Basal cell carcinoma medical therapy
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Risk calculators and risk factors for Basal cell carcinoma medical therapy |
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
The U.S. Food and Drug Administration (FDA) today approved oral Erivedge(vismodegib), manufactured by Genentech, for the treatment of adult patients with locally advanced basal cell carcinoma who are not candidates for surgery or radiation and for those with metastatic disease