What are the guidelines on the treatment of recurrent and metastatic basal cell carcinoma (BCC)?

Updated: Mar 02, 2020
  • Author: Robert S Bader, MD; Chief Editor: William D James, MD  more...
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For complicated high-risk tumors and regional recurrence, the NCCN guidelines recommend surgery and/or radiotherapy. If these modalities are contraindicated, management by a multidisciplinary tumor board and therapy should be pursued. For metastatic disease, treatment with the Hedgehog pathway (Hh) inhibitor vismodegib or enrollment in a clinical trial is recommended. [7]  A second Hh inhibitor, sonidegib, was approved by the FDA in 2015. [99]

AAD guidelines include the following recommendations for managing locally advanced or metastatic BCC [107] :

  • Multidisciplinary consultation and smoothened inhibitors (eg, vismodegib) are recommended for patients with metastatic BCC.
  • If treatment of metastatic BCC with smoothened inhibitors is not feasible, platinum-based chemotherapy or best supportive care is recommended.
  • If surgery and radiation therapy are contraindicated or inappropriate for the treatment of locally advanced BCC, or if residual tumor persists following surgery and/or radiation therapy and further surgery and radiation therapy are contraindicated or inappropriate, systemic therapy with a smoothened inhibitor should be considered.
  • Patients with advanced disease should be provided with or referred for best supportive and palliative care, to optimize symptom management and maximize quality of life.

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