TREATMENT FOR BASAL CELL CARCINOMA

Regional lymph node exam
Consider imaging
Multidisciplinary management
Surgery, if possible
Hedgehog pathway inhibitor
Primary or adjuvant radiation therapy
Consideration for clinical trials, systemic therapy

Mohs surgery or
Excision with complete histologic margin evaluation

Suspicious lesion

EDC
Cryosurgery
PDT
Imiquimod
Topical 5-FU
Excision
Mohs surgery^*

End

If tumor-free plane is not achievable
If extensive perineural or large-nerve involvement

^* If lesion meets appropriate use criteria for Mohs surgery.

Note: For nonsurgical candidates (>60 yr), radiation may be considered regardless of tumor characteristics.

Full-body exam
Biopsy

Locally advanced/surgically unresectable tumor
Metastatic tumor

High risk tumor (surgically resectable)

Critical area
Histologically aggressive
Perineural invasion
Large size (>2 cm)
Recurrent
Radiation field

Low risk tumor

<2 cm size
Superficial (epidermis/dermis)