Management of Aggressive Basal Cell Carcinoma

Abstract

Basal cell carcinoma (BCC), a malignant neoplasm derived from nonkeratinizing cells that originate in the basal layer of the epidermis, is the most common cancer in humans. Several factors such as anatomic location, histologic features, primary versus recurrent tumors, and patient characteristics influence the treatment modality for basal cell carcinoma. Mohs micrographic surgery facilitates optimal margin control and conservation of normal tissue for the management of aggressive basal cell carcinoma, basal cell carcinoma on the head, neck, or genitals, recurrent basal cell carcinoma, those with infiltrative histology or perineural invasion, and those occurring in immunosuppressed hosts; however, other treatment modalities may also be appropriately implemented for more indolent BCCs on non-high-risk sites. For the treatment of aggressive or advanced BCCs, surgical clearance with margin assessment is preferable whenever feasible, and at times, a multidisciplinary approach with adjuvant or rarely neoadjuvant therapy with targeted molecular therapeutic agents or radiation therapy when indicated.