Non-melanoma Skin Cancer in Canada Chapter 4: Management of Basal Cell Carcinoma

Abstract

Background: Basal cell carcinoma (BCC) is the most common malignancy. Growth of BCCs leads to local destruction of neighbouring healthy skin and underlying tissue and can result in significant functional and cosmetic morbidity.

Objective: To provide guidance to Canadian health care practitioners regarding management of BCCs.

Methods: Literature searches and development of graded recommendations were carried out as discussed in the accompanying Introduction.

Results: Although BCCs rarely metastasize, they can be aggressive and disfiguring. This chapter describes the natural history and prognosis of BCCs. Risk stratification is based on clinical features, including the site and size of the tumour, its histologic subtype (nodular vs sclerosing), and its history of recurrence.

Conclusions: Various options should be considered for BCC treatment, including cryosurgery, curettage, and topical or photodynamic approaches, as well as fixed-margin surgery and Mohs micrographic surgery. Stratification of recurrence risk for individual BCCs determines the most appropriate therapeutic course.

Keywords: Mohs micrographic surgery; basal cell carcinoma; cryosurgery; photodynamic therapy; radiation therapy; surgical margin.