Mohs Versus Traditional Surgery - Basal-Cell Carcinomas (BCC) (BACHIMO)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00699829
Recruitment Status : Unknown
Verified February 2009 by Hospital Ambroise Paré Paris.
Recruitment status was:  Recruiting
First Posted : June 18, 2008
Last Update Posted : February 16, 2009
Information provided by:
Hospital Ambroise Paré Paris

Brief Summary:

Mohs' micrographic surgery (MMS) is a treatment of choice for high recurrence risk basal-cell carcinomas (BCC). Realized under local anaesthesia, it induces very low recurrence rates and spares unnecessary excision of intact surrounding tissues, thus decreasing the needs for flaps, skin grafts, and allows immediate reconstruction…. Its disadvantages are mainly: need for a significant training of the operator, the pathologist and the non-medical personnel; longer duration of the procedure, with higher a priori costs, and constraints for the patient related to the duration of the intervention. Traditional surgical excision with immediate or differed reconstruction is the technique of reference. Provided that re-excisions are performed as long as previous ones do not guarantee free margins, it gives good results. Its real costs are poorly known and can be enhanced by several considerations: multiplicity of the operational acts if the initial excision is insufficient, more complex reconstruction procedures, duration of post-operative dressings, ….

The investigators' objective is to know the costs of the surgical treatment of the high risk CBC, comparing the CMM with the surgical excision with immediate or differed reconstruction, along with its effectiveness defined by the absence of recurrence. by its impact on the quality of life of the patient. It is a prospective, multicentric, comparative, not randomized, open, cohort study, of the type "here and elsewhere". Patients with high-risk CBC, as defined by the French ANAES Guidelines (2004), will be included:

  • clinically morpheaform aspect or ill-limited margins, aggressive histological forms;
  • already recurred BCC (except for superficial BCCs));
  • nodular BCC located in the high-risk zone (nose, peri-orificial areas of the head) and with diameter larger than 1 cm.

The effectiveness will be measured by the rate of recurrence at 5 years (as measured by the prolongation of the follow-up after the surgical procedure). The utility from the patient point of view will be evaluated by a specific dermatologic quality of life questionnaire (Skindex) and by a generic questionnaire (Euroqol 5D), supplemented by a questionnaire of satisfaction of the care (Attkisson). The economic perspectives studied will be those of the hospital, of the payer and of the society. Direct medical costs will be evaluated by micro-costing. The main production factors implied in the realization of one CMM or one traditional surgery in dermatology/surgery and anatomopathology wards will be identified, counted, and developed. The measuring units will be the estimate of the time devoted to each individual procedure, reported to the total activity of each ward and the wages of the various categories of personnel implied, and the unit costs in consumable and redeemable material, reported to their utilisation factor. The hospital indirect costs will be estimated by the financial services of the hospitals. Accrual of 150 CMM and 300 traditional excisions will be performed within a two year period of time.

Condition or disease
Carcinoma, Basal Cell

Study Type : Observational
Estimated Enrollment : 450 participants
Observational Model: Cohort
Time Perspective: Prospective
Official Title: Comparative Medico-Economic Evaluation of Micrographic Mohs Surgery (MMS) and Traditional Surgical Excision With Immediate or Differed Reconstruction to Treat High Recurrence Risk Basal-Cell Carcinomas (BCC)
Study Start Date : June 2008

Mohs' micrographic surgery (MMS)
Conventional surgery

Primary Outcome Measures :
  1. Cost-utility ratio [ Time Frame: 2 years ]

Secondary Outcome Measures :
  1. 2 and 5 years survival [ Time Frame: 2 & 5 yrs ]

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Probability Sample
Study Population
Patients de services de dermatologie et/ou chir plastique

Inclusion Criteria:

  • Age ≥ 18
  • Histologically proved cutaneous BCC
  • Categorized as "bad prognostic" according to the 2004 recommendations of ANAES

    1. morpheaform or ill-limited clinical forms and histologically aggressive forms (morpheaform, micronodular, infiltrating, squamous differentiation) OR
    2. already recurred BCC (except for superficial BCCs) OR
    3. nodular BCCs from the high-risk zone (nose and peri-orificial areas of the head) and with diameter larger than 1 cm.
  • Life expectancy greater than 3 years according to the investigator's opinion.
  • Patient being informed and having signed the consent to participate to the study

Exclusion Criteria:

  • History of X-ray therapy in the territory of the BCC
  • Counter-indication to surgery
  • Life expectancy < 3 years
  • superficial BCCs, even if recurred
  • Patient being unable to attend future follow-up visits
  • Patient with severe cognitive impairment
  • Patient not affiliated to a social security regimen

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00699829

Contact: Pr Philippe SAIAG

Hôpital Ambroise Paré Recruiting
Boulogne, France, 92100
Contact: Philippe SAIAG    +33 1 49 09 56 73      
Sponsors and Collaborators
Hospital Ambroise Paré Paris
Principal Investigator: Philippe SAIAG Hospital Ambroise Paré Paris
Principal Investigator: Jean-Marie SERVANT Hôpital Saint Louis

Responsible Party: Département de la Recherche Clinique, AP-HP Identifier: NCT00699829     History of Changes
Other Study ID Numbers: P070158
First Posted: June 18, 2008    Key Record Dates
Last Update Posted: February 16, 2009
Last Verified: February 2009

Additional relevant MeSH terms:
Carcinoma, Basal Cell
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Neoplasms, Basal Cell