Each year, physicians diagnose an estimated 2 to 3 million new cases of basal cell carcinoma (BCC) in the United States alone. Identified in its early stage, BCC typically can be cured with complete surgical excision and/or radiation. But, for the the more than 20,000 cases that progress to locally advanced or metastatic BCC annually, diagnosis, treatment, and management can be much more complex.1,2,3,4,5,6
In this exclusive report, experts in dermatology and oncology detail best-practice recommendations for developing an optimal care regimen based on the patient’s individual case. They provide a framework to determine when surgery is a solution, when it is not, and what is new to the armamentarium to address issues of efficacy, safety, and tolerability. This practical resource offers a comprehensive guide for meeting the challenges of advanced BCC—from diagnosis and team building to monitoring and long-term management.
By the time patients present to Darrell S. Rigel, MD, with advanced basal cell carcinoma (BCC), their lesions are likely to be too large or too numerous to be curable with a simple surgical solution. “You get to a point where there are just positive margins or the lesion is so large that it’s going to require inpatient treatment,” he says. “Because of the complexity, it’s important to build a multidisciplinary team to assess the patient, create a treatment plan, and optimize ongoing management.” Find out how to build a strong team and what each member can contribute.
What risks do patients with the highest stage advanced BCC have for metastasis or death? Chrysalyne D. Schmults, MD, and her team at Brigham and Women’s Hospital in Boston, Massachusetts, developed a new staging system to help answer that question. Here, she shares insights on tumor classification, its implication for treatment, and the ground rules for creating an effective tumor review board.
Darrell S. Rigel, MD, talks through the pros, cons, and unknowns of established medications such as Hedgehog inhibitors and newly FDA-approved drugs such as cemiplimab (Libtayo; Sanofi and Regeneron Pharmaceuticals). Get the latest on dosing, drug holidays, tolerability, and long-term disease management.
Chrysalyne D. Schmults, MD, provides talking points on assessing which patients are ideal candidates for surgery and, when surgery is not an option, matching medications to the needs and quality of life concerns for the individual patient. She offers best-practice guidance for optimizing treatment choices that address challenges surrounding extended durability, reduction of adverse effects, and improvement in rates of occurrence of progression.
In the world of medical oncologist Ann W. Silk, MD, MS a 30% response rate can be good news. So can drugs that can limit side effects to address a discontinuation rate that may be as high as 30%. Silk discusses the mechanisms of action of existing and new tools, such as immunotherapy, and recommendations for how physicians can maximize their effectiveness in a clinical setting.
Darrell S. Rigel, MD, MS, FAAD vision of the future treatment innovations for would include medications based on better-targeted immune pathways, effective ways to treat metastatic BCC, and a vaccine to prevent advanced BCC from developing. Rigel addresses these and other developments he sees or would like to see on the horizon.
Is timing everything? Chrysalyne D. Schmults, MD, FAAD looks to a future where clinicians have a better understanding of the “how” and “when” of using hedgehog inhibitors and anti-PD1 medication. Here are the questions she’d like to see answered in upcoming research.
Among other things, it is about what happens before the scalpel that Ann W. Silk, MD, MS would like to see more research into advanced BCC treatment. Neoadjuvant therapies show promise in helping patients avoid or downgrade surgery, as she explains here. Silk also delves into other areas of research that offer new potential for treating advanced BCC.
1. Puig S, Berrocal A. Management of high-risk and advanced basaI cell carcinoma. Clin Transl Oncol. 2015;17(7):497-503.
2. Cameron MC, Lee E, Hibler BP, et aI. Basal cell carcinoma: epidemiology; pathophysiology; cIinicaI and histological subtypes; and disease associations. J Am Acad Dermatol. 2019;80(2):303-317.
3. Migden MR, Chang ALS, Dirix L, Stratigos AJ, Lear JT. Emerging trends in the treatment of advanced basal cell carcinoma. Cancer Treat Rev. 2018;64:1-10.
4. Asgari MM, Moffet HH, Ray GT, Quesenberry CP. Trends in basal celI carcinoma incidence and identification of high-risk subgroups, 1998-2012. JAMA Dermatol. 2015;151(9):976-981.
5. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Basal Cell Skin Cancer V.2.2021. © National Comprehensive Cancer Network, Inc. 2021. All rights reserved. Accessed March 1, 2021. To view the most recent and complete version of the guidelines, go onIine to NCCN.org.
6. Skin Cancer Foundation. Our new approach to a challenging skin cancer statistic. Published April 1, 2021. Our New Approach to a Challenging Skin Cancer Statistic