TREATING BASAL CELL CARCINOMA:
BY STAGE

Low-Risk, Local BCC

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

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

What happens if these procedures do not get all the tumour? If the surgery does not remove all the cancer or if fat is reached during C & C, then typically another surgery will be performed. If that’s not possible, then radiotherapy will be considered.

High-Risk Local BCC

If your tumour 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 tumour 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). Immunotherapy (cemiplimab) can be used if you are not an appropriate candidate for a hedgehog inhibitor or if you progress while on a hedgehog inhibitor. 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, 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.

Distant Metastatic Disease

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).