0521779407-15 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:43
1062 Nonmelanoma Skin Cancers: BCC■Aggressive histologic types: morphea-like, micronodular sclerosing,
recurrent, baso-squamous type
■Size:>2cm
■Immunosuppressed patients
Cryosurgery:
■Best for smaller lesions not in the “H zone”, <2 cm in size
■Not for recurrent lesions or tumors involving bone or cartilage
Radiation therapy:
■Best for older patients with small lesions or patients unable or unwill-
ing to have surgery
■Not for previously x-rayed lesions
■Not for scalp or forehead, where permanent alopecia or bone necro-
sis may develop
Topical 5-FU:
■Only approved for superficial BCC
■Disadvantages: prolonged treatment time, discomfort, and risk of
eliminating the superficial component with persistence of deeper
subclinical foci
Laser surgery:
■Blind treatment similar to C&D, cryosurgery or radiation
Investigational:
■Intralesional 5-FU
■Systemic retinoids: patients with BCC nevus syndrome, xeroderma
pigmentosum and for chemoprevention
■Other: Imiquimod
➣Immunotherapy (IL-1, IL-2, interferon, Alfa-2A, interferon g)
➣Photodynamic therapy
follow-up
■Self-examination and regular follow-up by a physician with expertise
in skin cancer to detect new primary skin cancers and precancerous
lesions
■Life-long follow-up, since recurrences have been reported after 10
years (80% will occur in 2–5 years)
■Most patients q 6–12 months, but higher-risk patients (multiple BCC,
XP, BC nevus syndrome, chronic radiation dermatitis and immuno-
suppression) need to be seen more frequently
■Periodic general medical evaluation – some reports indicate an
increased incidence of internal malignancy (salivary glands, larynx,
lung, breast, kidney and non-Hodgkin’s lymphoma)