This document replaces previous guidance on electrochemotherapy for primary basal cell carcinoma and primary squamous cell carcinoma (interventional procedure guidance 447).
1.1 Current evidence on the safety of electrochemotherapy for primary basal cell carcinoma (BCC) and primary squamous cell carcinoma (SCC) raises no major concerns. Evidence on its efficacy is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and local audit, and with submission of data to a register (see 1.5).
1.2 Clinicians wishing to undertake electrochemotherapy for treating primary BCC and primary SCC should take the following actions:
Inform the clinical governance leads in their NHS trusts.
Ensure that patients understand the uncertainty about the procedure's efficacy and why it is being offered as an alternative to other established methods of treatment, and provide them with clear written information. In addition, the use of NICE's information for the public is recommended.
1.3 Patient selection should be carried out by a specialist skin cancer multidisciplinary team. Patient selection is particularly important because the cure rates for established treatments in accessible sites are very high. Careful consideration should be given to the reasons for offering electrochemotherapy, especially in the context of treating primary BCC and SCC with curative intent.
1.4 This procedure should only be carried out by clinicians with specific training in the technique.
1.5 Clinicians should submit data on all patients undergoing electrochemotherapy (including details of case selection, methods of follow-up and outcomes) to the InspECT register, an international register dedicated to electrochemotherapy, and review clinical outcomes locally. Entry into research trials should also be considered, with a view to providing data about cure and about recurrence rates, compared with other forms of treatment.