Abstract
Despite that basal cell carcinoma (BCC) is curative in the vast majority of cases, some patients are at high risk of recurrence and, in a few patients, lesions can progress to a point unsuitable for local therapy and prognosis is quite poor. The aim of the present work is to review clinical and pathologic characteristics as well as classical and new treatment options for high-risk, metastatic and locally advanced BCC. Surgery and radiotherapy remain the selected treatments for the majority of high-risk lesions. However, some patients are located on a blurry clinical boundary between high-risk and locally advanced BCC. Treatment of these patients is challenging and need an individualized and highly specialized approach. The treatment of locally advanced BCC, in which surgery or radiotherapy is unfeasible, inappropriate or contraindicated, and metastatic BCC has changed with new Hedgehog pathway inhibitors of which vismodegib is the first drug approved by FDA and EMA.
Highlights
Basal cell carcinoma (BCC) is the most common malignant tumor of the skin and is the most common human malignancy
Despite that basal cell carcinoma (BCC) is curative in the vast majority of cases, some patients are at high risk of recurrence and, in a few patients, lesions can progress to a point unsuitable for local therapy and prognosis is quite poor
Some patients are located on a blurry clinical boundary between high-risk and locally advanced BCC
Summary
Basal cell carcinoma (BCC) is the most common malignant tumor of the skin and is the most common human malignancy. The incidence of BCC is increasing in many countries around the world. The underlying cause of BCC is unknown, but ultraviolet light exposure and genetic predisposition seem to be the most significant etiological factors [1]. Aging of the population and frequent exposure to sunlight may explain the worldwide increase that has been observed in the incidence of this malignancy [2]. The likelihood of recurrence following treatment is used to categorize lesions as low or high risk. High-risk BCC denotes primary or already relapsed tumors with a significant risk of further relapse after local treatment. Surgery and radiotherapy are the treatment of choice for most patients with high-risk lesions [6]
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