Management of basal cell carcinoma at low risk of recurrence

BCC: basal cell carcinoma.
* Low-risk primary BCC:^[1]

• Well-defined, primary BCC <20 mm located on trunk or extremities (excluding genitalia, pretibia, hands, and feet).
• Histopathologically nodular or superficial histopathologic growth pattern, other nonaggressive growth patterns (infundibulocystic, fibroepithelioma of Pinkus). Lack of perineural invasion.
• No history of radiation therapy at site.
• Immunocompetent patient.

¶ Recurrent BCC following treatment with topical therapies or photodynamic therapy are considered high-risk tumors. These lesions are best treated with conventional re-excision or Mohs surgery. Refer to UpToDate topics on the management of BCC at high risk of recurrence for additional information.
Δ Radiation therapy is not indicated in patients <60 years because of risk of long-term, local complications and in patients with genetic syndromes predisposing to skin cancers (eg, Gorlin syndrome, xeroderma pigmentosum).
◊ In patients with multiple medical comorbidities or an anticipated limited lifespan, close clinical follow-up for a slow-growing, low-risk BCC may be a reasonable option.