Treatment of basal cell carcinoma

Linn Landrø | Apr 2020 | Dermatologi | Onkologi / Hematologi |

Linn Landrø
Senior Consultant, Assoc. Prof.,
Dep. of Dermatology,
Oslo University Hospital
and University of Oslo

Gro Mørk
Senior Consultant,
Dep. of Dermatology,
Oslo University Hospital

Ingrid Roscher
Senior Consultant,
Dep. of Dermatology,
Oslo University Hospital

Basal cell carcinoma (BCC) is the most common form of human cancer and its incidence continues to rise, both in the Nordic countries and worldwide1,2. Some studies point to an increasing incidence among young adults3,4. The main risk factors for developing BCC include UV-radiation from the sun and indoor tanning. BCC is a malignancy originating from the basal cells in the epidermis and is characterized by slow growth and almost negligible incidence of metastases. However, untreated BCC will cause local tissue invasion and destruction and lead to considerable morbidity. BCC is curable when the diagnosis is made early and the tumor is removed. Clinically BCCs are divided into three main subtypes: nodular (70%), superficial (15%) and morpheaform/sclerosing (15%)5. The latter has an aggressive growth pattern with diffuse growth of tumor nests combined with sclerosis. Risk of recurrence There is no available formal staging system for risk stratification specific to patients with BCC. However, the most relevant factor to consider is the risk of recurrence, which can be assessed from several clinical and histopathological parameters. A wide range of treatment modalities is available and the choice of treatment should be decided on the basis of the risk of recurrence, i.e. on clinical and histopathological subtype, location, size, and whether the tumor is recurrent or not. Assessment of the risk of recurrence is of the upmost importance when choosing treatment because an incompletely excised tumor or a recurrent tumor is a high-risk basal cell carcinoma, i.e. an unsuccessful treatment can lead to reclassification of a low-risk BCC to a  high-risk BCC. In addition, patient-specific factors such as age, comorbidity, life expectancy and ability to adhere to the treatment, as well as patient expectations, potential adverse effects and preservation of function should be taken into consideration for optimal customized treatment. Mohs micrographic surgery Mohs micrographic surgery (MMS) results in the highest cure rates for treatment of BCCs6. This method, introduced by Fredric Mohs in 1932 and subsequently modified several times, offers per-operative total margin visualization on fresh-frozen tissue sections. The method relies on the principle of sequential stages of excisions, where the...