First-line treatment | Second-line treatment | Clinical surgical margin | Histological surgical margin | |
---|---|---|---|---|
Superficial BCC | ||||
| Freezing1 or CO2laser, or ED in lower limbs | PDT × 22 or surgical excision | 3 mm | 1 mm |
| PDT × 2 (freezing after due consideration) | Surgical excision or treatment with ointments3 | 3-5 mm depending on location | >1 mm |
Nodular and fibroepithelioma (Pinkus tumour) | Surgical excision | Freezing after due consideration | 3 mm | 1 mm |
High-grade BCC | Surgical excision | Postsurgical or adjuvant radiotherapy, as necessary | 4-5 mm depending on location | 2-5 mm |
Perineural infiltration | Surgical excision | Postsurgical or adjuvant radiotherapy, as necessary | ≥5 mm | ≥3 mm |
1 To be used by a physician with adequate expertise in the technique, using it for long enough for the margins to thaw in 1 min. 2 PDT twice at an interval of 1-2 weeks. Photosensitizing methyl aminolevulinate ointment is applied to the skin. After letting the ointment work for 3 h, the area is subjected to red light (wavelength 630 nm) for about 8 min. The ointment and the light work together to cause a chemical reaction leading to the destruction of tumour cells. 3 Imiquimod (5%) five days a week for 4-6 weeks, until a crust reaction occurs, or fluorouracil (5%, may require special permit) twice daily for 3-4 weeks until crust reaction. CO2 = carbon dioxide; ED = electrodessication (electric peeling); PDT = photodynamic or light activation treatment | ||||||||||||
Non-surgical treatments
Follow-up and risk of recurrence
Risk of recurrence of basal cell carcinoma according to histological type of growth (WHO Classification of Skin Tumours, 2018 http://publications.iarc.fr/Book-And-Report-Series/Who-Classification-Of-Tumours/WHO-Classification-Of-Skin-Tumours-2018). Source: Source: Hernberg M, Ilmonen S, Juteau S, Jääskeläinen A-S, Koljonen V, et al. Finnish guideline for the treatment of non-melanoma skin cancers. Duodecim Publishing Company 2020.
Specialist consultation
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