Basal Cell Skin Cancer, Version 2.2024, NCCN Clinical Practice Guidelines in Oncology

Abstract

Basal cell carcinoma (BCC) is the most common form of skin cancer in the United States. Due to the high frequency, BCC occurrences are not typically recorded, and annual rates of incidence can only be estimated. Current estimated rates are 2 million Americans affected annually, and this continues to rise. Exposure to radiation, from either sunlight or previous medical therapy, is a key player in BCC development. BCC is not as aggressive as other skin cancers because it is less likely to metastasize. However, surgery and radiation are prevalent treatment options, therefore disfigurement and limitation of function are significant considerations. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) outline an updated risk stratification and treatment options available for BCC.

Management of Cutaneous Squamous Cell Carcinoma of the Scalp: The Role of Imaging and Therapeutic Approaches

“…Currently, two main staging systems are used to predict the risk of cSCC-related events (recurrence, nodal metastasis, and/or death): the American Joint Committee on Cancer's 8th edition staging system (AJCC8) and the Brigham and Women's Hospital T classification system (BWH) [2,7,9,[24][25][26][27]. Although the BWH system does not address nodal and metastasis classifications or advanced stage groups, it seems to be more accurate than the AJCC staging system in the classification of localized cSCC [9,10,24,25,27,28].…”

“…Most primary cSCCs are located on the head and neck area (approx. 35-70%) [4,5,8,9,12,30], which is associated with a higher risk of developing recurrences or metastasis compared to other locations [7,8,11].…”

“…Histological confirmation is the gold standard for the diagnosis, showing an atypical epithelial cells proliferation that extends beyond the epidermis into the underlying dermis, and in some cases may invade subjacent structures as well (i.e., subcutaneous fat, fascia, muscle, etc.) (Figures 4 and 5) [7,9,39]. It can be assessed either by an incisional biopsy (i.e., incision or punch), shave biopsy, or directly by performing an excisional biopsy of the entire lesion, depending on the characteristics of the lesions and the judgment Histological confirmation is the gold standard for the diagnosis, showing an atypical epithelial cells proliferation that extends beyond the epidermis into the underlying dermis, and in some cases may invade subjacent structures as well (i.e., subcutaneous fat, fascia, muscle, etc.)…”

“…It is the second most common subtype of skin cancer, accounting for 20-50% of keratinocyte carcinomas [2][3][4][5], and represents the second cause of death from skin cancer, after melanoma [6]. The etiology of cSCC is multifactorial, with both environmental and host factors implicated, but it is especially related with solar ultraviolet radiation and immunosuppression [1,3,[7][8][9][10]. Thus, cSCC occurs more frequently in elderly white men (ratio of men-women of 2:1), especially in chronic sun-exposed areas [2,4,5,[8][9][10][11][12][13][14].…”

“…Surgery remains the treatment of choice for cSCC, with a 5-year disease-free survival rate ≥91% [3,11,13,[15][16][17][18]. Although most cSCCs are successfully treated with surgery, there is a subgroup of tumors that present with cSCC-related complications [3,10]: local invasion, local and regional recurrences, and lymph node metastases, with distant metastasis being rare [18,19] and the mortality rate due to cSCC being quite low (2-3%) [7,18,[20][21][22][23].…”