Basal Cell Carcinoma: An Evidence-Based Treatment Update

Abstract

The available data suggest that surgical methods remain the gold standard in BCC treatment, with Mohs micrographic surgery typically utilized for high-risk lesions. Suitable alternate treatment options for appropriately selected primary low-risk lesions may include PDT, cryotherapy, topical imiquimod, and 5-FU. Radiotherapy is a suitable alternate for surgical methods for treatment in older patient populations. Electrodesiccation and curettage (ED&C) is a commonly used primary treatment option for low-risk lesions; however, there were no RCTs examining ED&C that met our inclusion criteria. New hedgehog pathway inhibitors are promising for the management of advanced BCC; however, side effects are a concern for some patients, and much remains to be learned regarding optimal treatment length, risk of recurrence, and potential development of resistance. There is insufficient evidence at present to make recommendations on topical solasodine glycoalkaloids, topical ingenol mebutate, and intralesional 5-FU and IFN-α. Overall continued research on the efficacy of treatment modalities is needed. In particular, studies should include histologic ascertainment of clearance, long-term follow-up, stratification based on tumor subtype, and comparison with surgical outcomes.

Surgery Versus 5% Imiquimod for Nodular and Superficial Basal Cell Carcinoma: 5-Year Results of the SINS Randomized Controlled Trial

“…The absolute response rate for topical imiquimod of 83% at 5 years, whilst clearly inferior to the 98% for excisional surgery for low risk BCC, might still represent a clinically useful treatment modality since a cream treatment can be carried out in a primary care setting and some patients may also prefer the option of a cream rather than surgery. Clark et al (2014) summarise 29 RCTs and 7 systematic reviews of comparative effectiveness of treatments for BCC published up to August 2013 from four databases and cite photodynamic therapy (PDT), topical imiquimod, cryotherapy and topical 5-fluorouracil as suitable treatment options for primary low-risk lesions. They found insufficient evidence to make recommendations on the use of topical ingenol mebutate, solasodine glycoalkaloids, IFN-α or intralesional 5-fluorouracil, and no RCT evidence on electrodessication and curettage, which is a commonly used procedure for low risk BCC.…”

“…Such a trend has resulted in guidance for more family practitioners to provide treatment for low risk lesions in the community (Fremlin et al, 2016). Although excisional surgery remains the gold standard for most common types of BCC, a range of non-surgical approaches are available including photodynamic therapy (Wang et al, 2015), topical imiquimod cream, topical 5-fluorouracil, and topical ingenol (Clark et al, 2014). We previously published the 3 year results of an independent comparison of topical imiquimod versus excisional surgery for the treatment of low risk superficial and nodular BCC in the SINS trial (Bath-Hextall et al, 2014).…”

Evaluation of the Cases Who Were Referred to Plastic Surgery Clinic Out of Suspicion of Non-melanoma Skin Cancer Localized at Head and Neck Region in Sivas Numune Hospital

“…61,62 NMCK'da sağ-kalımı etkileyen önemli faktörlerden biri, yeterli ve uygun cerrahi eksizyonun yapılmasıdır. Rekonstrüksiyonda oluşan defektin boyut ve lokalizasyonuna, cildin elastikiyetine göre primer kapatmayı, lokal flepleri, greftleri ve vaskülarize serbest flepleri içeren birçok rekonstrüksiyon seçeneği mevcuttur.…”

A hedonic response to an assay made on octogenarians using cosmetics that promise to donate comfort, attractiveness and youth

“…It is noticeable a -1% dermal collagen collapse per year, and moreover (especially in female) collagen is calcified by Calcium ions originating from ostheoporosis, that include a severe Calcium loss from bones [5][6][7][8][9][10][11][12][13][14][15][16][17].…”