Basal Cell Carcinoma – Review of Treatment Modalities

Basal cell carcinoma (BCC) is the most common type of skin cancer, thus numerous therapeutic approaches have been developed. Optimal treatment outcome should comprise complete removal of the tumor to the margin of normal tissue with the best possible aesthetic result. Surgical treatment remains the “gold standard” in therapy of BCC, showing excellent cure rates when used within the guidelines. However, it is not always possible to perform surgical excision, since it can be contraindicated in patients with certain comorbidities or in case of extensive size and/or difficult location of the tumor. Therefore, a variety of treatment modalities have been developed including cryotherapy, radiation therapy, photodynamic therapy, topical therapies, laser therapy and recently established systemic therapy. Radiation therapy is commonly performed in patients who are not good candidates for surgery and in cases when extensive or complex surgical procedure is required, often resulting in poor cosmetic outcome. Other treatment options including topical therapies, photodynamic therapy (PDT), cryotherapy, electrodesiccation and curettage are suitable for superficial and/or multiple lesions. Laser treatment, although potentially promising, is still not a widely used treatment modality for BCC, usually used only for small BCCs in low-risk anatomical areas. Finally, systemic therapy, vismodegib, is an orally administered Hedgehog pathway inhibitor, recently approved for treatment of metastatic and locally advanced BCC. The advantages, disadvantages and limitations, as well as cosmetic outcomes of each of these treatment modalities are widely discussed and reviewed in this article. Special emphasis is given to the importance of individual patient approach, taking into consideration all of the possible risks and benefits and patient quality-of-life issues when choosing a treatment modality. Conclusively, this paper aims to present a comprehensive review of current treatment modalities of BCC.