How are basal cell carcinoma classified in the NCCN and EDF guidelines?

Updated: Mar 23, 2021
  • Author: Robert S Bader, MD; Chief Editor: William D James, MD  more...
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Basal cell carcinoma rarely metastasizes and is usually not staged. The NCCN and EDF guidelines classify tumors as low or high risk, on the basis of risk factors associated with recurrence and metastasis. [7, 6]

The risk factors evaluated include the following:

  • Location
  • Size
  • Borders/clinical margins
  • Histological subtype
  • Features of aggression
  • Failure of previous treatment
  • Immunosuppression

The NCCN guidelines classify high-risk lesions by size and location, as follows [7] :

  • 2 cm or more in diameter in low-risk locations (L-area): the trunk and extremities, but not including the pretibia, hands, feet, ankles, and nail units

  • 1 cm or more in diameter in moderate-risk locations (M-area): cheeks, forehead, scalp, neck, and pretibia

  • 6 mm or more in diameter in high-risk locations (H-area): “mask area” of face (central face, eyelids, eyebrows, periorbital, nose, lips [cutaneous and vermilion], chin, mandible, preauricular and postauricular skin/sulci, temple, ear), genitalia, hands, and feet

Immunosuppression such as from antirejection therapy in organ transplant recipients and long-term use of psoralen and ultraviolet A light (PUVA) confers a higher risk of basal cell carcinoma recurrence and metastasis. Perineural involvement and previous radiotherapy are also associated with higher risk. [7]

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