Treatment of Facial Basal Cell Carcinoma: A Review

Vanessa Smith,Shernaz Walton

doi:10.1155/2011/380371

Abstract

Basal cell carcinomas (BCCs) are locally destructive malignancies of the skin. They are the most common type of cancer in the western world. The lifetime incidence may be up to 39%. UV exposure is the most common risk factor. The majority of these tumours occur on the head and neck. Despite BCCs being relatively indolent the high incidence means that their treatment now contributes a significant and increasing workload for the health service. A good understanding of the options available is important. Management decisions may be influenced by various factors including the patient's age and comorbidities and the lesion subtype and location. Due to the importance of a good cosmetic and curative outcome for facial BCCs treatment decisions may differ significantly to those that would be made for BCCs arising elsewhere. There is little good randomized controlled data available comparing treatment modalities. Although traditionally standard excision has been the treatment of choice various other options are available including: Mohs micrographic surgery, curettage and cautery, cryosurgery, radiotherapy, topical imiquimod, photodynamic therapy and topical 5-fluorouracil. We discuss and review the literature and evidence base for the treatment options that are currently available for facial BCCs.

Highlights

Basal cell carcinomas (BCCs) are locally destructive malignancies of the skin
A study comparing cryosurgery (20 seconds freeze, 60 seconds thaw 2 × cycles) to standard surgical excision for head and neck Superficial BCCs (sBCC) and small nodular BCCs (nBCC) found no significant difference in recurrence rates at 1-year but significantly worse cosmetic outcomes for those who had received cryosurgery [38]
A prospective randomized study comparing Photodynamic Therapy (PDT) and standard surgical excision for the treatment of nBCCs found 5 years recurrence rates to be 14% and 4%, respectively; cosmesis was better for PDT with 87% of patients rating the cosmetic outcome as good compared to 54% for surgery [53]

Summary

Introduction

Basal cell carcinomas (BCCs) are locally destructive malignancies of the skin. They are the most common type of cancer in Europe, Australia [1] and the U.S.A [2]. Despite BCCs being relatively indolent the high incidence means that the treatment of these tumours contributes a significant and ever growing workload for the NHS. The location of the lesion is important, as tumours that arise in cosmetically or functionally important areas are best managed with treatments that minimise the amount of tissue removed whilst ensuring a high chance of complete cure. The slow growing nature of BCCs means that less invasive treatments may be favoured despite the fact that some of these methods have higher recurrence rates.

Surgical Management

Non Surgical Management

Findings

Conclusion