Basal cell carcinoma medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Saarah T. Alkhairy, M.D.

Overview

After the suspicious lesion is evaluated, the medical therapy is divided into low-risk and high-risk basal carcinoma patients. Medical therapy consists of surgery, radiation therapy, and follow-up for recurrence.

Basal Cell Carcinoma Medical Therapy

After the suspicious lesion is evaluated, the medical therapy is divided into low-risk and high-risk basal carcinoma patients.

The table below summarizes the characteristics in low-risk and high-risk lesions[1].

H&P Low Risk High Risk
Location/size Area L <20 mm; Area M <10 mm; Area H <6 mm Area L ≥20 mm; Area M ≥10 mm; Area H ≥6 mm
Borders Well defined Poorly defined
Primary vs. recurrent Primary Recurrent
Immunosuppression (-) (+)
Site of prior radiation therapy (-) (+)
Subtype Nodular, superficial Aggressive growth pattern
Perineural involvement (-) (+)

Area H = “mask areas” of face (central face, eyelids, eyebrows, periorbital, nose, lips [cutaneous and vermilion], chin, mandible, preauricular and postauricular skin/sulci, temple, ear), genitalia, hands, and feet

Area M = cheeks, forehead, scalp, neck, and pre tibia

Area L = trunk and extremities (excluding pretibia, hands, feet, nail units, and ankles)


The algorithm below demonstrates a treatment protocol for low-risk lesions[2].

The algorithm below demonstrates a treatment protocol for high-risk lesions[3].

After the primary treatment, a follow-up is performed to evaluate for recurrence of the tumor.

The algorithm below demonstrates a follow-up protocol[4].

Other medical therapy techniques include the following:

  • Oral vismodegib - was approved by the FDA in January 2012 for adult patients with locally advanced basal cell carcinoma who are not candidates for surgery or radiation
  • Radiotherapy - used in elderly patients with extensive lesions when surgery is inappropriate
  • Topical photodynamic therapy - particularly for the management of superficial BCC that involves the application of a topical emulsion-based 5-aminolaevulinic acid
  • Fluorouracil - particularly for the management of multiple superficial BCC on the trunk and limbs
  • Imiquimod - particularly for the management of superficial BCC

References