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  • Presentation

Basal Cell Carcinoma: Review and Updates

Description

Dr. John Annegrees from Der Dermatology in Tampa, FL, presents a comprehensive review of basal cell carcinoma (BCC), highlighting its prevalence, increasing incidence, and associated morbidity and costs. He emphasizes why it is crucial to understand BCC, given that nearly one in five Americans will be affected. He discusses the potential for further skin cancers developing in patients with a history of BCC, especially melanoma, noting their significant risk factors. The presentation includes recent papers suggesting a reevaluation of treatment approaches for older patients and new methods for prevention, such as topical and systemic options like nicotinamide and isotretinoin. Novel therapeutic options targeting the Hedgehog pathway, including vismodegib, and promising updates on immune checkpoint inhibitors signify a shift toward more effective treatments. Dr. Annegrees also highlights evolving perspectives on surgical standards, including successes with Mohs micrographic surgery compared to emerging radiation therapies. He acknowledges the importance of patient preferences, particularly cosmetic concerns, in selecting treatment approaches, and urges careful consideration of systemic treatments, new drug developments, and the ongoing clinical trials aimed at refining BCC management. Overall, the latest insights seek to optimize and personalize care for individuals battling BCC.

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Conclusions

  • Basal cell carcinoma (BCC) affects nearly 1 in 5 Americans and accounts for 50% of all cancers in the US, with an increasing incidence.
  • Patients with a history of BCC have a high likelihood of developing subsequent skin cancers, including an 82% chance if they have had multiple lesions.
  • The treatment impact on health-related quality of life, particularly in older patients, necessitates a critical evaluation of treatment approaches based on life expectancy.
  • Common mutations contributing to BCC pathogenesis are primarily found in the Hedgehog signaling pathway, presenting targets for therapy.
  • DNA repair enzymes, antioxidants, and certain compounds like metformin show potential in preventing BCC development, particularly in patients with skin of color.
  • Nicotinamide can reduce the incidence of BCC lesions, though its effects do not persist beyond the treatment period.
  • New studies suggest emicuzumab may surpass traditional options like fluorouracil for basal cell cancer protection, although findings can be conflicting.
  • Image-guided superficial radiation therapy (SRT) presents a promising alternative to traditional surgical methods for BCC patient management, showing lower recurrence rates.
  • Surgical excision remains the gold standard for managing BCC, with consideration for cosmetic implications being a primary patient concern.
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  • Ciążyńska M, Narbutt J, Woźniacka A, Lesiak A. Trends in basal cell carcinoma incidence rates: a 16-year retrospective study of a population in central Poland. Postepy Dermatol Alergol. 2018;35(1):47-52.
  • Stern RS. The risk of squamous cell and basal cell cancer associated with psoralen and ultraviolet A therapy: a 30-year prospective study. J Am Acad Dermatol. 2012;66(4):553-562.
  • Ruiter R, Visser LE, Eijgelsheim M, et al. High-ceiling diuretics are associated with an increased risk of basal cell carcinoma in a population-based follow-up study. Eur J Cancer. 2010;46(13):2467-2472.
  • Wehner MR, Linos E, Parvataneni R, Stuart SE, Boscardin WJ, Chren MM. Timing of subsequent new tumors in patients who present with basal cell carcinoma or cutaneous squamous cell carcinoma. JAMA Dermatol. 2015;151(4):382-388.
  • Ricci F, Paradisi A, Fania L, et al. High melanoma risk in non-melanoma skin cancer patients under age 40: a large retrospective cohort study. Ital J Dermatol Venerol. 2021;156(2):240-243.
  • Sehgal VN, Chatterjee K, Pandhi D, Khurana A. Basal cell carcinoma: pathophysiology. Skinmed. 2014;12(3):176-181.
  • Kilgour JM, Jia JL, Sarin KY. Review of the Molecular Genetics of Basal Cell Carcinoma; Inherited Susceptibility, Somatic Mutations, and Targeted Therapeutics. Cancers (Basel). 2021;13(15):3870. Published 2021 Jul 31.
  • Fania L, Didona D, Morese R, et al. Basal Cell Carcinoma: From Pathophysiology to Novel Therapeutic Approaches. Biomedicines. 2020;8(11):449. Published 2020.
  • Chai JY, Sugumar V, Alshawsh MA, et al. The Role of Smoothened-Dependent and -Independent Hedgehog Signaling Pathway in Tumorigenesis. Biomedicines. 2021;9(9):1188. Published 2021 Sep 10.
  • Couve-Privat S, Le Bret M, Traiffort E, et al. Functional analysis of novel sonic hedgehog gene mutations identified in basal cell carcinomas from xeroderma pigmentosum patients. Cancer Res. 2004;64(10):3559-3565.
  • Mazzà D, Infante P, Colicchia V, Greco A, et al. PCAF ubiquitin ligase activity inhibits Hedgehog/Gli1 signaling in p53-dependent response to genotoxic stress. Cell Death Differ. 2013;20(1688-1697).
  • Wolff F, Loipetzberger A, Gruber W, et al. Imiquimod directly inhibits Hedgehog signalling by stimulating adenosine receptor/protein kinase A-mediated GLI phosphorylation. Oncogene. 2013;32(5574-5583).
  • Sohn GK, Kwon GP, Bailey-Healy I, et al. Topical Itraconazole for the Treatment of Basal Cell Carcinoma in Patients With Basal Cell Nevus Syndrome or High-Frequency Basal Cell Carcinomas: A Phase 2, Open-Label, Placebo-Controlled Trial. JAMA Dermatol. 2019;155(9):1078-1080.
  • Kilgour JM, Shah A, Urman NM, et al. Phase II Open-Label, Single-Arm Trial to Investigate the Efficacy and Safety of Topical Remetinostat Gel in Patients with Basal Cell Carcinoma. Clin Cancer Res. 2021;27(17):4717-4725.
  • Campolmi P, Brazzini B, Urso C, et al. Superpulsed C02 laser treatment of basal cell carcinoma with intraoperatory histopathologic and cytologic examination. Dermatol Surg. 2002;28(10):909-912.
  • Karsai S, Friedl H, Buhck H, Jünger M, Podda M. The role of the 595-nm pulsed dye laser in treating superficial basal cell carcinoma: outcome of a double-blind randomized placebo-controlled trial. Br J Dermatol. 2015;172(3):677-683.
  • Markowitz O, Bressler MY. Combining Nd:YAG laser with optical coherence tomography for nonsurgical treatment of basal cell carcinoma. Lasers Surg Med.
  • Kranz S, Brunnmeier G, Yilmaz P, et al. Optical coherence tomography-guided Nd:YAG laser treatment and follow-up of basal cell carcinoma. Lasers Surg Med. 2023;10.1002/lsm.23638.
  • Ross AS, Schlesinger T, Harmon CB, et al. Multicenter, prospective feasibility study of Nano-Pulse Stimulation technology for the treatment of both nodular and superficial low-risk basal cell carcinoma. Front Oncol. 2022;12:1044694. Published 2022 Dec 2.
  • Nuccitelli R, LaTowsky BM, Lain E, et al. Safety and Efficacy of Nano-Pulse Stimulation Treatment of Non-Genital, Cutaneous Warts (Verrucae). Lasers Surg Med. 2021 Dec;53(10):1301-1306.
  • Munavalli GS, Zelickson BD, Selim MM, et al. Safety and Efficacy of Nanosecond Pulsed Electric Field Treatment of Sebaceous Gland Hyperplasia. Dermatol Surg.
  • Hruza GJ, Zelickson BD, Selim MM, et al. Safety and Efficacy of Nanosecond Pulsed Electric Field Treatment of Seborrheic Keratoses. Dermatol Surg. 2020.
  • Chen AC, Martin AJ, Choy B, et al. A Phase 3 Randomized Trial of Nicotinamide for Skin-Cancer Chemoprevention. N Engl J Med. 2015;373(17):1618-1626.