Basal cell carcinoma medical therapy
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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
|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|
|Site of prior radiation therapy||(-)||(+)|
|Subtype||Nodular, superficial||Aggressive growth pattern|
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
After the primary treatment, a follow-up is performed to evaluate for recurrence of the tumor.
- It is an immunomodulatory agent that binds to toll-like receptor 7 and induces the release of pro-inflammatory cytokines including IFN-alpha, TNF-alpha and IL-12.
- It is approved for treatment of small superficial basal cell carcinoma and is applied nightly five times a week for six weeks.
- The complete cure rate was around 80%.
- Photodynamic therapy
- The other available option for basal cell carcinoma is photodynamic therapy (PDT) with 5-amino levulinic acid(MAL) or with its methyl ester plus red light.
- The MAL cream is applied to the tumor and covered with an occlusive dressing for three hours.
- The tumor cells then form increasing amounts of protoporphyrin IX, which is stimulated by irradiation with red light to form reactive oxygen species which are in turn cytotoxic.
- It should be repeated after 1–4 weeks.
- The achieved complete remission is expected to be 92%.
- The main disadvantages of photodynamic therapy are the pain during the irradiation and the local inflammatory reaction (erythema, erosions, pustules, and crusts).
- Sonic hedgehog pathway inhibitors(vismodegib, sonidegib)
- Small and superficial basal cell carcinoma is occasionally still treated with liquid nitrogen (–196°C) either with direct contact or using a spray.
- The wounds may heal with either hypopigmentation or scarring so making it a major disadvantage.
- 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.
- 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.