Advances in Management and Therapeutics of Cutaneous Basal Cell Carcinoma

Abstract

Basal cell carcinoma (BCC), the most common cancer in humans, is a malignant neoplasm of cells derived from the basal layer of the epidermis. Tumor characteristics such as histologic subtype, primary versus recurrent tumor, anatomic location, size, and patient attributes determine the risk level and acceptable treatment options. Surgical options offer histologic confirmation of tumor clearance. Standard excision provides post-treatment histologic assessment, while Mohs micrographic surgery (MMS) provides complete margin assessment intraoperatively. Additional treatment options may be employed in the correct clinical context. Small and low-risk BCCs, broad field cancerization, locally-advanced disease, metastatic disease, cosmetic concerns, or morbidity with surgical approaches raise consideration of other treatment modalities. We review herein a range of treatment approaches and advances in treatments for BCC, including standard excision, MMS, electrodesiccation and curettage, ablative laser treatment, radiation therapy, targeted molecular therapies, topical therapies, field therapies, immunotherapy, and experimental therapies.

Management of Cutaneous Head and Neck Squamous and Basal Cell Carcinomas for Immunocompromised Patients

“…RT is considered as a primary treatment for local low-risk and high-risk BCCs in non-surgical candidates, and a wide range of radiation techniques and dosing protocols are in use [ 90 ]. As in the immunocompetent population, BCC is rarely likely even amongst chronically immunosuppressed patients, and the recommendations for management of BCC are almost identical between the two [ 89 ].…”

Long-term follow-up of patients with high-risk facial basal cell carcinoma treated with interferon

“…Evaluations of other interventions for facial high-risk BCC, in which surgery is not possible (or desirable), are currently needed. 7 …”

Loss of ARHGAP40 expression in basal cell carcinoma via CpG island hypermethylation

“…BCC constitutes approximately 80% of all non‐melanoma skin cancers 1 . The incidence of BCC worldwide has increased in recent decades and is increasing by 3%–10% annually in the United States 2 . BCC is considerably more common in the Caucasian population than in other populations.…”

“…BCC has several clinical subtypes, comprising nodular, cystic, superficial, sclerosing, keratotic, pigmented and micronodular. BCC can be subtyped as lower‐risk (superficial, nodular and pigmented BCC) and high‐risk (morpheaform, infiltrative and micronodular BCC) based on histological features, anatomic locations and size in its greatest dimension 2 . BCC is primarily driven by the Sonic Hedgehog (Hh) pathway.…”

“…BCC can be subtyped as lower-risk (superficial, nodular and pigmented BCC) and high-risk (morpheaform, infiltrative and micronodular BCC) based on histological features, anatomic locations and size in its greatest dimension. 2 BCC is primarily driven by the Sonic Hedgehog (Hh) pathway. The patched/hedgehog intracellular signalling pathway is responsible for regulating cell growth, and constitutive activation of this pathway leads to BCC development.…”