Unknown Lesions Found on a 51-Year-Old Man With Eyelid Cyst

Robert S. Bader, MD

Disclosures

February 03, 2020

Treatment must be individualized for each lesion, with consideration of the histologic subtype of basal cell carcinoma, size, and site, and the age and sex of the patient. No single treatment is ideal for all types of basal cell carcinoma or for all patients. The goal of treatment is permanent cure with the best possible cosmetic result. Other factors, such as treatment cost, patient compliance, and postoperative course, must be considered. Recurrences are usually seen within the first year after treatment, and a minimum 5-year follow-up is recommended, especially to evaluate for the development of new tumors, because the risk for a second basal cell carcinoma is high.[3]

In most cases, a surgical modality is used, although nonsurgical treatment options are available. Such techniques include the following:

  • Electrodesiccation and curettage: This is a commonly used modality that is highly effective for nodular and superficial basal cell carcinoma, with reported cure rates as high as 95%. This treatment results in a scar, which in cosmetically sensitive areas must be considered. This treatment is not recommended for recurrent, infiltrative, or morpheaform types of basal cell carcinoma. The resultant wound requires daily care, which must be considered before treatment. Treatment on the lower legs can result in ulcers that can take 3 months or longer to heal, especially for larger or deep tumors.

  • Surgical excision: This is a commonly used treatment for most types of basal cell carcinoma. Frozen sections can be used for intraoperative margin control before closure. The tissue is processed with a bread-loafing technique, in which less than 1% of the margins are evaluated. Cure rates for nodular basal cell carcinoma have been reported to be 70%-95%.

  • Mohs micrographically controlled surgery: This has the highest cure rate for basal cell carcinoma. The surgeon also acts as pathologist and interprets the pathology slides. Unlike routine excision, all of the margins are evaluated histologically. Cure rates for primary, nonrecurrent tumors are as high as 99%. This method is the treatment of choice for morpheaform basal cell carcinoma and should be considered for recurrent tumors, tumors in areas where tissue sparing is essential (ie, ears, nose, eyelids, and the T-zone of the face), larger tumors, and young patients.

  • Cryosurgery: This can be considered for smaller tumors.

  • Topical therapy: The best studied treatment is imiquimod, which has a cure rate of approximately 80%. 5 fluorouracil can also be effective. Monitoring is indicated, as recurrences are not uncommon.[6]

  • Photodynamic therapy: This has emerged as a treatment option for basal cell carcinoma, especially the superficial type.[7,8]

  • Ionizing radiation: This has long been known to be effective for the treatment of basal cell carcinoma, with cure rates as high as 97%. Various methods of delivery are used that may reduce the total number of treatment sessions required. In general, radiation is considered for older patients, many of whom are not good surgical candidates.

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