Basal cell carcinoma: Topical therapy versus surgical treatment

Basal cell carcinoma (BCC) is a non-melanoma skin cancer and is one of the commonest malignancies of the skin encountered in daily clinical practice. It derives from non-keratinizing cells that originate in the basal layer of the epidermis. It accounts for approximately 75% of all skin cancer in the world, and 53.2% in Iraqi patients. Generally, most BCC cases are sporadic, but it may also appear in genetic disorders such as Gorlin’s syndrome, Rombo’s syndrome, and xeroderma pigmentosa (XP). If left untreated, BCC will continue to invade locally and may result in substantial tissue damage that compromises function and cosmetic look. Metastasis is an extremely rare event. The tumor characteristically develops on sun-exposed skin of lighter-skinned individuals.

There are two main modalities of therapy including topical like: Imiquimod, 5-fluorouracil (5-FU), photodynamic therapy (PDT), radiation therapy (RT), topical & intralesional zinc sulfate and topical 25% podophylline. While surgical one consists of: Moh’s Micrographic excision, standard excision, Curettage and desiccation (C&D), and cryosurgery.

After extensive reviewing of all modalities of therapy, in addition to our experience, we can conclude that all therapies could be effective in treatment of BCC. As each patient is unique so individualized treatment plan should be tailored to each one.