Basal cell carcinoma (BCC) is a common skin cancer that arises from the basal layer of epidermis and its appendages (picture 1A-B). Treatment of BCC is indicated due to the locally invasive, aggressive, and destructive effects of this tumor on skin and surrounding tissues (picture 2A-B). Effective therapies for BCC include electrodesiccation and curettage (ED&C), surgical excision, Mohs micrographic surgery, topical and intralesional agents, radiation therapy, and photodynamic therapy (table 1).
Tumor characteristics such as size, location, and pathology influence the selection of treatment. Treatments that are highly efficacious for BCCs without aggressive clinical or pathologic features may be less likely to cure more aggressive lesions. Factors such as treatment tolerability, cost, and patient preference also guide the selection of an appropriate therapy.
The treatment of BCCs without aggressive clinical or pathologic features and the prognosis of BCC will be reviewed here. The treatment of BCCs with a high risk for recurrence, the epidemiology and diagnosis of BCC, and the options for systemic therapy in locally advanced or metastatic BCC are discussed separately. (See "Treatment of basal cell carcinomas at high risk for recurrence" and "Epidemiology and clinical features of basal cell carcinoma" and "Evaluation for locoregional and distant metastases in cutaneous squamous cell and basal cell carcinoma" and "Systemic treatment of advanced cutaneous squamous and basal cell carcinomas".)
APPROACH TO TREATMENT
Tumor characteristics — The risk for lesion recurrence influences the approach to treatment. BCCs that lack aggressive clinical or pathologic features are less likely to recur than lesions with more aggressive features. Overly aggressive management of BCCs at low risk for recurrence may result in unnecessary inconveniences to the patient and increased cost to the medical system. Conversely, inadequate treatment of lesions with aggressive features can lead to subsequent tumor recurrence with potentially devastating consequences (picture 2A-B).
The following characteristics have been proposed as features that identify BCCs with a low likelihood for recurrence after treatment :