (77 [53.1%] male; median age, 68 [IQR, 31-89] years) with a primary, histologically proven nBCC were randomized to treatment with SC plus imiquimod (n\u2009=\u200973) or SE (n\u2009=\u200972). In total, 15 treatment failures occurred in the SC plus imiquimod group (5 treatment failures occurred between 1 and 5 years after treatment) and 1 in the SE group. The 5-year probability of remaining free from treatment failure was 77.8% (95% CI, 65.7%-86.0%) after SC plus imiquimod and 98.2% (95% CI, 88.0%-99.8%) after SE. The relative risk of treatment failure was 15.93 (95% CI, 2.10-120.64). The 95% CI does not exclude the noninferiority margin of 5.22. Death due to causes unrelated to BCC occurred in 20 patients, and the subhazard ratio from competing risk regression was 16.16 (95% CI, 2.18-119.72).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This secondary analysis of a randomized clinical trial found that although it cannot be concluded that SC plus imiquimod is noninferior to SE, SC plus imiquimod was substantially less effective at 5 years after treatment. Most treatment failures occurred in the first year after treatment, and the probability of tumor-free survival 5 years after treatment with SC plus imiquimod was still 77.8%. The information in this trial can be used to counsel patients on the relative benefits and trade-offs of the different treatment options for nBCC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial Registration<\/jats:title><jats:p>ClinicialTrials.gov Identifier: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/study\/NCT02242929\">NCT02242929<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jamadermatol.2024.5572","type":"journal-article","created":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T17:41:28Z","timestamp":1738172488000},"page":"299","source":"Crossref","is-referenced-by-count":2,"title":["Imiquimod Cream Preceded by Superficial Curettage vs Surgical Excision for Nodular Basal Cell Carcinoma"],"prefix":"10.1001","volume":"161","author":[{"given":"Babette J. A.","family":"Verkouteren","sequence":"first","affiliation":[{"name":"Department of Dermatology, Maastricht University Medical Centre, Maastricht, the Netherlands"},{"name":"GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patty J.","family":"Nelemans","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Maastricht University Medical Centre, Maastricht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly A. E.","family":"Sinx","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Maastricht University Medical Centre, Maastricht, the Netherlands"},{"name":"GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole W. J.","family":"Kelleners-Smeets","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Maastricht University Medical Centre, Maastricht, the Netherlands"},{"name":"GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V\u00e9ronique J. L.","family":"Winnepenninckx","sequence":"additional","affiliation":[{"name":"Department of Pathology, Maastricht University Medical Centre, Maastricht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aim\u00e9e H. M. M.","family":"Arits","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Catherina Hospital, Eindhoven, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klara","family":"Mosterd","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Maastricht University Medical Centre, Maastricht, the Netherlands"},{"name":"GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"4","key":"doi240067r1","doi-asserted-by":"publisher","first-page":"913","DOI":"10.1038\/jid.2012.431","article-title":"Trends in basal cell carcinoma incidence rates: a 37-year Dutch observational study.","volume":"133","author":"Flohil","year":"2013","journal-title":"J Invest 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