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21-06-2022 | Basal cell carcinoma | Adis Journal Club | Article

Oncology and Therapy

Basal Cell Carcinoma: A Narrative Review on Contemporary Diagnosis and Management

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Authors: Piyu Parth Naik & Munaf B. Desai

Abstract

Basal cell carcinoma (BCC) is the most common, accounting for 80–90% of skin cancers. It arises from the basal layer of the epidermis and its appendages. A complex interplay of environmental, phenotypic and genetic variables leads to the development of BCC. Literature has documented several clinical subtypes of BCC, the most common of which are nodular, superficial and morpheaform. Expeditious diagnosis and analysis are essential for improving the outcome of BCC. Preventive measures, particularly when implemented in childhood and adolescence, may play a critical role. Due to its low metastatic potential, treatment for BCC mostly focuses on local management. The standard treatment of basal cell carcinoma involved complete removal of the lesion by excision or Mohs surgery. In special circumstances, basal cell carcinoma can be treated with cryosurgery, electrodesiccation and curettage, topical medications and photodynamic therapy. This review aimed to evaluate the contemporary diagnosis and management of basal cell carcinoma.

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Key Summary Points / Key Points

Inspection by a physician and dermoscopy are used to make a preliminary diagnosis of basal cell carcinoma. Biopsy with histopathologic examination confirms the diagnosis.
The pathologic diagnosis with classification as low- or high-risk basal cell carcinoma will guide treatment. Low-risk basal cell carcinomas are removed by surgical excision or Mohs surgery, the latter with facial lesions or in areas where conserving normal adjacent tissue is required.
Metastatic or unresectable BCC can respond to treatment with Hedgehog pathway inhibitors, and because of its tumor mutation burden, it can respond to immune checkpoint inhibitors.

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