eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Pathology

Skin Cancer: Basal Cell Carcinoma: Follow-up

Author: M Abraham Kuriakose, MD, DDS, FRCS, Chairman, Head and Neck Institute, Amrita Institute of Medical Sciences
Contributor Information and Disclosures

Updated: Dec 11, 2006

Follow-up

Further Inpatient Care

  • The reconstruction of the surgical defect may be performed concurrent with the primary resection or following the final pathology result as a second procedure.

Further Outpatient Care

  • Patients with BCC require lifelong follow-up care. In the initial period, perform close examination of the primary tumor site to detect recurrence at an early stage. During follow-up, examine the sun-exposed area of the skin to identify second primary tumors. A general follow-up schedule calls for a 2-3 month intervals for 2 years, with annual follow-up thereafter.

Deterrence/Prevention

  • Prevention of BCC centers on measures to decrease UVR exposure. The peak period of UVR occurs from 10 AM to 4 PM. Lifestyle modification, protective clothing, and use of sunscreen preparations with a protective factor of 15 or more should be considered. Initiation of preventive measures from childhood decreases the incidence of BCC.
  • Patients with a high risk for BCC (eg, whites with Celtic ancestry), a previous history of BCC, or a lifestyle involving excessive sun exposure should be screened for BCC.

Complications

  • Early postoperative complications
    • Bleeding
    • Infection
    • Loss of skin graft
  • Late postoperative complications
  • Facial scar
  • Ectropion
  • Epiphora
  • Tumor recurrence

Prognosis

  • Incidence of recurrence following surgical excision is 30% in patients with a positive margin, 12% in patients with a close margin, and less than 5% in patients with a complete excision. With adequate treatment, a cure rate of more than 95% can be expected. Recurrent tumors following radiotherapy have a low tumor control rate.

Patient Education

  • Counsel patients regarding the need for preventive measures to decrease UVR exposure. The peak period of UVR occurs from 10 am to 4 pm. Advise patients to wear of protective clothing and the use of sunscreen preparations with a protective factor of 15 or more.
  • For excellent patient education resources, visit eMedicine's Cancer and Tumors Center. Also, see eMedicine's patient education articles Skin Cancer and Skin Biopsy.

Miscellaneous

Medicolegal Pitfalls

  • Early BCC is an indolent lesion, which may be confused with other benign dermatologic conditions, thus delaying diagnosis. Rule out BCC in elderly patients who have any persistent nodular or scaly lesions in the upper two thirds of the face.
  • Adequate excision of BCC results in a much wider defect than the clinical lesion. Adequately prepare patients for the functional and aesthetic results of surgery.
  • During postoperative surveillance, take care to detect early recurrence and new BCCs. Diagnosis of early recurrence may be difficult because of surgical scarring, fibrosis, and the presence of skin graft. Delay in diagnosis of tumor recurrence can affect the success of salvage treatment and its functional and aesthetic results.
 


More on Skin Cancer: Basal Cell Carcinoma

Overview: Skin Cancer: Basal Cell Carcinoma
Differential Diagnoses & Workup: Skin Cancer: Basal Cell Carcinoma
Treatment & Medication: Skin Cancer: Basal Cell Carcinoma
Follow-up: Skin Cancer: Basal Cell Carcinoma
Multimedia: Skin Cancer: Basal Cell Carcinoma
References
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References

  1. American Joint Committee on Cancer. Manual for Staging of Cancer. JB Lippincott;1992.

  2. Baker SR, Swanson NA, Grekin RC. An interdisciplinary approach to the management of basal cell carcinoma of the head and neck. J Dermatol Surg Oncol. Oct 1987;13(10):1095-106. [Medline].

  3. Gallagher RP, Hill GB, Bajdik CD, et al. Sunlight exposure, pigmentary factors, and risk of nonmelanocytic skin cancer & Basal cell carcinoma. Archives of Dermatology. 1995;131:157-63.

  4. Geisse J, Caro I, Lindholm J. Imiquimod 5% cream for the treatment of superficial basal cell carcinoma: results from two phase III, randomized, vehicle-controlled studies. Journal of the American Academy of Dermatology. 2004;50:722-33. [Full Text].

  5. Miller SJ. Biology of basal cell carcinoma (Part I). J Am Acad Dermatol. Jan 1991;24(1):1-13. [Medline].

  6. Pascal RR, Hobby LW, Lattes R, Crikelair GF. Prognosis of "incompletely excised" versus "completely excised" basal cell carcinoma. Plast Reconstr Surg. Apr 1968;41(4):328-32. [Medline].

  7. Shumack S, Robinson J, Kossard S, et al. Efficacy of topical 5% imiquimod cream for the treatment of nodular basal cell carcinoma: comparison of dosing regimens. Archives of Dermatology. 2002;138:1165-71. [Medline]. [Full Text].

  8. Sober AJ. Diagnosis and management of skin cancer. Cancer. Jun 15 1983;51(12 Suppl):2448-52. [Medline].

  9. Swanson NA. Mohs surgery. Technique, indications, applications, and the future. Arch Dermatol. Sep 1983;119(9):761-73. [Medline].

  10. Swetter SM, Waddell BL, Vazquez MD. Increased effectiveness of targeted skin cancer screening in the Veterans Affairs population of northern California. Preventive medicine. 2003;36:164-71. [Medline]. [Full Text].

  11. Weber RS, Miller MJ, Goepfert H. Basal and Squamous Cell Skin Cancers of the Head and Neck. Baltimore:. Lippincott Williams & Wilkins;1996:9-33.

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Further Reading

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Keywords

basal cell carcinoma of the skin, BCC, basal cell epithelioma, rodent ulcer, squamous cell carcinoma, SCC, nodular basal cell carcinoma, noduloulcerative basal cell carcinoma, morpheaform basal cell carcinoma, sclerosing basal cell carcinoma, superficial basal cell carcinoma, basosquamous carcinoma, basisquamous carcinoma, basal squamous cell carcinoma, skin BCC

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Contributor Information and Disclosures

Author

M Abraham Kuriakose, MD, DDS, FRCS, Chairman, Head and Neck Institute, Amrita Institute of Medical Sciences
M Abraham Kuriakose, MD, DDS, FRCS is a member of the following medical societies: American Association for Cancer Research, American Head and Neck Society, British Association of Oral and Maxillofacial Surgeons, and Royal College of Surgeons of England
Disclosure: Nothing to disclose.

Medical Editor

Jaime R Garza, MD, DDS, FACS, Consulting Staff, Private Practice
Jaime R Garza, MD, DDS, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, American Society for Aesthetic Plastic Surgery, American Society of Maxillofacial Surgeons, Texas Medical Association, and Texas Society of Plastic Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

M Sherif Said, MD, PhD, Assistant Professor of Pathology, Director of Head and Neck Pathology, Department of Pathology, University of Colorado Health Sciences Center
M Sherif Said, MD, PhD is a member of the following medical societies: American Medical Association, American Society of Clinical Pathologists, American Society of Cytopathology, College of American Pathologists, and Southern Medical Association
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: UST Grant/research funds Consulting

 
 
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