ADVANCED BASAL CELL CARCINOMA (BCC)

Advanced BCC encompasses a heterogeneous assortment of cases, including metastatic BCC as well as locally advanced BCC (for which no formal definition exists but which generally includes large, deep, aggressive, or recurrent tumors).

  • Most BCCs can be effectively treated with standard surgical excision, Mohs micrographic surgery, curettage and electrodessication, radiotherapy, and/or superficial field therapies (including 5-fluorouracil, imiquimod, and photodynamic therapy); however, a minority of patients develop advanced BCC.

Locally advanced Basal Cell Carcinoma (LaBCC) In general, this classification often includes large, aggressive, or recurrent tumors or those with deeper penetration into the underlying skin and surrounding tissues.

  • LaBCC may be broadly categorized as cases for which (further) surgery is considered inappropriate (i.e., would be substantially disfiguring, may cause significant morbidity, loss of function), and radiation is considered inappropriate as a single modality or second-line treatment.

Metastatic BCC is defined as primary cutaneous basal cell carcinoma that has spread to local or distant lymph nodes or to distant organs or tissues.

Risk for Recurrence and Metastasis

Recurrence of primary BCC lesions can also occur. The 3 year risk of BCC recurrence after having a single BCC is about 44%.

  • Despite the fact that recurrent lesions tend to be more aggressive, the prognosis for patients with recurrent BCC generally remains favorable. However, recurrent BCC is an indication for even more frequent monitoring and skin examinations.

Risk factors for BCC recurrence and the rare likelihood of metastasis include tumor location and size, tumor involvement of clinical borders, recurrent disease, immunosuppression, prior radiotherapy, perineural involvement, and micronodular, infiltrative, sclerosing, and morpheaform patterns on histology.

 

Treatment Options

Most basal cell carcinomas can be removed with surgery if they are found early, however, the course of treatment for BCC depends on the size and location of the tumour. Only a small proportion of BCC patients progress to advanced disease that cannot be treated with surgery or radiotherapy. Learn about the different treatment options for BCC CLICK HERE