Treatment Of Low Risk Basal Cell Carcinoma (BCC)

  • Primary treatment options for low-risk BCC include:
    • Curettage and electrodesiccation:
      • In areas without hair growth:
        • Provided that the treatment be changed to excision if the adipose is reached
    • Standard excision:
      • With 4 mm clinical margins
    • RT for nonsurgical candidates:
      • If margins are positive after excision:
        • Patients should receive adjuvant therapy
    • Mohs micrographic surgery (MMS)
    • Resection with complete circumferential peripheral and deep margin assessment (CCPDMA) with frozen or permanent section
    • Standard reexcision for area L regions (trunk, extremities):
      • Is recommended:
        • Whereas radiation may be administered to nonsurgical candidates
Table 3
  • Several randomized studies and meta-analyses have compared superficial therapies for low-risk BCC, including:
    • Topical therapies such as imiquimod or 5-fluorouracil (5-FU)
    • Photodynamic therapy (PDT) with methyl aminolevulinate (MAL) or 5-aminolevulinic acid (ALA),
    • Cryotherapy
  • 5-FU:
    • Is an antineoplastic antimetabolite
  • Imiquimod:
    • Is a synthetic immune response modifier:
      • That enhances cell-mediated immune response via the induction of proinflammatory cytokines
  • For the treatment of superficial BCC:
    • 5-FU can be applied daily to the tumor and several millimeters of surrounding skin for a period of at least 4 weeks:
      • After a 2- to 3-week interval:
        • The area is then evaluated, often by biopsy, to ensure adequate therapy
  • PDT:
    • Involves the application of a photosensitizing agent on the skin, followed by irradiation with a light source
  • Cryosurgery:
    • Destroys tumor cells by freeze-thaw cycles, but a key limitation is poorer cosmetic outcomes compared with other treatment options
    • Contraindications to cryosurgery for BCC include:
      • Indistinct borders
      • Recurrent tumor
      • Certain tumor location overlying nerves
      • Size greater than 1 cm on the face
      • Certain pathologic features of:
        • Morpheaform, sclerosing, infiltrative, or perineural invasion
      • Patient characteristics, including:
        • Dark skin type
        • Cosmetically sensitive patient
        • Previous poor response to cryotherapy
        • Raynaud phenomenon
    • Imiquimod and 5-FU:
      • Have been found to be effective in treating superficial BCC in randomized studies:
        • The efficacy and cosmetic results of some of these comparison studies are demonstrated in the table
        • One study indicates that PDT has similar efficacy as cryotherapy but better cosmetic outcomes
        • Another study demonstrates that PDT, imiquimod, and 5-FU have similar efficacy and cosmetic outcomes:
          • Although the risk of recurrence may be somewhat higher with PDT versus imiquimod
        • The National Comprehensive Cancer Network panel agrees that these superficial therapies:
          • May be effective for anatomically challenging locations where surgery or radiation is contraindicated or impractical:
            • But the cure rates of these approaches are lower compared with surgery
#Arrangoiz #CancerSurgeon #SurgicalOncologist #HeadandNeckSurgeon #MountSinaiMedicalCenter #MSMC #Miami #Mexico

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