Management of basal cell carcinoma at high risk for recurrence

BCC: basal cell carcinoma; CCPDMA: complete circumferential peripheral and deep margin assessment.

* High-risk primary BCC:^[1]

• Tumors of any size on the head, neck, hands, feet, pretibia, and anogenital areas
• Tumors ≥20 mm in diameter on trunk and extremities
• Poorly defined borders
• Histopathology showing aggressive features (micronodular, morpheaform, sclerosing, mixed infiltrative, basosquamous or carcinosarcomatous); perineural invasion
• Recurrent tumors
• Tumors in sites of prior radiation therapy
• Immunocompromised patient

¶ Nonsurgical candidates include older patients with multiple comorbidities who may not tolerate surgery, patients with locally advanced disease, and patients who decline surgery.

Δ Tumor location may preclude the use of radiation therapy in some patients. Refer to additional UpToDate topics for more information.

◊ Systemic therapies for advanced BCC are discussed in detail in the additional UpToDate topics on the systemic treatment of advanced BCC and cutaneous squamous cell carcinoma not amenable to local therapies.