title: Basal cell carcinoma-treatments for the commonest skin cancer.
abstract: BACKGROUND
  With an incidence of 70 to over 800 new cases per 100 000 persons per year, basal cell carcinoma (BCC) is a very common disease, accounting for about 80% of all cases of non-melanoma skin cancer. It very rarely metastasizes. A variety of treatments are available for the different subtypes and stages of BCC.
  
  
  METHODS
  This review is based on pertinent literature retrieved by a selective search in the Medline database, as well as the American Cancer Society guidelines on BCC and the German guidelines on BCC and skin cancer prevention.
  
  
  RESULTS
  The gold standard of treatment is surgical excision with histological control of excision margins, which has a 5-year recurrence rate of less than 3% on the face. For superficial BCC, approved medications such as imiquimod (total remission rate, 82-90%) and topical 5-fluorouracil (80%) are available, as is photodynamic therapy (71-87%). Other ablative methods (laser, cryosurgery) are applicable in some cases. Radiotherapy is an alternative treatment for invasive, inoperable BCC, with 5-year tumor control rates of 89-96%. Recently, drugs that inhibit an intracellular signaling pathway have become available for the treatment of locally advanced or metastatic BCC. Phase I and II clinical trials revealed that vismodegib was associated with objective response rates of 30-55% and tumor control rates of 80-90%. This drug was approved on the basis of a non-randomized trial with no control arm. It has side effects ranging from muscle cramps (71%) and hair loss (65%) to taste disturbances (55%) and birth defects.
  
  
  CONCLUSIONS
  The established, standard treatments are generally highly effective. Vismodegib is a newly approved treatment option for locally advanced BCC that is not amenable to either surgery or radiotherapy.
authors: Clinic and Policlinic for Dermatology and Allergology, Ludwig Maximilian University of Munich (LMU), Department of Dermatology, Allergology and Venerology, University Medical Center Schleswig-Holstein, Kiel, Department of Radiotherapy, University Medical Center Regensburg, Germany, Department of Oral and Maxillofacial Radiology, Clinic for Oral and Craniomaxillofacial Surgery, Ludwig-Maximilians University of Munich (LMU), Department of Dermatology and Allergology, Hannover Skin Cancer Center, Hannover Medical School.
authors: Carola
authors: C
authors: Berking
authors: Axel
authors: A
authors: Hauschild
authors: Oliver
authors: O
authors: Kölbl
authors: Gerson
authors: G
authors: Mast
authors: Ralf
authors: R
authors: Gutzmer
mesh_terms: D000813:Anilides / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002280:Basal Cell Carcinoma / Q000175:diagnosis* / Q000628:therapy*; D059248:Chemoradiotherapy / Q000379:methods*; D003131:Combined Modality Therapy; D062109:Dermatologic Surgical Procedures / Q000379:methods*; D006801:Humans; D010778:Photochemotherapy / Q000379:methods*; D011725:Pyridines / Q000627:therapeutic use; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000628:therapy*
chemical_list: D000813:Anilides; D000970:Antineoplastic Agents; C538724:HhAntag691; D011725:Pyridines