TREATING BASAL CELL CARCINOMA:
BY STAGE

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.

 

Low-Risk, Local BCC

For low-risk, local BCC the most recommended approaches are:

  • Curettage and electrodesiccation (C & E) (except on areas that have hair)
  • Standard surgical excision

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.

 

High-Risk Local BCC

If your tumor is high risk, you are a candidate for one or more of the treatments below:

  • Standard surgical excision
  • Mohs surgery
  • Radiation therapy

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.

 

Advanced BCC

 

Locally Advanced BCC (difficult to treat)

If possible, locally advanced BCCs should be managed by:

  • Surgery
  • Radiotherapy

If the BCC can not be managed surgically or the BCC is extensive the next step would be:

  • Systemic therapy with a hedgehog inhibitor (if curative radiotherapy is not feasible). See Clinical Considerations box “When do I need a multidisciplinary team for my BCC?

If any of these approaches does not produce satisfactory results, a clinical trial could be considered.

 

Regional Disease

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, most likely with vismodegib, or they may enroll you in a clinical trial.

 

Distant Metastatic Disease

Patients with BCC with distant disease, the recommendation is systemic therapy with a hedgehog inhibitor or enrollment in a clinical trial. Surgery or radiotherapy can be considered for symptomatic sites (as palliation, to make you more comfortable or assure normal function).

Clinical Consideration

When do I need a multidisciplinary team for my BCC?

For most cases of BCC, your expert dermatologist or surgeon can manage the disease surgically. But if your tumor has high-risk features, it might make sense to seek out a dermatologist who works in a multidisciplinary team setting, where there is ready access to other experts in radiation oncology, surgical oncology, head-and-neck surgery, and medical oncology. This setting is typically the case for academic dermatologists or dermatologists associated with a cancer center.

If your dermatologist can’t cure you surgically, a multispecialty team approach might be needed to treat your BCC. Typical situations like that include:

  • Surgically challenging (or high-risk) tumors on the head-and-neck region
  • Tumors that are in other locations that are hard to manage surgically
  • Your tumor is recurrent
  • Your tumor can’t be managed with surgery or radiotherapy
  • Disease that has spread to the regional area (the lymph node)
  • Disease that has spread (metastasized) to other parts of your body

Key terms:

Palliation: Relief of symptoms and suffering caused by cancer and other life-threatening diseases. Palliation helps a patient feel more comfortable and improves the quality of life but does not cure the disease.

Weighing Your Treatment Options

Once you know the options based on the stage of your disease, you can weight the efficacy, safety, convenience, and other treatment factors that are important to you. Consider going over the following worksheet with your doctor.

Click Here to Download a PDF of the Worksheet Below

*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.