From the Guidelines
For fully excised basal cell carcinoma (BCC), follow-up examinations should occur every 6-12 months for at least 5 years, as recommended by the most recent guidelines 1. These visits should include a complete skin examination and assessment of the surgical site for any signs of recurrence. Patients should perform monthly self-examinations of their skin and the surgical site, looking for any new growths, changes in existing lesions, or abnormalities at the excision site. Daily sun protection is essential, including applying broad-spectrum sunscreen with SPF 30+ every 2 hours when outdoors, wearing protective clothing (wide-brimmed hats, long sleeves), and avoiding peak sun hours (10 AM to 4 PM). No specific medications are typically needed after complete excision. These recommendations are important because patients with a history of BCC have a 30-50% risk of developing another BCC within 5 years, as noted in previous studies 1. Regular follow-up allows for early detection of recurrence or new skin cancers, while sun protection helps prevent future skin cancers by reducing exposure to ultraviolet radiation, which is the primary risk factor for BCC development. Some key points to consider in the follow-up of patients with fully excised BCC include:
- The risk of developing another BCC within 5 years is significantly higher in patients with a history of BCC, making regular follow-up crucial 1
- Patient education on sun protection and self-examination is essential for early detection and prevention of future skin cancers
- The use of oral and topical retinoids, celecoxib, and other medications may be considered for prevention of recurrence and new primary keratinocyte cancer formation, but are not typically recommended for all patients 1
From the FDA Drug Label
The clinical outcome of therapy can be determined after resolution of application site reactions and/or local skin reactions. Patients with sBCC treated with Imiquimod Cream should have regular follow-up to re-evaluate the treatment site. The FDA drug label recommends regular follow-up to re-evaluate the treatment site for patients with superficial basal cell carcinoma (sBCC) treated with imiquimod cream, after the skin reaction has subsided.
- Follow-up is necessary to determine the clinical outcome of therapy.
- The label does not provide specific recommendations for follow-up after full excision of the basal cell carcinoma. 2
From the Research
Follow-up Recommendations for Fully Excised BCC
- The need for follow-up of patients after excision of basal cell carcinoma (BCC) varies, but a study from 3 suggests that complete excision is the key to surgical control, and there is no need to follow up patients routinely if the BCC has been completely excised.
- However, other studies such as 4 recommend long-term follow-up in patients with high-risk BCC subtypes, high-risk sites, multiple BCCs, and naevoid basal cell carcinoma syndrome (NBCCS).
- The follow-up period and frequency may vary depending on the individual patient's risk factors and the characteristics of the tumor.
Treatment Options for BCC
- Surgical therapy is considered the gold standard for the treatment of BCC, with high cure rates and the ability to histologically confirm tumor clearance 5.
- Topical therapies such as 5% imiquimod and 5% fluorouracil are effective treatment options for superficial BCC 6, 7.
- Photodynamic therapy is also an effective treatment for superficial BCC and thin nodular BCC 6, 7.
Recurrence Rates and Follow-up
- The overall recurrence rate for BCC is around 5.1%, with 39% of lesions recurring if the tumor is incompletely excised, compared to 1% if it is excised completely 3.
- A study from 6 found that the proportion of patients tumor-free at both 3 and 12 months was 72.8% for photodynamic therapy, 83.4% for imiquimod cream, and 80.1% for fluorouracil cream.
- Regular follow-up is recommended to monitor for recurrence and to detect any new lesions early 4.