First-line treatment | Second-line treatment | Clinical surgical margin | Histological surgical margin | |
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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 | ||||
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 | HASH(0x2fcfe80) 5 mm | HASH(0x2fcfe80) 3 mm |
Low-grade BCC | High-grade BCC |
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Superficial | Infiltrating |
Fibroepithelioma or Pinkus tumour | Sclerosing (morpheaform) |
Nodular | Micronodular |
Pigmented | Basosquamous |
Infundibular cystic | Sarcomatoid |