Primary Basal Cell Carcinoma Research Articles

Small margin (up to 2 mm) excision of periocular basal cell carcinomas in the setting of a one-stop clinic-long-term outcomes at a minimum of 11 years' follow-up.

To analyse the long-term outcome of small margin (up to 2 mm) excision of clinically well-demarcated primary periocular basal cell carcinomas (BCCs). Retrospective evaluation of 185 patients with excised well-demarcated primary BCCs at a minimum of 11 years following excision. All patients underwent tumour excision with maximum margins of 2 mm. Resulting defects were, if possible, closed directly. Reconstruction requiring flaps or grafts was delayed until receipt of the histological report, which was obtained in all cases. Of 185 patients evaluated, 69 (37.3%) were still alive at the time of the study, at least 11 years post excision. One-stage excision and direct closure was performed in 60/69 patients (86.96%). In 9/69 patients (13.04%), excision was undertaken with reconstruction 4 days later, after receipt of the histopathology report. Histological assessment confirmed complete initial excision in 59/69 patients (85.5%) rising to 68 (98.6%) after two excisions. Mean follow-up was 13 years, with no recurrence in the living cohort. Three deceased patients had a recurrence, one of whose tumour was reported histologically as incompletely excised but declined further surgery, giving an overall recurrence rate of 3/185 (1.62%). For patients who completed treatment, the recurrence rate was 2 in 184 (1.09%). Six of the sixty-nine patients (8.7%) developed new tumours on the contralateral eyelid or the forehead. Primary, clinically well-demarcated periocular BCCs can be safely treated using small (up to 2 mm) excision margins in a one-stop setting with immediate reconstruction for those defects which can be closed directly without recourse to flaps or grafts. A retrospective study of 185 patients who had small margin (≤2 mm) excision of clinically well-demarcated primary periocular BCCs demonstrated a recurrence rate of 3/185 (1.62%) at a minimum of 11 years' follow-up.

Periocular basal cell carcinoma: 20-years experience at a tertiary eye care center of South India

PURPOSE: To study the clinical profile and management outcomes of periocular basal cell carcinoma (BCC).MATERIALS AND METHODS: A retrospective analysis of all histopathologically proven cases of BCC between 1995 and 2015 was done. The demographic data, clinical presentation, histopathological subtype, and management outcomes were analyzed.RESULTS: We had a total of 185 malignant eyelid tumors during the study period, out of which 37 (20%) were BCC. Thirty-two (86.5%) out of 37 cases were primary BCC. The mean age was 63.3 years. Pigmented ulcerative lesion (14, 38%), lower eyelid (19, 51%), and nodular BCC (15, 40%) were the most common presentation, periocular site, and histological subtype, respectively. 28 patients underwent excision under frozen section with an average tumor-free margin of 3.5 mm. Mean follow-up period was 18.78 months. Recurrence rate of 0% and 3.1% was noted in primary and recurrent BCC, respectively.CONCLUSION: Periocular BCC commonly presents as pigmented ulcerative lesion in the lower lid. Excision biopsy under frozen section with an average tumor-free margin of 3.5 mm offers cure in most cases.

Periocular Basal Cell Carcinoma: 20-Years Experience at a Tertiary Eye Care Center of South India.

PURPOSE:To study the clinical profile and management outcomes of periocular basal cell carcinoma (BCC).MATERIALS AND METHODS:A retrospective analysis of all histopathologically proven cases of BCC between 1995 and 2015 was done. The demographic data, clinical presentation, histopathological subtype, and management outcomes were analyzed.RESULTS:We had a total of 185 malignant eyelid tumors during the study period, out of which 37 (20%) were BCC. Thirty-two (86.5%) out of 37 cases were primary BCC. The mean age was 63.3 years. Pigmented ulcerative lesion (14, 38%), lower eyelid (19, 51%), and nodular BCC (15, 40%) were the most common presentation, periocular site, and histological subtype, respectively. 28 patients underwent excision under frozen section with an average tumor-free margin of 3.5 mm. Mean follow-up period was 18.78 months. Recurrence rate of 0% and 3.1% was noted in primary and recurrent BCC, respectively.CONCLUSION:Periocular BCC commonly presents as pigmented ulcerative lesion in the lower lid. Excision biopsy under frozen section with an average tumor-free margin of 3.5 mm offers cure in most cases.

Excisional biopsy of primary and well-defined basal cell carcinoma diagnosed by clinic and- dermoscopy: diagnostic and 118 therapeutic accuracy

Excisional biopsy of primary and well-defined basal cell carcinoma diagnosed by clinic and- dermoscopy: diagnostic and 118 therapeutic accuracy

Cumulative solar ultraviolet radiation exposure and basal cell carcinoma of the skin in a nationwide US cohort using satellite and ground-based measures

BackgroundBasal cell carcinoma of the skin (BCC) is the most common cancer in populations of European ancestry. Although consistently linked with basal cell carcinoma of the skin in case-control studies, few prospective cohort studies have evaluated the shape of the exposure-response of basal cell carcinoma associated with cumulative radiant solar ultraviolet exposure (UVR).MethodsWe followed 63,912 white cancer-free US radiologic technologists from entry (1983–1998) to exit (2003–2005) with known ultraviolet irradiance at up to 5 residential locations. Using generalized-additive and relative risk models we analyzed the exposure-response of basal cell carcinomas associated with ambient cumulative ultraviolet radiant exposure using ground-based National Solar Radiation database Average Daily Total Global data and satellite-based National Aeronautics and Space Administration Total Ozone Mapping Spectrometer data.ResultsThere were 2151 technologists with an incident primary basal cell carcinoma. Risk of basal cell carcinoma rose with increasing cumulative ultraviolet radiation exposure using both measures, such that 1 MJ cm− 2 increased basal cell carcinoma risk by 8.48 (95% CI 5.22, 11.09, p < 0.001) and by 10.15 (95% CI 6.67, 13.10, p < 0.001) per 10,000 persons per year using the Average Daily Total Global and Total Ozone Mapping Spectrometer ultraviolet data, respectively; relative risk was likewise elevated. There was some evidence of upward curvature in the cumulative ultraviolet exposure response using both exposure measures with a greater increase in risk of basal cell carcinoma at higher levels of ultraviolet radiation exposure, but less evidence for curvature in relative risk. There are indications of substantial variation of relative risk with time after exposure and age at exposure, so that risk is highest for the period 10–14 years after ultraviolet radiation exposure and for those exposed under the age of 25.ConclusionsWe observed increases in risk of basal cell carcinoma and a similar exposure-response for ground-based and satellite ultraviolet radiation measures. Our observations suggest that interventions should concentrate on persons with higher levels of ultraviolet radiation exposure.

Electrochemotherapy for the treatment of primary basal cell carcinoma; A randomised control trial comparing electrochemotherapy and surgery with five year follow up

Basal cell carcinoma (BCC) are the commonest cutaneous malignancy and incidence continues to increase. There is a need to expand the therapeutic toolbox to increase options for patients that are unsuitable for or unwilling to undergo the current therapies.Electrochemotherapy (ECT) is a technique where cells are temporarily permeabilized after exposure to a brief pulsed electrical field and combined with low dose chemotherapeutics to ablate malignancies. It is a simple technique causing minimal damage to the surrounding healthy tissue and has the potential to avoid the need for complex reconstruction. ECT is an established treatment for skin metastases but its role as a primary treatment modality is not demonstrated.A prospective randomised control trial evaluating ECT against the gold standard of treatment, Surgery, was performed for patients with primary BCC and patients followed for 5 years. All lesions treated with ECT (n = 69) responded although 8/69 (12%) needed a second treatment to ensure a complete response. All surgical lesions (n = 48) showed histological evidence of complete excision with 2/48 (4%) undergoing a second excision. At 5 years, in the surgical arm there was no evidence of recurrence in 39/40 (97.5%) lesions with 1/40 (2.5%) confirmed recurrence. In the ECT arm there was no evidence of recurrence in 42/48 lesions (87.5%). There was 5 confirmed recurrences. These groups show statistical equivalence in this non inferiority study design (p = 0.33).ECT is an effective and durable treatment option for primary BCC and should be considered as part of the armamentarium of options available.

Horizontal histological sections in the preliminary evaluation of basal cell carcinoma submitted to Mohs micrographic surgery

BackgroundMohs micrographic surgery is a surgical technique for the treatment of nonmelanoma skin cancer. Surgery begins by removing the visible tumor before excision of the tissue specimens for evaluation of the tumor margins. ObjectivesTo present a new way to evaluate the material obtained from debulking, by horizontal histological analysis of the fragment. MethodsDescriptive retrospective cross-sectional study based on the medical records and histological lamellae of patients with primary basal cell carcinomas smaller than 1.5cm submitted to Mohs micrographic surgery and who had the visible tumor analyzed by horizontal histological sections. ResultsThe sample evaluated included 16 patients with lesions located on the face. Comparing the histopathological examinations of incisional biopsy in vertical sections and debulking in horizontal sections, there was agreement in seven cases. The histological analysis performed in horizontal sections allowed identification of the tumor site in 13 cases, and the relation between tumor and margin showed that in 11 cases, the lateral margin was compromised.Study limitations: The technique was better-applied in lesions smaller than 2cm. ConclusionHorizontal histological analysis of debulking has advantages for Mohs surgery, since it allows visualization of almost all tumor extension in the same view plane of the dermatoscopy, allowing better definition of the histological subtype, tumor site, and tumor/margin of lesions less than 1.5cm.

Factors predictive of recurrence, metastasis, and death from primary basal cell carcinoma 2 cm or larger in diameter

Basal cell carcinoma (BCC) recurrence and metastatic rates are known to be very low. The risk factors for these rare outcomes are subsequently not well studied. To identify risk factors independently associated with local recurrence (LR) and metastasis and/or death (M/D) in large (≥2cm) BCC. BCCs histologically confirmed between 2000 and 2009 were retrospectively screened for tumor diameter at 2 academic centers. Medical records of all large BCCs and an equal number of randomly selected small BCCs were reviewed for LR and M/D. Included were 248 large BCC and 248 small BCC tumors. Large BCCs had a significantly higher risk of LR and M/D than small BCCs (LR: 8.9% vs 0.8%, P<.001; M/D: 6.5% vs. 0%, P<.001). Because the risks were so low in small BCCs, they were excluded from further analysis. On multivariable logistic regression, head/neck location (odds ratio [OR], 9.7; 95% confidence interval [CI], 3.0-31.3) and depth beyond fat (OR, 3.1; 95% CI, 1.0-9.6) were associated with LR in large BCCs. Risk of LR was lower with Mohs micrographic surgery (OR, 0.14; 95% CI, 0.04-0.5). Head/neck location (OR, 5.3; 95% CI, 1.2-23.2), tumor diameter ≥4cm (OR, 11.9; 95% CI, 2.4-59.4), and depth beyond fat (OR, 28.6; 95% CI, 6.7-121) were significant predictors of M/D in large BCCs. Retrospective cohort design. Large BCCs, particularly those with additional risk factors, have a high enough risk of recurrence and metastasis to warrant further investigation to optimize management.

A Systematic Review and Meta-Analysis of the Accuracy of in VivoReflectance Confocal Microscopy for the Diagnosis of Primary Basal Cell Carcinoma.

Basal cell carcinoma (BCC) is the most common cancer worldwide and its incidence is constantly rising. Early diagnosis and treatment can significantly reduce patient morbidity and healthcare costs. The value of reflectance confocal microscopy (RCM) in non-melanoma skin cancer diagnosis is still under debate. This systematic review and meta-analysis were conducted to assess the diagnostic accuracy of RCM in primary BCC. PubMed, Google Scholar, Scopus, and Web of Science databases were searched up to July 05, 2019, to collect articles concerning primary BCC diagnosis through RCM. The studies’ methodological quality was assessed by the QUADAS-2 tool. The meta-analysis was conducted using Stata 13.0, RevMan 5.0, and MetaDisc 1.4 software. We included 15 studies totaling a number of 4163 lesions. The pooled sensitivity and specificity were 0.92 (95% CI, 0.87–0.95; I2 = 85.27%) and 0.93 (95% CI, 0.85–0.97; I2 = 94.61%), the pooled positive and negative likelihood ratios were 13.51 (95% CI, 5.8–31.37; I2 = 91.01%) and 0.08 (95% CI, 0.05–0.14; I2 = 84.83%), and the pooled diagnostic odds ratio was 160.31 (95% CI, 64.73–397.02; I2 = 71%). Despite the heterogeneity and risk of bias, this study demonstrates that RCM, through its high sensitivity and specificity, may have a significant clinical impact on the diagnosis of primary BCC.

Factors Affecting Recurrence and Costs of Basal Cell Carcinoma Undergoing Mohs Micrographic Surgery: A Hospital-Based Retrospective Cohort Study

Background: Around 80% of the all non-melanoma skin cancer cases suffer from basal cell carcinoma (BCC). Mohs surgery is one of the common method used for treatment in recent years. There are several treatment methods for primary BCC. One of these methods is Mohs micrographic surgery (Mohs surgery), which has become popular in recent years. Objectives: The aim of this study was to investigate 4-year recurrence and factors affecting the recurrence of BCC patients after Mohs surgery. Methods: This is a retrospective cohort study. The study population included all BCCs, who underwent Mohs surgery in Alzarha Hospital in Isfahan between 2007 and 2014, and were monitored for recurrence for 4 years. Cox regression analysis was used to determine factors affecting time recurrence. Results: The most and least frequent locations of this disease are nose (30.3%) and body (0.5%). The most common locations for recurrence are scalp (50%), nose (15%), and around the eyes (15%). The 4-year recurrence frequency of BCC after Mohs surgery was 0.9%. Cox regression analysis relationship between determining factors affecting time recurrence was not significance. Conclusions: The causes of recurrence can include the less use of protective equipment in front of sunlight or low precision of doctors in the lesion surgery in locations of the body, arms, feet, head, neck, hands, legs or genital organs, and other parts of the body.

The role of protein-53 amyloid in determining the aggressiveness of basal cell carcinoma regulated by interleukin-6, myeloid cell leukemia-1 and basic fibroblast growth factor

Basal cell carcinoma (BCC) is a common malignant skin tumor that rarely metastasized, although it is often locally destructive and aggressive. The amyloid in BCC is resulted from degenerated epithelial cell through apoptosis caused by activation of p53. Interleukin-6, MCL-1 and bFGF are inflammatory mediators which have important role in angiogenesis. To prove that high expression of p53 amyloid is related to aggressiveness of BCC via the regulation of IL-6, MCL-1 and bFGF expression. Archived specimens from 51 cases diagnosed with Primary BCC. We performed immunohistochemical staining for IL-6, MCL-1, bFGF expression and p53 amyloid deposit. There was a significant difference in the expression of p53 (p = 0.04), amyloid deposits (p = 0.015), P53 amyloid deposits (p = 0.038), IL-6 (p = 0.040), MCL-1 (p = 0.032), bFGF (p = 0.044) in A BCC compared with NA BCC. There were a significant association between MCL-1 and bFGF (p = 0.07) and p53 amyloid with bFGF (p = 0.051). p53 amyloid, IL-6, MCL-1 and bFGF have an important role in BCC aggresivity.

Electrochemotherapy in the treatment of locally advanced or recurrent eyelid-periocular basal cell carcinomas

There is increasing evidence about the effectiveness of electrochemotherapy (ECT) in the treatment of basal cell carcinomas in the head and neck region, although its role in the management of eyelid-periocular skin tumors has to be clarified. The aim of the present study is to evaluate the results of ECT in the treatment of locally advanced primary and recurrent eyelid-periocular skin basal cell carcinomas. Twelve patients with basal cell carcinoma involving the eyelid-periocular skin region were treated with ECT. Three patients had locally advanced primary tumors, while 9 patients had recurrent tumors. All treatments were performed according to the ESOPE guidelines, using Cliniporator TM device. All patients received bleomycin based ECT. The route of administration was intratumoral in 3 patients and intravenous in 9 patients. Tumor response was evaluated using the RECIST 1.1. criteria. ECT resulted in complete response of the periocular skin tumors in all patients. Lower eyelid ectropion was developed in 3 patients which had to be corrected surgically. ECT can be used effectively in the treatment of locally advanced or recurrent basal cell carcinomas in the eyelid-periocular skin region. Excellent tumor control can be achieved with good functional and cosmetic results without systemic adverse events with short interval follow-up.

Multiple primary skin cancer: case report and literature review

Multiple primary form of melanoma is one of the variants of the clinical course of this tumor. Typically two primary lesions are diagnosed and secondary tumor differs much in terms of clinical and pathological characteristics. Besides subsequent melanomas, patients are at higher risk of developing non-melanoma skin cancer, tumors of the breast, prostate gland, kidneys and the gastrointestinal tract. The article describes the case of multiple primary skin cancer, manifested by two primary melanomas and basal cell carcinoma, and literature review on this issue.

To Mohs or Not to Mohs

ABSTRACT Mohs micrographic surgery is a common procedure used to treat nonmelanoma skin cancers. With a clearance rate of approximately 98% in small primary basal cell carcinomas and approximately 97% in small primary squamous cell carcinomas, it is the gold standard of care. When considering a Mohs procedure, several criteria are reviewed and evaluated to make sure that Mohs is an appropriate treatment option for the specific tumor, and that the patient is an appropriate candidate to undergo Mohs. However, there are no such criteria for a specific age or functional status at which Mohs is deemed inappropriate (Connolly et al., 2012). Some may argue that patients in their 90s with a nonfatal skin cancer should not undergo an invasive surgery, as their quality of life may be impacted. Others may argue that, if they are healthy, surgery is the best answer. It is necessary for elderly patients and their caregivers to be fully informed about what type of skin cancer the patient has, its prognosis, and how it affects the patient’s quality of life. All possible treatment regimens should be explained by the provider with opinions and advice given in respect to the patients’ current health status and wishes in mind. Ultimately, care of the elderly patient regarding having or not having Mohs surgery should be a decision made between patient and provider, with the patient’s preference as the priority.

Long-term recurrence rates of whole specimen intraoperative frozen section analysis in basal cell carcinomas of the face with WIFSA.

Recent studies show that whole specimen intraoperative frozen section analysis (WIFSA) is a reliable method for margin analysis in basal cell carcinoma (BCC) and has low recurrence rates after five-years follow-up. There are no studies with longer follow-up. Our aim is to present long-term recurrence rates after WIFSA. All patients with a facial BCC receiving excision with WIFSA between 1992 and 2007 were evaluated. Recurrence rates were examined for primary BCC (pBCC), recurrent BCCs (rBCC), and the different histological subtypes. The accuracy of WIFSA was assessed by comparing with formalin-fixed paraffin-embedded section analysis. A total of 1140 patients with 1265 BCCs underwent excision with WIFSA, with a median and maximum follow-up of 10 and 25.3 years, respectively. Of all tumors, 90.0% were primary. Excisions were radical after an average of 1.4 excision rounds;5, 10, and 15-year recurrence rates for pBCCs are 3.3%, 5.1%, and 7.3%, respectively. An aggressive growth pattern and rBCCs are associated with more recurrences. The accuracy of WIFSA is 98.4%. WIFSA provides a highly accurate analysis and has a low recurrence rate for primary BCCs. The increasing recurrence rates over time imply 5 years of follow-up may be insufficient.

Patient indications for Mohs micrographic surgery: a clinical practice guideline.

The purpose of the present work was to develop evidence-based indications for Mohs micrographic surgery in patients with a diagnosis of skin cancer. The guideline was developed by Cancer Care Ontario's Program in Evidence-Based Care, together with the Melanoma Disease Site Group and the Surgical Oncology Program, through a systematic review of relevant literature, patient- and caregiver-specific consultation, and internal and external reviews. Given a lack of high-quality, comparative evidence, surgery (with postoperative or intraoperative margin assessment) or radiation (for those who are ineligible for surgery) should remain the standard of care for patients with skin cancer. Mohs micrographic surgery is recommended for patients with histologically confirmed recurrent basal cell carcinoma of the face and is appropriate for primary basal cell carcinomas of the face that are larger than 1 cm, have aggressive histology, or are located on the H zone of the face. Mohs micrographic surgery should be performed by physicians who have completed a degree in medicine or equivalent, including a Royal College of Physicians and Surgeons of Canada Specialist Certificate or equivalent, and have received advanced training in Mohs micrographic surgery.

Tissue-sparing properties of Mohs micrographic surgery for infiltrative basal cell carcinoma

Mohs micrographic surgery (MMS) should lead to tissue sparing of healthy skin compared with standard surgical excision because smaller surgical margins are used. To quantify the tissue-sparing properties of MMS in primary basal cell carcinoma (BCC) with an infiltrative growth pattern. A prospective study including 256 primary BCCs with an infiltrative growth pattern was performed. Tumor sizes were measured in 2 perpendicular directions. Surface defect areas after MMS were measured. The suspected defect surface area with standard excision using a 5-mm margin was calculated. The primary outcome of this study was the size of the defect surface area spared with MMS compared with the calculated defect surface area with a standard excision. The median tumor size was 71mm2, and the median defect size after MMS was 154mm2. The median defect size calculated for standard surgical excision was 298mm2. We have shown that MMS of BCC with an infiltrative growth pattern had a 46.4% tissue-sparing effect when compared with standard surgical excision (95% confidence interval, 43.4%-49.1%; P value<.001). Single-center study design. Lack of a randomized control group for ethical reasons. A rate of tissue sparing of 46% can bereached by using MMS for primary BCC with an infiltrative growth pattern.

Histologic subtype of treatment failures after noninvasive therapy for superficial basal cell carcinoma: An observational study

There have been concerns that recurrences after noninvasive therapy for basal cell carcinoma (BCC) transform into a "more aggressive" histologic subtype. We sought to evaluate the proportion of patients with a nonsuperficial treatment failure after noninvasive therapy for superficial BCC. An observational study was performed using data from a single blind, noninferiority, randomized controlled trial (March 2008-August 2010) with 5-year follow-up in patients with primary superficial BCC treated with methylaminolevulinate-photodynamic therapy, 5-fluorouracil, or imiquimod. Data were used from 166 adults with a histologically confirmed treatment failure. A nonsuperficial subtype was found in 64 of 166 treatment failures (38.6%). Proportions with a more aggressive subtype than the primary tumor were 51.3% (38/74) for early and 28.3% (26/92) for later treatment failures (P=.003). The proportion of more aggressive early failures was significantly lower after imiquimod (26.3%) compared with methylaminolevulinate-photodynamic therapy (54.8%, P=.086) and 5-fluorouracil (66.7%, P=.011). There was limited information on the exact time of occurrence of treatment failures. More aggressive treatment failure recurrences after noninvasive therapy for superficial BCC occur most often within the first 3months posttreatment, probably indicating underdiagnosis of more aggressive components in the primary tumor rather than transformation.

Cells to Surgery Quiz: December 2018

Cells to Surgery Quiz: December 2018

Treatments of Primary Basal Cell Carcinoma of the Skin: A Systematic Review and Network Meta-analysis.

Most interventions for basal cell carcinoma (BCC) have not been compared in head-to-head randomized trials. To evaluate the comparative effectiveness and safety of treatments of primary BCC in adults. English-language searches of MEDLINE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Embase from inception to May 2018; reference lists of guidelines and systematic reviews; and a search of ClinicalTrials.gov in August 2016. Comparative studies of treatments currently used in adults with primary BCC. One investigator extracted data on recurrence, histologic clearance, clinical clearance, cosmetic outcomes, quality of life, and mortality, and a second reviewer verified extractions. Several investigators evaluated risk of bias for each study. Forty randomized trials and 5 nonrandomized studies compared 18 interventions in 9 categories. Relative intervention effects and mean outcome frequencies were estimated using frequentist network meta-analyses. Estimated recurrence rates were similar for excision (3.8% [95% CI, 1.5% to 9.5%]), Mohs surgery (3.8% [CI, 0.7% to 18.2%]), curettage and diathermy (6.9% [CI, 0.9% to 36.6%]), and external-beam radiation (3.5% [CI, 0.7% to 16.8%]). Recurrence rates were higher for cryotherapy (22.3% [CI, 10.2% to 42.0%]), curettage and cryotherapy (19.9% [CI, 4.6% to 56.1%]), 5-fluorouracil (18.8% [CI, 10.1% to 32.5%]), imiquimod (14.1% [CI, 5.4% to 32.4%]), and photodynamic therapy using methyl-aminolevulinic acid (18.8% [CI, 10.1% to 32.5%]) or aminolevulinic acid (16.6% [CI, 7.5% to 32.8%]). The proportion of patients reporting good or better cosmetic outcomes was better for photodynamic therapy using methyl-aminolevulinic acid (93.8% [CI, 79.2% to 98.3%]) or aminolevulinic acid (95.8% [CI, 84.2% to 99.0%]) than for excision (77.8% [CI, 44.8% to 93.8%]) or cryotherapy (51.1% [CI, 15.8% to 85.4%]). Data on quality of life and mortality were too sparse for quantitative synthesis. Data are sparse, and effect estimates are imprecise and informed by indirect comparisons. Surgical treatments and external-beam radiation have low recurrence rates for the treatment of low-risk BCC, but substantial uncertainty exists about their comparative effectiveness versus other treatments. Gaps remain regarding high-risk BCC subtypes and important outcomes, including costs. Agency for Healthcare Research and Quality. (PROSPERO: CRD42016043353).