Basal cell carcinoma (BCC) is the most common type of skin cancer, accounting for about 80% of all skin cancers.

BCC is a slow-growing cancer that rarely spreads to other parts of the body, but if left untreated, it can grow into the surrounding tissue and cause significant damage. Locally advanced basal cell carcinoma (laBCC) is a subtype of BCC that has grown larger than 2 cm in diameter and has invaded the surrounding tissue, which can be more challenging to treat than early-stage BCC.

In this article, we will discuss some innovative treatment options for laBCC.

Mohs Surgery

Mohs surgery is a micrographic surgery that is often used to treat BCC, especially laBCC. During Mohs surgery, the tumor is removed in stages, and each stage is examined under a microscope to ensure that all the cancerous cells have been removed.

This process is repeated until the cancer is completely removed. Mohs surgery is a highly effective treatment for laBCC because it allows the surgeon to remove as much cancerous tissue as possible while preserving the surrounding healthy tissue.

Mohs surgery has a high success rate, with cure rates of 99% for primary BCC and 95% for recurrent BCC.

Immunotherapy

Immunotherapy is a type of treatment that uses the body’s own immune system to fight cancer. One type of immunotherapy that has shown promise in the treatment of laBCC is PD-1 inhibitors.

PD-1 inhibitors block a protein called PD-1, which is present on the surface of certain immune cells. By blocking PD-1, the immune cells are able to recognize and attack the cancer cells more effectively. PD-1 inhibitors have been shown to be highly effective in treating laBCC, with a response rate of 58% and a complete response rate of 25%.

PD-1 inhibitors are usually given intravenously and may be associated with side effects such as fatigue, rash, and diarrhea.

Electrochemotherapy

Electrochemotherapy is a technique that combines chemotherapy with an electric field to enhance the uptake of the chemotherapy drug into the cancer cells.

During electrochemotherapy, the chemotherapy drug is injected into the tumor, and then an electric field is applied to the tumor, which creates small pores in the cell membrane, allowing the chemotherapy drug to enter the cancer cells more easily. Electrochemotherapy has been shown to be highly effective in treating laBCC, with a complete response rate of 66% and a partial response rate of 25%.

Electrochemotherapy is usually done under local anesthesia and may be associated with side effects such as pain, swelling, and skin irritation.

Hedgehog Pathway Inhibitors

The Hedgehog pathway is a signaling pathway that plays a crucial role in the development of BCC. Hedgehog pathway inhibitors are a type of targeted therapy that block the activation of the Hedgehog pathway and can be used to treat laBCC.

The two Hedgehog pathway inhibitors that are currently approved for the treatment of laBCC are vismodegib and sonidegib. Both drugs have been shown to be highly effective in treating laBCC, with response rates of 60-70%. Hedgehog pathway inhibitors are usually taken orally and may be associated with side effects such as muscle spasms, hair loss, and nausea.

Radiotherapy

Radiotherapy is a type of treatment that uses high-energy radiation to kill cancer cells. Radiotherapy is often used to treat laBCC when surgery is not possible or when the cancer has spread to other parts of the body.

Radiotherapy can be delivered externally, using an external beam of radiation, or internally, using radioactive implants. Radiotherapy has been shown to be highly effective in treating laBCC, with a cure rate of 90-95%. Radiotherapy may be associated with side effects such as skin irritation, fatigue, and hair loss.

Cryotherapy

Cryotherapy is a technique that uses extreme cold to destroy cancer cells. During cryotherapy, liquid nitrogen is applied to the tumor, which freezes the cancer cells and causes them to die.

Cryotherapy is a minimally invasive treatment for laBCC that can be done in a doctor’s office. Cryotherapy has been shown to be highly effective in treating laBCC, with a cure rate of 85-95%. Cryotherapy may be associated with side effects such as skin irritation, blistering, and pain.

Photodynamic Therapy

Photodynamic therapy is a technique that uses a photosensitizing agent and a light source to destroy cancer cells.

During photodynamic therapy, the photosensitizing agent is applied to the tumor, and then a light source is used to activate the photosensitizing agent, which generates reactive oxygen species that destroy the cancer cells. Photodynamic therapy is a minimally invasive treatment for laBCC that can be done in a doctor’s office. Photodynamic therapy has been shown to be highly effective in treating laBCC, with a complete response rate of 80%.

Photodynamic therapy may be associated with side effects such as skin irritation, sensitivity to light, and pain.

Biotherapy

Biotherapy is a type of treatment that uses natural substances to boost the body’s immune system and fight cancer. One type of biotherapy that has shown promise in the treatment of laBCC is curcumin.

Curcumin is a natural substance that is found in turmeric and has been shown to have anti-inflammatory and anti-cancer properties. Curcumin can be taken orally or applied topically and has been shown to be effective in treating laBCC.

Combination Therapy

Combination therapy is a treatment approach that involves using more than one type of treatment to treat cancer. Combination therapy can be more effective than single-agent therapy because it targets the cancer cells in multiple ways.

Several studies have shown that combination therapy, such as vismodegib and radiotherapy or vismodegib and electrochemotherapy, can be highly effective in treating laBCC.