From the Guidelines
Mohs micrographic surgery (MMS) is the recommended skin removal technique for high-risk basal cell carcinoma, particularly in areas where tissue preservation is crucial, such as the face, or for recurrent tumors. This technique involves removing thin layers of skin and examining them microscopically during the procedure until all cancer cells are removed, ensuring complete removal of the tumor while preserving as much healthy tissue as possible 1. For low-risk primary basal cell carcinomas, surgical excision with 4-mm clinical margins and histologic margin assessment is recommended 1. The choice of technique depends on the tumor's size, location, subtype, and whether it's a primary or recurrent lesion. Other removal techniques, such as curettage and electrodesiccation, cryosurgery, and laser surgery, may be considered for specific cases, but MMS is generally preferred for its high cure rate and tissue-sparing capabilities 1. Key considerations in selecting a skin removal technique include:
- Tumor size and location
- Subtype of basal cell carcinoma
- Risk of recurrence
- Patient expectations and preferences
- Potential adverse effects of the procedure
- Need for tissue preservation, particularly in high-risk areas like the face.
From the Research
Skin Removal Techniques for Basal Cell Carcinoma
The following skin removal techniques are used to remove basal cell carcinoma:
- Surgical excision: This is the standard treatment for basal cell carcinoma, and it involves removing the tumor and some surrounding skin 2, 3, 4.
- Mohs micrographic surgery: This is a specialized surgical technique that involves removing the tumor layer by layer, and it is often used for high-risk lesions or lesions in sensitive areas 2, 3, 4.
- Electrodesiccation and curettage (ED&C): This is a procedure that involves scraping away the tumor with a curette and then using an electric current to destroy any remaining cancer cells 2.
- Radiotherapy: This is a treatment that uses radiation to kill cancer cells, and it may be used as an alternative to surgery in some cases 2, 3, 5.
Factors Influencing Treatment Choice
The choice of treatment for basal cell carcinoma depends on several factors, including:
- The size and location of the tumor 3, 4
- The type of basal cell carcinoma (e.g. primary or recurrent) 3
- The patient's overall health and medical history 3, 4
- The potential for scarring or disfigurement 3, 4
Effectiveness of Treatment Options
Studies have shown that:
- Mohs micrographic surgery has a higher cure rate than surgical excision for recurrent basal cell carcinoma 3
- Radiotherapy is a effective treatment option for basal cell carcinoma, especially for patients who are not surgical candidates 5
- Hedgehog pathway inhibitors are a promising new treatment option for advanced basal cell carcinoma 6