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Update in the Management of Basal Cell Carcinoma

Nicole Basset-Seguin, Florian Herms
DOI: 10.2340/00015555-3495

Preview of fully accepted paper, still not published in any volume

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.

Significance

Basal cell carcinoma is the most frequent cancer in fair-skinned adults. The molecular background to these tumours includes activation of a cellular pathway called the “sonic hedgehog pathway”. Basal cell carcinomas are induced by ultraviolet light and occur more frequently on areas of skin that are exposed to the sun. Basal cell carcinomas rarely spread to other sites in the body, although there is a risk that they will recur. There are different subtypes of these tumours with different potential to relapse. This paper gives an update of what is known about basal cell carcinomas and their treatment. The standard treatment is surgery. The prognosis for advanced basal cell carcinomas that cannot be operated on has improved with the development of systemic drugs targeting the hedgehog pathway.

Supplementary content

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