What are the implications of basal cell carcinoma (BCC) found on pathology report?

From the Guidelines

Basal cell carcinoma (BCC) found on pathology requires prompt treatment to prevent further growth and tissue damage, and the recommended approach typically involves complete removal of the cancer through surgical excision with 4-5mm margins, Mohs micrographic surgery, or other methods as indicated by the size, location, and subtype of the BCC 1. The management of BCC primarily consists of surgical approaches, with radiation therapy as an alternate or adjuvant option, and many superficial therapies have been explored and continue to be developed, including topicals, cryosurgery, and photodynamic therapy 1. Some key considerations in the management of BCC include:

• The size, location, and subtype of the BCC, which can influence the choice of treatment
• The use of surgical excision with 4-5mm margins, Mohs micrographic surgery, electrodessication and curettage, or topical treatments like imiquimod 5% cream or 5-fluorouracil for very superficial BCCs
• The potential role of radiation therapy for patients who cannot undergo surgery
• The importance of regular skin examinations every 6-12 months after treatment, as patients with one BCC have a 30-50% chance of developing another within 5 years 1
• The need for sun protection to prevent recurrence, including daily broad-spectrum sunscreen (SPF 30+), protective clothing, wide-brimmed hats, and avoiding peak sun hours (10am-4pm) It is also important to note that BCCs develop from abnormal basal cells in the epidermis, typically due to cumulative UV radiation exposure causing DNA damage, which explains why they commonly appear on sun-exposed areas like the face and neck 1. In terms of specific treatment options, surgical excision with 4-5mm margins is a highly effective treatment for primary BCC, with a recurrence rate of < 2% reported 5 years following histologically complete excision 1. Additionally, Mohs micrographic surgery is a useful approach for facial BCCs or recurrent tumors, as it allows for the complete removal of the cancer while preserving as much normal tissue as possible 1. Overall, the goal of treatment for BCC is to completely remove the cancer while minimizing morbidity and preserving quality of life, and the choice of treatment should be individualized based on the specific characteristics of the tumor and the patient's overall health status 1.

From the FDA Drug Label

ODOMZO is a hedgehog pathway inhibitor indicated for the treatment of adult patients with locally advanced basal cell carcinoma (BCC) that has recurred following surgery or radiation therapy, or those who are not candidates for surgery or radiation therapy (1)

• Basal cell carcinoma treatment: The patient has basal cell carcinoma found on pathology.
• Treatment option: Sonidegib (ODOMZO) is indicated for the treatment of adult patients with locally advanced basal cell carcinoma (BCC) that has recurred following surgery or radiation therapy, or those who are not candidates for surgery or radiation therapy 2.
• Alternative treatment: Imiquimod cream is also an option for the treatment of superficial basal cell carcinoma, with a composite clearance rate of 75% at 12 weeks post-treatment 3.

From the Research

Basal Cell Carcinoma Diagnosis and Treatment

• Basal cell carcinoma (BCC) is the most commonly diagnosed skin cancer worldwide, with various treatment options available depending on the stage and location of the cancer 4, 5.
• The standard treatment for BCC involves complete removal of the lesion by excision or Mohs surgery, with other options including cryosurgery, electrodesiccation and curettage, topical medications, and photodynamic therapy 6, 7, 8.
• For advanced BCC, hedgehog pathway inhibitors such as vismodegib and sonidegib have emerged as important treatment options, with clinical efficacy and safety demonstrated in large, international phase 2 clinical trials 4.
• The choice of treatment depends on various factors, including the size and location of the tumor, the patient's overall health, and the risk of recurrence 5, 7.
• Topical treatments such as imiquimod and 5-fluorouracil may be effective for small, low-risk BCC lesions, but are generally considered inferior to surgical excision 6, 7.

Treatment Outcomes and Prognosis

• The prognosis for BCC is generally good, with a low metastatic potential and high cure rates when treated early 5, 8.
• However, advanced BCC can be challenging to treat and may have poorer outcomes, with a higher risk of recurrence and metastasis 4, 5.
• The use of hedgehog pathway inhibitors has improved treatment outcomes for advanced BCC, but more research is needed to fully understand their efficacy and safety 4, 5.

Future Directions

• Further research is needed to improve treatment outcomes for BCC, particularly for advanced cases 4, 5, 7.
• The development of new treatments, such as molecular targeting agents, may offer promising therapeutic options for BCC 5, 7.
• Continued education and awareness about skin cancer prevention and early detection are essential for improving outcomes and reducing the incidence of BCC 8.