Management of High Risk Basal Cell Carcinoma (BCC)

  • 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

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