Basal cell carcinoma
Also known as: basalioma · BCC · keratinocyte carcinoma · nonmelanoma skin cancer
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Guidelines of care for the management of basal cell carcinoma
American Academy of Dermatology (AAD) · 2018 · 2018 guideline (companion cutaneous squamous cell carcinoma guideline published the same year)
The AAD basal cell carcinoma guideline page, hosting the guideline published in the Journal of the American Academy of Dermatology. It covers risk stratification, biopsy technique, surgical and non-surgical treatment options, management of advanced disease, and follow-up surveillance for recurrence and new primary skin cancers. A companion AAD guideline covers cutaneous squamous cell carcinoma.
- The page describes risk stratification of basal cell carcinoma aligned with NCCN categories and recommends surgery as the cornerstone of treatment. source
- Non-surgical modalities are described as having lower cure rates and reserved for selected low-risk tumours. source
- Ongoing annual skin checks are advised for recurrence and new primary skin cancers. source
European consensus-based interdisciplinary guideline for diagnosis and treatment of basal cell carcinoma - update 2023
EADO, European Dermatology Forum (EDF), ESTRO, UEMS and EADV · 2023 · Update 2023
The European interdisciplinary guideline on basal cell carcinoma, published in the European Journal of Cancer by a multi-society expert group. It sets out diagnosis based on clinical and dermoscopic features with histopathology where uncertain, and treatment recommendations ranging from surgery through topical and destructive modalities to systemic therapy for advanced disease.
- Introduces an EADO clinical classification separating 'easy-to-treat' from 'difficult-to-treat' basal cell carcinoma. source
- Complete surgical excision is the first-line treatment, with micrographically controlled surgery for high-risk, recurrent or critically located tumours. source
- Hedgehog pathway inhibitors are recommended for locally advanced and metastatic disease, with anti-PD1 immunotherapy as a subsequent option. source
US vs EU key differences
- Both agree that micrographically controlled surgery (Mohs) is the operation of choice for high-risk, recurrent and critically sited basal cell carcinoma, with the AAD specifying 4 mm clinical margins plus histologic margin assessment for standard excision of low-risk primary tumours. source
- Advanced-disease systemic therapy differs by a full drug class: the European 2023 update positions anti-PD-1 therapy with cemiplimab as second-line after progression on, contraindication to or intolerance of hedgehog inhibitors, whereas the 2018 AAD guideline predates that approval and names only hedgehog inhibitors such as vismodegib. source
- Risk vocabulary differs: the European guideline applies an EADO clinical classification splitting tumours into 'easy-to-treat' (common) and 'difficult-to-treat' BCC, while the AAD works from low-risk versus high-risk tumour categories. source
- Version currency differs by five years: the US basal cell carcinoma guideline dates to 2018 while the European interdisciplinary guideline was updated in 2023, which also sets out radiotherapy, photodynamic therapy and electrochemotherapy as alternatives when surgery is declined or contraindicated. source
What changed recently
- EU2019 → Update 20232023-09-01
The 2023 European BCC update was triggered by a new clinical classification and by therapies that postdated the 2019 guideline, notably electrochemotherapy and immunotherapy. It positions hedgehog pathway inhibitors as first-line systemic treatment for locally advanced and metastatic BCC and adds anti-PD-1 immunotherapy as a second-line option for patients who progress on, cannot tolerate, or have a contraindication to them.
source ↗curation confidence 90%
See the full update feed for changes across every system.