Basal Cell Carcinoma Treatment

Question 1

What are the options for basal cell carcinoma treatment?

Answer 1

Excision (absolutely first-line)
Mohs micrographic surgery
Radiotherapy
Topical 5-fluorouracil cream

Question 2

Why excision to treat BCC?

Answer 2

Commonly removes all malignant cells

Also allows diagnosis to be made histologically

Question 3

What is Mohs micrographic surgery, how does it work, and why use it to treat BCC?

Answer 3

Aims for extremely narrow excision margins
- uses repeat histology to guide fine limit of excision border
Useful where there is limited local skin for closure and/or if there are nearby structures that are best avoided

Question 4

Why radiotherapy to treat BCC?

Answer 4

Used to shrink lesions and reduce troublesome bleeding, often in cases where resection is difficult because:

• lesion is so large that flap reconstruction would be necessary
• patient is unsuitable for general anaesthetic

Question 5

Why topical 5-fluorouracil cream to treat BCC?

Answer 5

Commonly used for areas of skin with multiple/recurrent actinic keratosis
Recently used in some instances of basal cell carcinoma (just remember it’s not contraindicated so can be used)

Question 6

Why not use chemotherapy for treatment of BCC?

Answer 6

• Significant side-effects
• Existing variety of effective local therapies
• BCCs do not metastasise

TLDR - unnecessary and not indicated