title: Management of high-risk and advanced basal cell carcinoma.
abstract: Despite that basal cell carcinoma (BCC) is curative in the vast majority of cases, some patients are at high risk of recurrence and, in a few patients, lesions can progress to a point unsuitable for local therapy and prognosis is quite poor. The aim of the present work is to review clinical and pathologic characteristics as well as classical and new treatment options for high-risk, metastatic and locally advanced BCC. Surgery and radiotherapy remain the selected treatments for the majority of high-risk lesions. However, some patients are located on a blurry clinical boundary between high-risk and locally advanced BCC. Treatment of these patients is challenging and need an individualized and highly specialized approach. The treatment of locally advanced BCC, in which surgery or radiotherapy is unfeasible, inappropriate or contraindicated, and metastatic BCC has changed with new Hedgehog pathway inhibitors of which vismodegib is the first drug approved by FDA and EMA.
authors: Melanoma Unit, Dermatology Department, Hospital Clínic Barcelona, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain, susipuig@gmail.com.
authors: S
authors: S
authors: Puig
authors: A
authors: A
authors: Berrocal
mesh_terms: D000813:Anilides / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002280:Basal Cell Carcinoma / Q000473:pathology / Q000628:therapy*; D062109:Dermatologic Surgical Procedures / Q000379:methods; D006801:Humans; D015580:Mohs Surgery / Q000379:methods*; D011725:Pyridines / Q000627:therapeutic use*; D011878:Radiotherapy / Q000379:methods*; D012878:Skin Neoplasms / Q000473:pathology / Q000628:therapy*
chemical_list: D000813:Anilides; D000970:Antineoplastic Agents; C538724:HhAntag691; D011725:Pyridines
references: J Cutan Pathol. 2005 Aug;32(7):502-5
references: 16008695
references: Eur J Dermatol. 2006 Jul-Aug;16(4):394-401
references: 16935797
references: Am J Ophthalmol. 2006 Aug;142(2):293-7
references: 16876511
references: Cancer Invest. 2006 Jun-Jul;24(4):396-400
references: 16777692
references: Br J Dermatol. 2008 Jul;159(1):35-48
references: 18593385
references: Acta Derm Venereol. 2012 Nov;92(6):621-2
references: 22965800
references: J Natl Cancer Inst. 1996 Mar 20;88(6):349-54
references: 8609643
references: J Skin Cancer. 2011;2011:392151
references: 21151693
references: J Plast Reconstr Aesthet Surg. 2007;60(10):1103-9
references: 17434350
references: Dermatol Surg. 2002 Nov;28(11):1082-4
references: 12460309
references: ANZ J Surg. 2004 Aug;74(8):704-5
references: 15315581
references: Eur J Dermatol. 2006 Nov-Dec;16(6):691-2
references: 17229614
references: J Am Acad Dermatol. 1984 Jun;10(6):1043-60
references: 6736323
references: J Am Acad Dermatol. 2012 Oct;67(4):531-50
references: 22959232
references: Br J Dermatol. 2004 Sep;151(3):623-6
references: 15377349
references: Cancer. 1985 Apr 15;55(8):1629-32
references: 4038911
references: Am J Otolaryngol. 2001 Nov-Dec;22(6):387-90
references: 11713722
references: Aust N Z J Ophthalmol. 1992 Feb;20(1):5-10
references: 1599668
references: Dermatol Online J. 2006 Sep 08;12(5):7
references: 16962022
references: Nat Rev Cancer. 2008 Oct;8(10):743-54
references: 18813320
references: N Engl J Med. 2012 Jun 7;366(23):2171-9
references: 22670903
references: Dermatol Online J. 2008 Aug 15;14(8):5
references: 19061565
references: Br J Radiol. 2008 Dec;81(972):e290-2
references: 19029050
references: Acta Oncol. 2012 Sep;51(7):952-4
references: 22471747
references: Aust N Z J Ophthalmol. 1997 Nov;25(4):289-93
references: 9395832
references: Arch Dermatol. 2008 Sep;144(9):1186-8
references: 18794464
references: Eye (Lond). 1998;12 ( Pt 2):214-8
references: 9683941
references: Cancer. 1994 Jan 15;73(2):328-35
references: 8293396
references: Lancet Oncol. 2008 Dec;9(12):1149-56
references: 19010733
references: Actas Dermosifiliogr. 2012 Nov;103(9):759-61
references: 22579039
references: Postgrad Med J. 1997 Sep;73(863):538-42
references: 9373591
references: Dermatol Clin. 2012 Jan;30(1):167-75, x
references: 22117877
references: Facial Plast Surg. 2011 Jun;27(3):258-65
references: 21567345
references: Skull Base. 2010 Nov;20(6):409-14
references: 21772797
references: Br J Dermatol. 2005 Sep;153(3):679-80
references: 16120172
references: Am J Ophthalmol. 1992 Feb 15;113(2):123-33
references: 1550179
references: Dermatol Surg. 2005 Nov;31(11 Pt 1):1468-71
references: 16416624
references: Eur J Dermatol. 2006 Sep-Oct;16(5):467-75
references: 17101465
references: N Engl J Med. 2009 Sep 17;361(12):1164-72
references: 19726763
references: Ann Plast Surg. 2009 Nov;63(5):531-5
references: 19801921
references: Eur J Dermatol. 2010 May-Jun;20(3):276-82
references: 20406722
references: Laryngoscope. 2005 Jun;115(6):931-7
references: 15933497
references: N Engl J Med. 2005 Nov 24;353(21):2262-9
references: 16306523
references: Am J Dermatopathol. 2012 Oct;34(7):737-45
references: 23000878
references: Mod Pathol. 2006 Feb;19 Suppl 2:S127-47
references: 16446711
references: Cancer Treat Rev. 2005 Apr;31(2):143-6
references: 15847982
references: Head Neck. 1993 Jul-Aug;15(4):320-4
references: 8360054