![]() Location below the knee is a relative contraindication because of prolonged wound healing. It is a well-established treatment method for small, well-defined primary BCCs without sclerosing or infiltrative growth patterns. Ĭryotherapy with liquid nitrogen (−196.5☌) has been used to treat nonmelanoma skin cancer since the early 1960s. Furthermore, the cosmetic outcome is regarded as inferior compared with standard excision and therefore it is best avoided in cosmetically sensitive areas. The effectiveness depends heavily on the physician’s skills and technique, and therefore proper training is important. In terminal hair-bearing skin, with a potential follicular extension of the tumor (scalp, pubic, and axillary regions as well as the beard area in men), C&ED is considered less effective. In the latest American Academy of Dermatology guidelines, C&ED is one of the recommended treatment options for carefully selected low-risk primary lesions. Several retrospective studies show its effectiveness for correctly selected lesions (93.0%–96.9% clearance rates after 5 years of follow-up), but many studies fail to provide precise descriptions on the materials and technical protocols that are used. The aim of this review is to summarize the effectiveness, potential adverse events, and indications of the main nonsurgical treatment alternatives for BCC.Īlthough C&ED has been used for decades as a simple and easily performed therapy for low-risk BCCs, there is a lack of randomized controlled studies on the method. Many low-risk tumors can be successfully managed with destructive methods, photodynamic therapy (PDT), or topical medications, while advanced or inoperable BCCs may benefit from radiotherapy or hedgehog pathway inhibitors (HPIs). Nevertheless, with the rising number of patients with BCC, increasing health care costs, and the lack of access to dermatologists in many countries, nonsurgical options may be considered. With regard to the management of BCC, surgery (including Mohs micrographic surgery) is considered the gold standard. Research has reported abnormal function and mutations in PTCH1 in up to 90% of BCCs, making it a target for drug development. Individuals with Gorlin syndrome develop multiple BCCs starting at an early age and the responsible mutation lies in the Hedgehog (Hh) receptor Patched 1 ( PTCH1) gene that mediates Sonic Hh signaling. These understandings have to some extent been derived from studying patients with different genetic syndromes predisposing them to BCC development (eg, Gorlin syndrome) who have a higher risk of developing BCCs. ĭuring the latest decades, insights into genetic and molecular changes behind the origin of BCC have increased. A white background can often be seen, sometimes together with a smaller number of thin arborizing vessels. The morpheaform variant is often feature-poor, even when using dermoscopy. Other findings include white-red structureless areas and ulceration. In infiltrative BCCs, arborizing vessels are usually thinner than in nBCCs. The dermoscopic findings in more aggressive forms of BCC are less well studied. Superficial BCCs (sBCCs) characteristically show fine, short telangiectasias on a whitish-red background and multiple erosions. Under polarized light, shiny white lines can also be found. In nodular BCC (nBCC), arborizing vessels are a common finding, sometimes together with ulceration. The first articles on BCC focused on pigmented BCCs showing a lack of pigment network in combination with blue-gray ovoid nests, multiple blue-gray dots/globules, leaf-like areas, spoke wheel/concentric areas, ulceration, and/or arborizing vessels. Ĭlinically, dermoscopy can assist physicians in the correct diagnosis of BCC, including the histopathological subtype, with relatively high diagnostic accuracy. ![]() The infiltrative, morpheaform, and micronodular subtypes grow in a more aggressive way, whereas superficial and nodular subtypes generally have a less aggressive course and generally respond better to treatment. Moreover, the group includes fibroepithelial basal cell carcinoma with adnexal differentiation, basosquamous carcinoma, and keratotic basal cell carcinoma. The World Health Organization classification of BCC includes superficial, nodular, micronodular, and infiltrating basal cell carcinoma. The exact origin of BCC is not established, but they are considered to arise from keratinocyte cells located in the basal layer and in the dermo-epidermal junction zone. This belief is supported by the fact that the majority of BCCs are found on sun-exposed body parts in middle-aged to elderly people. Exposure from ultraviolet radiation is believed to be the main risk factor for developing BCCs. In Europe, reports show BCC incidence rates between 77 and 158 per 100,000 person-years age-standardized to the European standard population. Basal cell carcinoma (BCC) is by far the most common cancer type in humans.
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