What are the AAD treatment guidelines for basal cell carcinoma (BCC)?

Updated: Mar 02, 2020
  • Author: Robert S Bader, MD; Chief Editor: William D James, MD  more...
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The American Academy of Dermatology (AAD) guidelines include the following recommendations for surgical treatment [107] :

  • The treatment plan should consider recurrence rate, preservation of function, patient expectations, and potential adverse effects.
  • Curettage and electrodessication (C&E) may be considered for low-risk tumors in non–terminal hair–bearing locations.
  • For low-risk primary BCC, surgical excision with 4-mm clinical margins and histologic margin assessment is recommended.
  • Standard excision may be considered for select high-risk tumors. However, strong caution is advised when selecting a treatment modality without complete margin assessment for high-risk tumors.
  • MMS is recommended for high-risk BCC.

AAD recommendations for non-surgical treatment are as follows [107] :

  • Cryosurgery may be considered for low-risk BCC when more effective therapies are contraindicated or impractical.
  • If surgical therapy is not feasible or preferred, topical therapy (eg, imiquimod or 5-fluorouracil), photodynamic therapy with aminolevulinic acid (ALA) or methyl aminolevulinate (MAL), and radiation therapy (eg, superficial radiation therapy, brachytherapy, external electron beam, and other traditional radiotherapy forms for BCC) can be considered when tumors are low risk, with the understanding that the cure rate may be lower.
  • Adjustment of topical therapy dosing regimen on the basis of side effect tolerance is recommended.
  • There is insufficient evidence to recommend the routine use of laser or electronic surface brachytherapy in the treatment of BCC.

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