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 cell 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 cell carcinoma patients.

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

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-tibial area

Area L = trunk and extremities (excluding pre-tibial area, hands, feet, nail units, and ankles)

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

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

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

The algorithm below demonstrates a follow-up protocol.

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