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Review
. 2020 Jun 3;100(11):adv00140.
doi: 10.2340/00015555-3495.

Update in the Management of Basal Cell Carcinoma

Nicole Basset-Seguin, Florian Herms
Review

Update in the Management of Basal Cell Carcinoma

Nicole Basset-Seguin et al. Acta Derm Venereol. .

Abstract

Basal cell carcinomas are the most frequent skin cancers in the fair-skinned adult population over 50 years of age. Their incidence is increasing throughout the world. Ultraviolet (UV) exposure is the major carcinogenic factor. Some genodermatosis can predispose to formation of basal cell carcinomas at an earlier age. Basal cell carcinomas are heterogeneous, from superficial or nodular lesions of good prognosis to very extensive difficult-to-treat lesions that must be discussed in multidisciplinary committees. Recent guidelines have updated the management of basal cell carcinoma. The prognosis is linked to the risk of recurrence of basal cell carcinoma or its local destructive capacity. Characteristic molecular events in these tumours are: (i) activation of the hedgehog pathway, which has allowed the development of hedgehog inhibitors for difficult-to-treat lesions that are not accessible to surgery or radiotherapy; (ii) high mutational burden, which suggests that hedgehog inhibitor refractory tumours could be offered immunotherapy; some trials are ongoing. The standard treatment for most basal cell carcinomas is surgery, as it allows excision margin control and shows a low risk of recurrence. Superficial lesions can be treated by non-surgical methods with significant efficacy.

Keywords: prognosis; radiotherapy, hedgehog inhibitors; surgery; treatment; basal cell carcinoma.

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Figures

Fig. 1
Fig. 1
Various basal cell carcinoma (BCC) clinical subtypes. (A) Nodular BCC. (B) Superficial BCC. (C) Morpheiform BCC.
Fig. 2
Fig. 2
Schematic view of the hedgehog (HH) pathway. When HH ligand binds to the transmembrane receptor PTCH1 it releases its inhibitory activity toward smoothened (SMO), which inhibits another negative regulator of the pathway SUFU leading to activation of GLI and GLI target genes. Hedgehog inhibitors are anti-SMO molecules. GLI is a transcription factor activated by SMO.
Fig. 3
Fig. 3
Schematic landscape of treatment options for basal cell carcinoma (BCC).
See this image and copyright information in PMC

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