Skin Cancer Basal Cell Carcinoma Treatment
There are several factors to consider before choosing the best treatment modality. Options depend on the location, histologic type and patient concerns.
Nodular and superficial BCCs are the least aggressive and can be completely removed by electrodesiccation and curettage or by simple surgical excision. Superficial BCC can be treated with every other day application of imiquimod cream. This immune modulating agent induces an intense inflammatory reaction and the tumor clears without scarring.
The histologic helps to determine therapy. The micronodular, infiltrative, and morpheaform BCCs have a higher incidence of positive tumor margins after excision and have the greatest recurrence rate. Clinically, BCCs with these patterns have poorly defined borders and are not apparent during physical examination. They subtly extend into surrounding tissue and are easily missed by blind treatment techniques such as surgical excision. These tumors need more aggressive treatment with wide excision or microscopically controlled surgery.
Tumor size is important consideration. Electrodesiccation and curettage afford excellent results for small (less than 2 cm) nodular BCCs located on the forehead and cheeks. Nodular BCCs on the forehead and cheek that are larger and have well-defined margins should be excised and closed; electrosurgery for large tumors may result in large, unsightly scars. The margins of sclerosing BCCs cannot be determined by inspection, and either excision or, preferably, Moh’s micrographic surgery should be performed.
The location of the tumor must also be considered when making a decision about treatment. Tumors about the nose, eye, and ear require special consideration. Lesions of the nose greater than 1 cm, lesions of the margin of the eyelid and the vermilion border of the lip, lesions involving cartilage, and sclerosing epitheliomas respond poorly to electrodesiccation and curettage. BCCs of the medial canthus are particularly dangerous. The skin rests close to bone and cartilage, and tumor cells initially invade and proceed to migrate undetected along periosteum or perichondrium. Healing occurs over inadequately treated tumors, and deep invasion and lateral extension can remain undetected, resulting in a tumor of massive proportions. Extension to the eye and brain is possible.