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: Maneesha Nandimandalam, M.B.B.S.[2],Saarah T. Alkhairy, M.D.

Overview

After the suspicious lesion is evaluated, the medical therapy is divided based on low-risk and high-risk basal cell carcinoma patients. Medical therapy consists of topical and systemic therapy. Among topical therapy imiquimod, photodynamic therapy, 5-fluorouracil are included. Systemic therapy consists of sonic hedgehog pathway inhibitors like vismodegib, sonidegib.

Basal Cell Carcinoma Medical Therapy

Once the suspicious lesion is evaluated, the medical therapy is based upon the low-risk and high-risk basal cell 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-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[2].

Low Risk Basal Cell.jpg

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

High Risk Basal Cell.jpg

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].

Followup Basal Cell.jpg

The medical therapy for basal cell carcinoma is divided into[5][6]:

  • Toipcal
  • Systemic

Topical therapy

Systemic therapy

Cryotherapy

References

  1. http://www.nccn.org/professionals/physician_gls/PDF/nmsc.pdf
  2. http://www.nccn.org/professionals/physician_gls/PDF/nmsc.pdf
  3. http://www.nccn.org/professionals/physician_gls/PDF/nmsc.pdf
  4. http://www.nccn.org/professionals/physician_gls/PDF/nmsc.pdf
  5. Berking C, Hauschild A, Kölbl O, Mast G, Gutzmer R (May 2014). "Basal cell carcinoma-treatments for the commonest skin cancer". Dtsch Arztebl Int. 111 (22): 389–95. doi:10.3238/arztebl.2014.0389. PMID 24980564.
  6. Wong CS, Strange RC, Lear JT (October 2003). "Basal cell carcinoma". BMJ. 327 (7418): 794–8. doi:10.1136/bmj.327.7418.794. PMC 214105. PMID 14525881.

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