New Directions in the Treatment of Basal Cell Carcinoma - Episode 1

Overview and Burden of BCC

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Sherrif F. Ibrahim, MD, PhD, and Vishal Patel, MD, FAAD, FACMS, provide an overview of BCC and discuss disease burden.

Sherrif F. Ibrahim, MD, PhD: Welcome to this Dermatology Times® Recognize & Refer presentation titled, “New Directions in the Treatment of Basal Cell Carcinoma.” I’m Dr Sherrif Ibrahim, an associate professor of dermatology at the University of Rochester Medical Center. I have the pleasure of being joined by Dr Vishal Patel, an associate professor of dermatology and medicine/oncology at the George Washington School of Medicine. He’s also the director of the cutaneous oncology program there. Welcome, Dr Patel. It’s a pleasure to have this discussion with you. We’ll provide an overview of basal cell carcinoma [BCC] and discuss how to treat BCC with a multidisciplinary approach. In addition, we’ll look at one hypothetical case based on a real case, which will be a nice focal point for our discussion. Let’s dive right into it.

Dr Patel, you and I treat a lot of basal cell carcinoma. It’s probably the most common thing we treat. Certainly, in my practice it is. With the increasing incidence of basal cell carcinoma, give us an overriding statement about the burden of basal cell cancer on the health care system, how important it is for people to see dermatologists, especially patients who are at risk, and how you’ve been seeing patterns of basal cell carcinoma change in your own practice.

Vishal Patel, MD, FAAD, FACMS: First, thanks for having me, Dr Ibrahim. It’s an honor to be here, and I’m excited about this discussion. To frame our discussion, this is a great question. We’re clearly seeing this rising incidence of basal cell carcinoma. It comprises more cancers than all cancers combined, that 1 specific subtype of nonmelanoma skin cancer, when you combine it with squamous cell carcinomas. It’s the vast majority of what we see and the vast majority of cancers that affect Americans as well as patients worldwide.

Basal cell carcinoma is unique in the sense that there’s a vast variety of presentations. The vast majority of them are easily managed with early intervention. We’re now seeing some practice variations, whether you look at how Europeans, Australians, and Americans manage that as a function of the commonality of that disease, but also as a function of how we’re seeing younger patients being diagnosed with basal cell carcinoma.

The gold standard of surgery is the obvious slam dunk choice for basal cell carcinoma in most cases, but not all of them. That can go either way, such as avoiding surgery because the cancer is extremely large or because it doesn’t fit the patient now that we’re seeing younger patients. It’s thoughtful to think about the disease and what it’s going to do as a whole to figure out what works for our patient. I’m curious about your thoughts as well, Dr Ibrahim.

Sherrif F. Ibrahim, MD, PhD: I couldn’t agree more. The name of the game is identifying the lesions early and then treating them accordingly. A lot of what I hear is, “Doctor, if it isn’t going to kill me and it’s slow growing, why should I take care of it? Why should I bother doing anything?” Then I usually show them 1 picture of what an advanced basal cell cancer can look like, and they’re ready to begin treatment.

I always ask patients, “How long have you had this? How long has it been since you first noticed something?” We’re usually the third doctor that they see, because they’ve had this spot. What does every patient say? “I thought it was a pimple. I thought it was a bug bite.” If it sits on their nasal bridge, they say, “I thought it was from my glasses rubbing or from my CPAP [continuous positive airway pressure] machine.” They have this spot they’ve had for a few months, it has been bleeding and hasn’t been healing. They see their primary care doctor, who says, “I’m not sure what that is.” But the astute ones say, “I’m not sure. I’ll make a referral to dermatology.” For dermatologists, this is our bread and butter. We can look at it, visually diagnose it, and say, “This is a basal cell cancer.” Then the general dermatologists will biopsy it and make the referral typically to the Mohs surgeon, especially for lesions on the head and neck.

Transcript Edited for Clarity