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When Surgery is Not the Best Option for BCC

Learn how radiation therapy and medication therapy may be used to treat basal cell carcinoma.

When Surgery is Not the Best Option for BCC

Medically reviewed in March 2021

Anyone who begins researching basal cell carcinoma (BCC) will quickly come across a wealth of information about the various surgical techniques and other procedures that are used to treat early-stage BCC. In the early stages of BCC, the goal of treatment is to remove the cancer completely with minimal damage to healthy surrounding tissue.

However, in cases of more advanced BCC, these therapy techniques may not be an appropriate treatment option. For example:

  • The surgery required would lead to severe scarring, disfigurement, or deformity.
  • The tumor is large in size and/or has invaded surrounding tissues and cannot be completely removed by surgery.
  • The cancer has spread to other areas of the body.
  • A person may not be a candidate for surgery for another reason.

Here, we look at treatment options other than surgery that a person with BCC may discuss with their healthcare provider. Keep in mind that not every therapy described below will be appropriate for every person and that all treatments come with a risk of side effects.

Your best source of information is your healthcare team. Anytime you are starting a new cancer treatment, it is important to discuss the risks and benefits of that treatment with your healthcare providers.

Radiation therapy
Radiation therapy uses concentrated doses of energy (such as X-rays or electrons) to destroy cancer cells. Like surgery, it targets specific tumor locations and may be a good option for BCC tumors that cannot be removed by surgery. It may also be used after surgery to destroy any cancer cells the surgery missed, and to treat tumors located in other areas in the body in cases where BCC has metastasized.

Targeted therapies
Targeted therapies are a category of drugs that are able to target cells that have specific mutations. The targeted therapies that are used in the treatment of BCC target something called the hedgehog pathway.

The hedgehog pathway plays an important role in embryo development during pregnancy, and also plays an important role in the repair of tissues and the growth of new cells throughout a person’s life.

BCC can use the hedgehog pathway to fuel the growth of cancer cells. Targeted therapies called hedgehog inhibitors (HHIs) target a protein in the hedgehog pathway and interfere with the cancer’s ability to grow and spread. These HHIs are oral medications.

Immunotherapy
Immunotherapy is one of the newer innovations in cancer treatment. Unlike other cancer therapies, immunotherapy drugs do not target cancer cells directly, but help the body’s immune system identify and destroy cancer cells. The first immunotherapy drug indicated for BCC was approved by the Food & Drug Administration (FDA) in February of 2021.

Chemotherapy
Chemotherapy drugs contain powerful chemicals that kill fast-dividing cells, which makes them effective at destroying cancerous cells. Topical chemotherapy drugs are lotions or gels that are applied directly to the skin and can be used in the treatment of BCC.

Systemic chemotherapy drugs, which are given with an IV infusion, may be used in cases where the cancer has spread to other sites in the body.

Sources:

Elsevier Point of Care. "Clinical Overview: Basal cell carcinoma."
Cleveland Clinic. "Basal Cell Carcinoma (BCC)."
Mayo Clinic. "Basal cell carcinoma."
"Advanced Basal Cell Carcinoma: Treatment Overview." The Dermatologist, 2014. Vol. 22, No. 3.
Michael R. Migden, Anne Lynn S. Chang, et al. "Emerging trends in the treatment of advanced basal cell carcinoma." Cancer Treatment Reviews, 2018. Vol. 64.
American Cancer Society. "Radiation Therapy for Basal and Squamous Cell Skin Cancers."
Skin Cancer Foundation. "Basal Cell Carcinoma Treatment."
American Cancer Society. "Targeted Therapy for Basal and Squamous Cell Skin Cancers."
Jorge E. Cortes, Ralf Gutzmer, Mark W. Kieran, and James A. Solomon. "Hedgehog signaling inhibitors in solid and hematological cancers." Cancer Treatment Review, 2019. Vol. 76.
U.S. Food & Drug Administration. "FDA approves cemiplimab-rwlc for locally advanced and metastatic basal cell carcinoma."
Memorial Sloan Kettering Cancer Center. "Basal Cell Carcinoma Treatment."
American Cancer Society. "Local Treatments Other than Surgery for Basal and Squamous Cell Skin Cancers."
American Cancer Society. "Systemic Chemotherapy for Basal and Squamous Cell Skin Cancers."

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