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...
  • Print
Answer

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.

Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!