From the Guidelines
Nodular and infiltrative BCC is a type of basal cell carcinoma that requires thorough treatment, typically through surgical removal with clear margins, due to its aggressive nature and higher risk of recurrence. This type of BCC is characterized by a combination of a raised, nodular component and a deeper, infiltrating growth pattern, making it harder to detect visually and more difficult to treat completely 1. The infiltrative component is particularly concerning because it can extend beyond visible borders, increasing the risk of recurrence if not completely removed 1. Regular follow-up skin examinations are essential after treatment since this type of BCC has a higher recurrence risk compared to purely nodular types 1. Some key points to consider in the treatment of nodular and infiltrative BCC include:
- Surgical excision with 4-mm clinical margins and histologic margin assessment is recommended for low-risk primary BCC 1
- Mohs micrographic surgery is recommended for high-risk BCC 1
- Location of BCC in the H-zone constitutes high risk, independent of size 1
- Radiation therapy may be considered as an alternate or adjuvant option 1
- Hedgehog pathway inhibitors may be considered for advanced and metastatic BCC 1
From the Research
Definition of Nodular and Infiltrate BCC
- Nodular BCC refers to a type of basal cell carcinoma that is characterized by its nodular growth pattern 2.
- Infiltrate BCC is not explicitly defined in the provided studies, but it can be inferred that it refers to a type of BCC that infiltrates or invades surrounding tissues.
Characteristics of Nodular BCC
- Nodular BCC is a common subtype of BCC, and preoperative curettage may be helpful in delineating its margins 2.
- Nodular BCC can be effectively treated with surgical excision, and preoperative curettage may lead to a complete or almost complete tumor removal 2.
Treatment Options for BCC
- Surgical excision is the standard treatment for BCC, but other options such as Mohs micrographic surgery, cryosurgery, electrodesiccation and curettage, topical imiquimod, and photodynamic therapy may be considered depending on the patient's condition and tumor characteristics 3, 4, 5.
- For locally advanced BCC, systemic therapies such as Hedgehog pathway inhibitors or immune checkpoint inhibitors may be indicated when surgical excision is not possible 6.
Management of Locally Advanced BCC
- The management of locally advanced BCC relies on a multidisciplinary team approach, with goals including local control, palliation of symptoms, achieving acceptable cosmetic results, and reducing the risk of recurrence 6.
- Surgical excision is the first line of treatment for locally advanced BCC, but when resection is not possible, systemic therapies such as Hedgehog pathway inhibitors or immune checkpoint inhibitors are indicated 6.