High-risk basal cell carcinoma: an update

Abstract

High-risk basal cell carcinoma (BCC) is an aggressive malignant tumor of the skin, with a potential of perineural, lymphatic and vascular spreading. This review presents the most common types and anatomical sites of high-risk BCC, and evaluates the diagnosis, clinical presentation and treatment options available. Based on the current data, micrographically controlled (Mohs) surgery or frozen section controlled excision is the treatment of choice. In cases with impossible complete tumor resection, radiotherapy is an alternative. In patients with a high risk of recurrence, adjuvant radiotherapy is used. Medical treatment of high-risk BCC is rather limited. Metastatic BCC have been treated with cisplatin-based chemotherapy. Chemo-immunotherapy, monoclonal antibodies and electrochemotherapy have been used more recently, but only case reports have been published. There is a need for controlled clinical trials. Regular follow-up is necessary in patients with high-risk BCC, but as yet no international consensus has been achieved. The German Dermatologic Society recommends 5 years of follow-up for all BCC patients.