Discovering Dermatology Times: September 2023 BCC Management Supplement

The August Frontline Forum basal cell carcinoma (BCC) supplement of Dermatology Times, "Improving Basal Cell Carcinoma Management", includes a collection of thought-provoking discussions and BCC management strategies from Brent Moody, MD; Sarah Arron, MD, PhD; Justine Cohen, DO; Emily Ruiz, MD, MPH; and Todd Schlesinger, MD. Be sure to take a look at the highlights from the supplement below. Also, don’t miss a moment of Dermatology Times by signing up for our eNewsletters and subscribing to receive the free print issue and supplements each month.

Part 1

“A lot of our colleagues in practice still have a lot of gaps in their understanding of systemic therapies for basal cell carcinoma [BCC],” said Brent Moody, MD, to kick off the discussion surrounding the improvement of BCC management. “I think particularly in the Mohs surgery community that was unmasked in the recent board exams.” BCCs account for approximately 80% of nonmelanoma skin cancers. Their incidence increased significantly, by an estimated 145%, from the 1976 to 1984 period to the 2000 to 2010 period. Although mortality associated with BCC is very low (< 0.1%), untreated disease can spread locally and cause significant cosmetic and functional morbidity, particularly because many BCCs are located on the face. In the Dermatology Times Frontline Forum custom video series “Expert Perspectives in the Management of Basal Cell Carcinoma,” moderated by Moody, panelists discussed the importance of a multidisciplinary team for advanced BCC, management strategies for real-world clinical cases in their respective practices, and potential opportunities to enhance options for systemic treatment of BCC.

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Part 2

The panelists agreed that, to optimize treatment of advanced BCC, the multidisciplinary team should start with 1 physician champion who is invested in and comfortable with managing BCC and should include, at a minimum, a surgeon, medical oncologist, and radiation oncologist. Ruiz noted that a radiation oncologist is particularly important because many decisions about the best treatment option require a strong understanding of the involved surrounding structures. The members of the multidisciplinary team may also differ depending on the anatomic location of the BCC (eg, Arron would choose a different radiation oncologist for head and neck BCCs than she would for BCCs on the trunk). Another benefit to multidisciplinary care is the ability to leverage additional resources. For example, oncology practices often have a robust support network that includes insurance authorizations for medications, social work, oncology nursing support, and home help agencies.

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Part 3

Ruiz noted that the type of skin cancer is the major factor in her decision to pursue nonsurgical treatment, and she has found that Mohs surgery is usually the easiest treatment for patients with BCC. However, the multidisciplinary team, the patient, and the patient’s family should all be involved in the decision-making process. Ruiz shared that when her institution implemented a multidisciplinary tumor board in 2020, it appeared to improve the patient experience and outcomes as well as the quality of care provided by the multidisciplinary team members. “Thinking about the options up front in advance of attempting a surgery has helped us better define where is that the best option and where should we be doing something else,” she said. “The patient recognizes in advance that it may not be as successful. It reaffirms what you’re doing, and it reaffirms to the patient that this is the best approach.”

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Part 4 - Clinical Cases

For Schlesinger’s patient with a large BCC lesion on his left temple, the panelists said they would likely choose Mohs surgery. Assessing the risk of disease progression is important because the lesion’s raised appearance suggests a high likelihood of deep invasion, microscopic positive margins after surgery, and lymph node involvement, said Schlesinger. Ruiz said that if she chose surgery, she would also counsel the patient about the possibility of losing the temporal nerve. If the patient opted against surgery, definitive radiation therapy would be preferred by many of the panelists. For these patients, Arron and Zeitouni noted that they book follow-up appointments after the patients meet with the radiation oncologist because patients often become more amenable to surgery after learning that the radiation protocol is several weeks long and there is a possibility of hair loss in the radiated area.

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Click here to view the whole series online.