Management of High Risk Basal Cell Carcinoma (BCC)

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Options for high-risk BCC lesions include:
    • Standard excision using wider margins with linear or delayed repair with standard reexcision
    • Mohs Mircrographic surgery (MMS)
    • Resection with complete circumferential peripheral and deep margen assessment (CCPDMA)
    • RT for nonsurgical candidates
    • Patients treated with MMS or resection with CCPDMA should receive adjuvant radiation if clear margins cannot be achieved
  • Recommended adjuvant therapy options include:
    • Radiation and/or multidisciplinary consultation:
      • To consider systemic therapy with a hedgehog pathway inhibitor or involvement in a clinical trial:
        • In select cases, hedgehog inhibitors can be considered in a neoadjuvant fashion if there is a potential benefit of decreasing the lesion to spare surgical morbidity, as demonstrated here
    • Adjuvant RT is recommended for patients with negative margins after surgery:
      • But with large nerve or extensive perineural involvement
Figure 4
Basal cell carcinoma before (a) and after (b) treatment with the neoadjuvant hedgehog inhibitor

Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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