Basal cell carcinoma (BCC) is the most common form of skin cancer, accounting for around 80% of all cases. In most cases, BCC is treatable and has a high cure rate.

However, some cases of BCC may become locally advanced, which means the cancer has grown into nearby structures, such as bones, cartilage, or lymph nodes. Locally advanced BCC (laBCC) is a rare and challenging type of skin cancer that requires aggressive treatment. In this article, we will discuss the latest developments in the treatment of laBCC and offer hope for those living with the condition.

What is Locally Advanced Basal Cell Carcinoma?

As mentioned earlier, locally advanced basal cell carcinoma is a rare and advanced form of skin cancer.

LaBCC means that the cancer has spread beyond the primary site of the tumor and into the surrounding tissues, making it difficult to remove entirely.

LaBCC usually develops in areas of the body that have been exposed to the sun for many years, such as the face, scalp, neck, and ears. It can also occur in areas of previous radiation therapy or with pre-existing scars or ulcers.

Some of the common signs and symptoms of laBCC include:.

A non-healing sore or ulcer that bleeds and crusts over
A growth or lump with a shiny, pearly appearance
A scar-like area with poorly defined borders
A waxy, dark patch on the skin
Difficulty swallowing or breathing if the laBCC has spread to the throat

Traditional Treatment for Locally Advanced Basal Cell Carcinoma

Traditionally, surgery has been the standard treatment for basal cell carcinoma. However, for patients with laBCC, surgery may not be the best option.

This is because laBCC often invades underlying tissues and structures, and surgery may not be able to remove all of the cancerous cells. In addition, surgery may be complicated by the location of the tumor and the surrounding structures, such as nerves, blood vessels, and bones.

Another treatment option is radiation therapy. Radiation therapy is often used for patients who are not candidates for surgery, either due to the location of the tumor or other factors such as age or health status.

However, radiation therapy may not be effective in all cases, and it has been associated with side effects such as skin damage, fatigue, and the risk of secondary malignancies.

Chemotherapy may also be used to treat laBCC, either alone or in combination with radiation therapy.

However, chemotherapy is generally not considered a curative treatment for laBCC, and it is often used to manage symptoms or to shrink the tumor before surgery or radiation therapy.

New Hope for Locally Advanced Basal Cell Carcinoma

Recently, there have been several new treatment options for laBCC that are providing hope for patients with this condition. These include:.

1. Targeted Therapy

Targeted therapy is a relatively new approach to cancer treatment that targets specific molecules involved in the growth and spread of cancer cells.

In the case of BCC, a molecule called the Hedgehog pathway is often involved in the development of the cancer. Targeted therapy drugs such as vismodegib and sonidegib have been approved for use in patients with advanced BCC, including laBCC.

These drugs are taken orally and work by blocking the Hedgehog pathway, thereby slowing or stopping the growth of cancer cells.

2. Immunotherapy

Immunotherapy is a type of cancer treatment that harnesses the power of the immune system to fight cancer. It works by stimulating the immune system to recognize and attack cancer cells.

In recent years, several immunotherapy drugs have been approved for the treatment of various types of cancer, including melanoma and lung cancer. However, the role of immunotherapy in the treatment of laBCC is still being investigated. One such drug, cemiplimab, has shown promising results in early clinical trials.

Cemiplimab works by blocking a protein called PD-1 that is involved in the suppression of the immune response to cancer cells. This allows the immune system to recognize and attack cancer cells more effectively.

3. Mohs Micrographic Surgery

Mohs micrographic surgery is a specialized surgical technique that is used to remove skin cancers, including laBCC. The technique involves removing a thin layer of skin and examining it under a microscope to check for cancer cells.

This process is repeated until no cancer cells are detected. Mohs surgery allows for the precise removal of cancerous cells while preserving as much healthy tissue as possible. It is particularly useful for tumors that are difficult to remove with traditional surgery, such as those on the face or scalp.

4. Electrochemotherapy

Electrochemotherapy is a relatively new treatment option for laBCC that combines chemotherapy with a technique called electroporation.

Electroporation uses electrical impulses to create small holes in the cell membranes of cancer cells, allowing chemotherapy drugs to enter the cells more easily. This makes the chemotherapy more effective and reduces the side effects. The procedure is usually done under local anesthesia and takes around 30 minutes to complete.

Conclusion

Locally advanced basal cell carcinoma is a challenging condition that requires aggressive treatment.

While traditional treatment options such as surgery, radiation therapy, and chemotherapy have been the standard approach, they may not always be effective in the case of laBCC. Fortunately, there are several new treatment options that are providing hope for patients with this condition. These include targeted therapy, immunotherapy, Mohs micrographic surgery, and electrochemotherapy.

These new treatments have shown promising results in clinical trials and offer hope for a cure for patients with laBCC.