A narrative review published in Cancer Medicine examines recent advances in detecting, diagnosing, and treating basal cell carcinoma (BCC), the most common skin cancer worldwide, highlighting how expanding treatment options can now be better tailored to individual patient profiles and tumour characteristics.
Diagnostic advances include dermoscopy and reflectance confocal microscopy (RCM), which have improved BCC detection, particularly in patients with darker skin tones. The review recommends using dermoscopy for preliminary evaluation, followed by RCM when appropriate. However, experts note that whilst dermoscopy is widely available and considered part of routine skin examination, RCM remains accessible only to a small fraction of dermatologists and is typically used as a second-line diagnostic tool.
For treatment, Mohs surgery remains the gold standard, particularly for lesions on the face, neck, hands, feet, or genitals, achieving efficacy rates as high as 99% in specific scenarios. Standard excision offers 98% efficacy when certain criteria are met, whilst electrodessication and curettage achieve 93-98% success rates depending on treatment location.
Radiation therapy provides approximately 95% cure rates for patients who cannot undergo surgery, though it carries risks, including potential secondary skin cancers decades post-treatment. Systemic options, including sonic hedgehog pathway inhibitors such as sonidegib and vismodegib, are typically reserved for cases where surgery or radiation are not viable.
Emerging approaches under investigation include lasers targeting angiogenesis, photodynamic therapy, and isotretinoin, though these are not yet FDA-approved for BCC. There is also growing interest in prevention, with niacinamide’s anti-inflammatory properties potentially helping reduce UV-induced immunosuppression.
Treatment selection depends on tumour risk factors, patient characteristics, and the ability to achieve clear margins.
strong>Source: Physicians Weekly / Cancer Medicine (2026)
Diagnostic advances include dermoscopy and reflectance confocal microscopy (RCM), which have improved BCC detection, particularly in patients with darker skin tones. The review recommends using dermoscopy for preliminary evaluation, followed by RCM when appropriate. However, experts note that whilst dermoscopy is widely available and considered part of routine skin examination, RCM remains accessible only to a small fraction of dermatologists and is typically used as a second-line diagnostic tool.
For treatment, Mohs surgery remains the gold standard, particularly for lesions on the face, neck, hands, feet, or genitals, achieving efficacy rates as high as 99% in specific scenarios. Standard excision offers 98% efficacy when certain criteria are met, whilst electrodessication and curettage achieve 93-98% success rates depending on treatment location.
Radiation therapy provides approximately 95% cure rates for patients who cannot undergo surgery, though it carries risks, including potential secondary skin cancers decades post-treatment. Systemic options, including sonic hedgehog pathway inhibitors such as sonidegib and vismodegib, are typically reserved for cases where surgery or radiation are not viable.
Emerging approaches under investigation include lasers targeting angiogenesis, photodynamic therapy, and isotretinoin, though these are not yet FDA-approved for BCC. There is also growing interest in prevention, with niacinamide’s anti-inflammatory properties potentially helping reduce UV-induced immunosuppression.
Treatment selection depends on tumour risk factors, patient characteristics, and the ability to achieve clear margins.
strong>Source: Physicians Weekly / Cancer Medicine (2026)