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Nevoid Basal Cell Carcinoma Syndrome Medication

  • Author: Daniel Berg, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Sep 04, 2015
 

Medication Summary

Topical agents such as imiquimod and 5-fluorouracil are available and have been approved for treatment of basal cell carcinoma (BCC) in the United States. These medications have a lower cure rate than surgical therapy but may be useful adjuncts in patients with multiple lesions.

Investigations and clinical trials are evaluating the use of these and other novel agents such as ALA and methyl-ALA in topical photodynamic therapy, tazarotene (Tazorac), and newly developed HH pathway inhibitors, both topical and systemic.[2] Tazarotene and photodynamic therapy are available (off-label), and vismodegib (hedgehog inhibitor) and more recently sonidegib are now FDA approved for the treatment of metastatic or locally advanaced BCC—as such, their use solely in NBCSS, while clearly effective,[24] also remains off-label at present.

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Topical Skin Product

Class Summary

Agents such as imiquimod and 5-fluorouracil are approved in the United States for use topically for BCC. Despite the lower cure rate (than with surgery), imiquimod and 5-fluorouracil may play a useful role in allowing patients to treat their own selected smaller lesions, especially superficial BCCs on the trunk and extremities. In general, such medications should be considered best for use in smaller or more superficial lesions, away from critical anatomic sites.

Imiquimod (Aldara)

 

The precise mechanism of imiquimod on superficial BCC is unknown. It may increase tumor infiltration of lymphocytes, dendritic cells, and macrophages. It is indicated for biopsy-confirmed, primary superficial BCC in adults with normal immune systems. Additionally, tumors generally should not exceed 2 cm in diameter on certain areas of the body. It is indicated primarily when surgical methods are not appropriate, including in situations in which, because of multiple lesions, scarring from surgical methods may be a consideration.

5-Fluorouracil (Efudex, Carac, Fluoroplex)

 

5-Fluorouracil is a cycle-specific agent that has activity as single agent and, for many years, has been combined with the biochemical modulator leucovorin. It is shown to be effective in an adjuvant setting. 5-Fluorouracil inhibits tumor cell growth through at least 3 different mechanisms that ultimately disrupt DNA synthesis or cellular viability. It is used topically for the management of superficial BCC.

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Contributor Information and Disclosures
Author

Daniel Berg, MD Clinical Professor of Dermatology, University of Washington School of Medicine

Daniel Berg, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Mohs Surgery, American Academy of Dermatology, American Society for Dermatologic Surgery

Disclosure: Received honoraria from Genentech for review panel membership; Received honoraria from DUSA Pharmaceuticals for review panel membership.

Coauthor(s)

Jonathan M Olson, MD Fellow, Division of Dermatology, University of Washington Medical Center

Jonathan M Olson, MD is a member of the following medical societies: American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Edward F Chan, MD Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

R Stan Taylor, MD The JB Howell Professor in Melanoma Education and Detection, Departments of Dermatology and Plastic Surgery, Director, Skin Surgery and Oncology Clinic, University of Texas Southwestern Medical Center

R Stan Taylor, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, American Medical Association

Disclosure: Nothing to disclose.

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Multiple basal cell carcinomas on the back of a patient with nevoid basal cell carcinoma syndrome.
Multiple small papules on the neck and upper trunk in a 10-year-old patient. Biopsy confirmed basal cell carcinoma.
Palmar pits in an adult.
Syndactyly is noted in some affected persons such as this 8-year-old boy.
 
 
 
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