Beyond Mohs surgery and excisions: A focused review of treatment options for subtypes of basal cell carcinoma

Abstract

Basal cell carcinoma (BCC) is the most common nonmelanoma skin cancer. It originates from undifferentiated cells in the basal cell layer of the epidermis or from the outer root sheath of the hair follicle. The most important factor in development of BCC is ultraviolet radiation. Surgery is considered the gold standard of treatment for BCC. However, nonsurgical options are available for individuals who are unsuitable for surgery. The purpose of this review is to summarize the efficacy and indications of alternative, nonsurgical treatments that can be used in the management of BCC. An extensive literature review was performed for the nonsurgical options for the treatment of BCC. Resources searched included PubMed and Google Scholars, limited to the years 1995 to 2020. Key words searched included BCC, destructive methods, photodynamic therapy (PDT), radiotherapy, topical medication, laser, hedgehog pathway inhibitors (HPIs). The most relevant results such as systematic reviews, randomized controlled trials, or comparative studies were selected to provide a summary for the most common nonsurgical methods used for treating BCC. Effective nonsurgical treatments for BCC include destructive methods (eg, curettage alone, cryosurgery, or electrodessication), PDT, topical medications, radiotherapy, laser, and HPIs. Nonsurgical therapeutic alternatives are safe and effective for the treatment of BCC. Factors such as tumor location, size, and histopathological subtype should be taken into consideration when selecting optimal treatment. In addition to clinical factors, cosmetic results and patient preference should be considered.

High-dose-rate plesiotherapy with customized molds in non-melanoma skin cancer: efficacy and safety at 10 years—single institution experience

“…At times, both treatment modalities are used, for instance if tumor-free margins are not achieved in surgery or risk factors for recurrence are detected in the surgical specimen [ 8 ]. One factor that plays into the decision on treatment modality is the location of the lesion: for tumors on the face, radiotherapy, used alone or as an adjuvant therapy, is quite common, as the aesthetic impact is lower than with surgery alone and good outcomes are obtained [ 9 ]. Recently, the role of systemic treatments (especially the use of hedgehog pathway inhibitors) is also being assessed in the context of neoadjuvant or definitive treatments in certain types of lesions that cannot be treated surgically or with radiotherapy initially due to their size, infiltration or number.…”

Real-Life Data on the Management of Incompletely Excised Basal Cell Carcinoma

“…Finally, imiquimod, cryosurgery, or their combination was applied in 18 patients and only 2 of them (11.1%) experienced a recurrence. The efficacy of these modalities for treatment of the primary BCC is well known, with clinical and histopathologic cure rates ranging from 60% to 80% in well-designed RCTs [2,6,[14][15][16]25]. Although scarce evidence exists on their efficacy for treatment of incompletely excised BCC, in our study they were associated with the lowest recurrence rate as compared to all other options [7,10].…”