Basal Cell Carcinoma: Epidemiology, Risk Factors, and Treatment Options

Ultraviolent (UV) solar radiation is considered to be the dominant risk factor for development of basal cell carcinoma (BCC). The development of BCC is thought to arise from intense, intermittent sun exposure leading to burns. Identifying patients with high-risk factors for developing BCC includes chronic immunosuppression, exposure to ionizing radiation, and certain genetic syndromes. Primary treatment goals of BCC include cure of tumor with maximal preservation of function. Although rarely metastatic, BCC can produce substantial local destruction. Treatment modalities can be divided into surgical and nonsurgical therapies, although surgical therapy is the mainstay of treatment. Superficial therapies, such as topical imiquimod or 5-fluorouracil, photodynamic therapy, or cryotherapy, may be effective for anatomically challenging locations where surgery or radiation is contraindicated, but the cure rates of these approaches are lower compared with surgery. Recent FDA-approved hedgehog pathway inhibitors include vismodegib and sonidegib for patients who have exhausted surgical and radiation options for treating advanced BCC. This review contains 4 figures, 5 tables, and 25 references. Key words: cryosurgery, cutaneous basal cell carcinoma, hedgehog pathway inhibitors, Mohs micrographic surgery, pathologic risk factors, photodynamic therapy, radiation therapy, surgical margins, topical therapies