Basal cell carcinoma medical therapy

Basal cell carcinoma Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Basal Cell Carcinoma from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

Staging

History and Symptoms

Physical Examination

Laboratory Findings

CT scan

MRI

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Basal cell carcinoma medical therapy On the Web

Most recent articles

cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Basal cell carcinoma medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Basal cell carcinoma medical therapy

CDC on Basal cell carcinoma medical therapy

Basal cell carcinoma medical therapy in the news

Blogs on Basal cell carcinoma medical therapy

Directions to Hospitals Treating Basal cell carcinoma

Risk calculators and risk factors for Basal cell carcinoma medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:  Maneesha Nandimandalam, M.B.B.S.[2],Saarah T. Alkhairy, M.D.

## Overview

[edit | edit source]

After the suspicious lesion is evaluated, the medical therapy is divided based on low-risk and high-risk basal cell carcinoma patients. Medical therapy consists of topical and systemic therapy. Among topical therapy imiquimod, photodynamic therapy, 5-fluorouracil are included. Systemic therapy consists of sonic hedgehog pathway inhibitors like vismodegib, sonidegib.

## Basal Cell Carcinoma Medical Therapy

[edit | edit source]

Once the suspicious lesion is evaluated, the medical therapy is based upon the low-risk and high-risk basal cell carcinoma patients.

The table below summarizes the characteristics in low-risk and high-risk lesions[1].

H&P | Low risk | high risk

|
|

Location/size | Area L < 20 mm; Area M < 10 mm; Area H < 6 mm | Area L ≥ 20 mm; Area M ≥ 10 mm; Area H ≥ 6 mm
Borders | Well defined | Poorly defined
Primary vs. recurrent | Primary | Recurrent
Immunosuppression | (-) | (+)
Site of prior radiation therapy | (-) | (+)
Subtype | Nodular, superficial | Aggressive growth pattern
Perineural involvement | (-) | (+)

Area H = “mask areas” of face (central face, eyelids, eyebrows, periorbital, nose, lips [cutaneous and vermilion], chin, mandible, preauricular and postauricular skin/sulci, temple, ear), genitalia, hands, and feet

Area M = cheeks, forehead, scalp, neck, and pre-tibial area

Area L = trunk and extremities (excluding pre-tibial area, hands, feet, nail units, and ankles)

The algorithm below demonstrates a treatment protocol for low-risk lesions[2].

The algorithm below demonstrates a treatment protocol for high-risk lesions[3].

After the primary treatment, a follow-up is performed to evaluate for recurrence of the tumor.

The algorithm below demonstrates a follow-up protocol[4].

The medical therapy for basal cell carcinoma is divided into[5][6]:

* Toipcal
* Systemic

Topical therapy

* Imiquimod
* It is an immunomodulatory agent that binds to toll-like receptor 7 and induces the release of pro-inflammatory cytokines including IFN-alpha, TNF-alpha and IL-12.
* It is approved for treatment of small superficial basal cell carcinoma and is applied nightly five times a week for six weeks.
* The complete cure rate was around 80%.
* Photodynamic therapy
* The other available option for basal cell carcinoma is photodynamic therapy (PDT) with 5-amino levulinic acid(MAL) or with its methyl ester plus red light.
* The MAL cream is applied to the tumor and covered with an occlusive dressing for three hours.
* The tumor cells then form increasing amounts of protoporphyrin IX, which is stimulated by irradiation with red light to form reactive oxygen species which are in turn cytotoxic.
* It should be repeated after 1–4 weeks.
* The achieved complete remission is expected to be 92%.
* The main disadvantages of photodynamic therapy are the pain during the irradiation and the local inflammatory reaction (erythema, erosions, pustules, and crusts).
* 5-fluorouracil
* It is a cytostatic agent which is available as a 5% prescription cream that is designed to be applied twice daily for 3–12 weeks until erosions develop.

Systemic therapy

* Sonic hedgehog pathway inhibitors(vismodegib, sonidegib)
* They are markedly teratogenic and embryotoxic.
* The commonest adverse effects of vismodegib include muscle cramps, hair loss, taste disturbances and weight loss.

Cryotherapy

* Small and superficial basal cell carcinoma is occasionally still treated with liquid nitrogen (–196°C) either with direct contact or using a spray.
* The wounds may heal with either hypopigmentation or scarring so making it a major disadvantage.

## References

[edit | edit source]

1. ↑ http://www.nccn.org/professionals/physician_gls/PDF/nmsc.pdf
2. ↑ http://www.nccn.org/professionals/physician_gls/PDF/nmsc.pdf
3. ↑ http://www.nccn.org/professionals/physician_gls/PDF/nmsc.pdf
4. ↑ http://www.nccn.org/professionals/physician_gls/PDF/nmsc.pdf
5. ↑ Berking C, Hauschild A, Kölbl O, Mast G, Gutzmer R (May 2014). "Basal cell carcinoma-treatments for the commonest skin cancer". Dtsch Arztebl Int. 111 (22): 389–95. doi:10.3238/arztebl.2014.0389. PMID 24980564.
6. ↑ Wong CS, Strange RC, Lear JT (October 2003). "Basal cell carcinoma". BMJ. 327 (7418): 794–8. doi:10.1136/bmj.327.7418.794. PMC 214105. PMID 14525881.

Template:WH Template:WS