Basal Cell Carcinoma Treatment & Management

basal cell carcinoma treatment

Approach Considerations

According to the 2011 National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology: Basal Cell and Squamous Cell Skin Cancers, the goal of treatment is elimination of the tumor with maximal preservation of function and physical appearance. As such, treatment decisions should be individualized according to the patient's particular risk factors and preferences. [4] In nearly all cases, the recommended treatment modality for basal cell carcinoma (BCC) is surgery. [2, 3] Treatments vary according to cancer size, depth, and location. Dermatologists may perform nearly all of the therapeutic options in an outpatient setting. Most therapies are well established and widely applied; nevertheless, researchers are studying some additional options (eg, photodynamic therapy with photosensitizers) [62, 63, 64] ) and awaiting further reports.

Local therapy with chemotherapeutic and immune-modulating agents is useful in some cases of BCC. In particular, small and superficial BCC may respond to these compounds. Topical 5% imiquimod is approved by the US Food and Drug Administration (FDA) for the treatment of nonfacial superficial BCCs that are less than 2 cm in diameter. Lesions are generally treated once daily, 5 days per week, for a duration of 6-12 weeks. Likewise, topical fluorouracil is approved by the FDA for the treatment of superficial BCC, administered twice daily for 3-6 weeks. [65] Although no formal restrictions on fluorouracil have been determined based on lesion size or location, it is most commonly used on smaller superficial BCC on the trunk and extremities. Both imiquimod and fluorouracil may be used topically for prophylaxis or maintenance in patients who are prone to having many BCCs

For tumors that are more difficult to treat (ie,

infiltrative BCC, morpheaform [sclerosing] BCC, micronodular BCC, and recurrent BCC) or those in which sparing normal (noncancerous) tissue is paramount, Mohs micrographic surgery should be considered and discussed with the patient.

For metastatic BCC, the 2011 NCCN guideline recommends clinical trials of systemic chemotherapy, particularly platinum-based combination therapy, which has been observed to produce useful, even complete, responses in a few patients. Clinical trials of investigational biologic modifiers such as hedgehog pathway inhibitors are also recommended. [4]

Surgical Modalities and Guidelines

The goal of therapy for patients with BCC is removal of the tumor with the best possible cosmetic result. By far, surgical modalities are the most studied, most effective, and most used BCC treatments. The effectiveness of surgical modalities depends heavily on the surgeon's skills; considerable differences in cure rates have been observed among surgeons. Modalities used include electrodesiccation and curettage, excisional surgery, Mohs micrographically controlled surgery, and cryosurgery. [66, 67, 68]

The 2011 NCCN guidelines recommend that low-risk patients younger than 60 years of age be treated with curettage and electrodessication in non–hair-bearing areas. If fat is reached, surgical excision should generally be performed. An alternative is excision with postoperative margin assessment. High-risk patients should undergo excision with postoperative margin assessment or a Mohs resection. [4]

Some studies suggest that dermato-oncological surgery is associated with a high risk of infection. [38] This risk is greater in patients with diabetes and in those having such surgery in the thigh or lower leg and foot.

See the Medscape Reference topic Surgical Treatment of Basal Cell Carcinoma for more complete information on this topic.

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