When selecting a therapy for your basal cell carcinoma (BCC), you and your doctor will discuss the stage of your disease, any other medical conditions you may have, and your personal preferences for different types of therapy. This section reviews recommendations for therapy by stage and provides some guidance on how to weight the efficacy, safety, convenience, and other treatment factors that are important to you.
For low-risk, local BCC the most recommended approaches are:
What happens if these procedures do not get all the tumor? If the surgery does not remove all the cancer or if fat is reached during C & E, then typically another surgery will be performed. If that’s not possible, then radiotherapy will be considered.
If your tumor is high risk, you are a candidate for one or more of the treatments below:
What happens if the surgery does not get it all or they find additional issues? If the surgery does not remove all the cancer, then another surgery may be an option. If that’s not possible, then radiation therapy, systemic therapy, or a clinical trial may be considered. Also, sometimes if you have a tumor that has invaded your nerves, particularly large nerves, your oncology team may consider giving you radiotherapy in the adjuvant setting to prevent the disease from coming back.
If possible, locally advanced BCCs should be managed by:
If the BCC can not be managed surgically or the BCC is extensive the next step would be:
If any of these approaches does not produce satisfactory results, a clinical trial could be considered.
If your doctor is concerned that your BCC may have spread beyond the skin, s/he may choose to do a CT or PET scan to evaluate it further. Although BCC rarely metastasizes, when it, does it can spread to the nearest lymph nodes but can also spread to distant sites readily.
After your doctor takes a sampling of the lymph node through fine needle aspiration or core biopsy and finds positive nodes, a number of steps will be taken. Your team may provide radiotherapy (if possible) and systemic therapy, with a hedgehog inhibitor. If you are not an appropriate candidate for or progress on a hedgehog inhibitor, immunotherapy (cemiplimab) can be used. If these strategies don’t work, your doctor may enroll you in a clinical trial.
If you have BCC with distant disease, a systemic therapy with a hedgehog inhibitor can be used. If you are not an appropriate candidate for or progress on a hedgehog inhibitor, immunotherapy (cemiplimab) can be used. If these strategies don’t work, your doctor may enroll you in a clinical trial. Surgery or radiotherapy can be considered for symptomatic sites (as palliation, to make you more comfortable or assure normal function).
*Throughout these treatment sections, we make references to recommended treatment strategies. We consulted the American Academy of Dermatology (AAD) and the National Comprehensive Cancer Network (NCCN) guidelines on these topics. These professional groups are the foremost authorities on skin cancer management. To consult these guidelines, please see RESOURCES.