Management Options cont.
Superficial skin surgery
This includes shave, curettage, and electrocautery. They are rapid treatments requiring some local anaesthetic and no sutures. These procedures are suitable for small, well-defined nodular or superficial BCCs located on trunk or limbs. The wounds are left to heal by secondary intention. Followed with a moist dressing often leading to healing within a few weeks. Scar quality can be variable.
Cryotherapy
Cryotherapy is a superficial treatment using liquid nitrogen to freeze. It’s suitable for small superficial BCCs affecting the trunk and limbs. A double freeze thaw technique is advised. The cosmetic results involve a blister that crusts over and heals within several weeks often leaving a permanent white area.
Photodynamic therapy (PDT)
PDT is a technique, which treats BCCs with a photosensitising chemical, followed with exposure to light several hours later. Topical photosensitisers include aminolevulinic acid lotion and methyl aminolevulinate cream. PDT is more suited to low risk, small superficial BCCs. This is less suited skin lesions which have a high risk of recurrence. After the first treatment there is an inflammatory reaction lasting 3-4 days. The treatment is then repeated 7 days later. It is favoured for its excellent cosmetic results.
Imiquimod cream
This topical treatment cream is suited to treating superficial BCCs less than 2cm in diameter. Its advised to apply 3-5 x a week for 6-16 weeks. There are variable inflammatory results which usually maximise at 3 weeks. There is often minimal scarring.
Fluorouracil cream
This is a cytotoxic topical cream used for small superficial BCCs. The course requires twice daily application over 6-12 weeks. There is often inflammatory reactions and high recurrent rates.
Radiotherapy
Radiotherapy treatment can be used to treat primary BCCs or as adjunctive treatment if margins are incomplete. This is often not a first choice treatment and is reserved if surgery isn’t suitable. It tends to be avoided in younger patients, particularly if their BCC is related to a genetic predisposition. There is a risk of radiodermatitis, late recurrence and new tumours. It can also cause scarring. (3)