The goal of treatment for BCC is complete removal of the tumour, in a manner likely to result in a cosmetic outcome that is acceptable to the patient.1
Surgical modalities are the most common and effective treatment for most primary BCCs.2 The type of surgical procedure used is dependent on the characteristics of the tumour.3 Mohs micrographic surgery – a microscopically controlled technique that affords precise margin control – is associated with an extremely high cure rate (five-year cure rate using Mohs surgery is estimated at 99% for primary BCCs, and up to 95% for recurrent BCCs).4 Curettage and electrodessication/cautery, or cryosurgery, can each achieve five-year cure rates of 95% or more but are best reserved for low-risk lesions that are small, well defined and in a non-critical site.4-6
Tumours that are not appropriate for surgery, or for which surgery would result in substantial deformity (such as difficult to treat locations) may require treatment with non-surgical approaches. Radiotherapy is a useful treatment for some inoperable or unresectable basal cell carcinoma lesions, in patients who cannot tolerate surgery and for elderly patients.4 It is less suitable for younger patients and for large tumours in critical sites,6 and is contraindicated in genetic syndromes predisposing to skin cancer, such as Gorlin syndrome.1 Photodynamic therapy or topical creams can be effective for certain superficial BCCs and generally provide good cosmetic outcomes.7-9 However, each of these treatments is generally less effective for the most common type of BCC, nodular BCCs.6,10
1. Telfer NR, et al. Guidelines for the management of basal cell carcinoma. Brit J Dermatol. 2008; 159(1):35-48.
2. Epstein EH. Basal cell carcinomas: attack of the hedgehog. Nat Rev Cancer. 2008;8:743-754.
3. Samarasinghe V. Focus on basal cell carcinoma. J Skin Cancer. 2011;328615.
4. Wong B, et al. Basal Cell Carcinoma. BMJ. 2003;327:794-798.
5. Zacarian SA. Cryosurgery of cutaneous carcinomas. J Am Acad Dermatol. 1983;9(6):947-956.
6. Sterry W. Guidelines: The management of basal cell carcinoma. Eur J Dermatol. 2006;16(5):467-475.
7. Gollnick H, et al. Recurrence rate of superficial basal cell carcinoma following treatment with imiquimod 5% cream: conclusion of a 5-year long-term follow-up study in Europe. Eur J Dermatol. 2008;18(6):677-682.
8. Gross K, et al. 5% 5-Fluorouracil Cream for the Treatment of Small Superficial Basal Cell Carcinoma: Efficacy, Tolerability, Cosmetic Outcome, and Patient Satisfaction. Dermatol Surg. 2007;33:433-440.
9. Rhodes LE, et al. Five-Year Follow-up of a Randomized, Prospective Trial of Topical Methyl Aminolevulinate Photodynamic Therapy vs Surgery for Nodular Basal Cell Carcinoma. Arch Dermatol. 2007;143(9):1131-1136.10. Alessi SS, et al. Treatment of cutaneous tumors with topical 5% imiquimod cream. Clinics. 2009;64(10):961-966.