This protocol applies to localized basal cell carcinoma at low risk for recurrence: tumors in area L (trunk and extremities) smaller than 20 mm, or in area M (cheeks, forehead, scalp, neck, pretibia) smaller than 10 mm, with well-defined borders, primary (non-recurrent) status, no immunosuppression, no prior radiation at the site, nodular or superficial histologic growth pattern, and no perineural involvement. Differentiating low-risk from high-risk tumors is the most clinically relevant stratification guiding management of BCC.
The first-line approach for this population is surgical excision — standard excision with histologic margin assessment — or, where applicable, curettage and electrodessication. This protocol is reached when that prior step did not achieve its goal: complete tumor removal with histologically negative surgical margins.
When surgical therapy is not feasible or preferred, the protocol addresses nonsurgical modalities for qualifying low-risk tumors — including topical therapy and photodynamic approaches — targeting clinical and histologic clearance of the basal cell carcinoma.
The most clinically relevant stratification to guide the management of patients with BCC is the differentiation between localized tumors at low versus high risk for recurrence.
If surgical therapy is not feasible or preferred, topical therapy (eg, imiquimod or 5-FU), MAL- or ALA-PDT, and radiation therapy (eg, superficial radiation therapy, brachytherapy, external electron beam, and other traditional radiotherapy forms for BCC) can be considered when tumors are low risk, with the understanding that the cure rate may be lower.
Cryosurgery may be considered for low-risk BCC when more effective therapies are contraindicated or impractical.
DOI: 10.1016/j.jaad.2017.10.006
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