163 BASAL CELL CARCINOMA SECTION 12 SKIN CANCER

MHBD125-163[704-711].qxd 8/15/08 11:39 AM Page 707BASAL CELL CARCINOMAPART 13DERMATOLOGY707with 5 mm halo.This can be divided up into two 30 second freezeswith a thaw in between. Some patients might prefer local anestheticif the freezing is too painful. SOR• Curettage and desiccation (six studies, n 4212): Recurrence rateranged from 4.3% to 18.1%; cumulative 5-year rate ranged from5.7% to 18.8%. 1 Three cycles of curettage and desiccation can producehigher cure rates than one cycle. 1 SOR• Imiquimod is FDA approved for the treatment of superficial BCCless than 2 cm in diameter. 2 SOR Confi m diagnosis with biopsyand use when surgical methods are contraindicated. 2PATIENT EDUCATIONWhile most of the sun damage has been done, patients should stillpractice skin cancer prevention by sun-protective behaviors such asavoiding peak sun, covering up and using sunscreen.FOLLOW-UPPatients should be seen at least yearly after the diagnosis andtreatment of a BCC.The 3-year risk of BCC recurrence after having asingle BCC is 44%. 3PATIENT RESOURCESThe Skin Cancer Foundation has an excellent web site with photosand patient information—http://www.skincancer.org/basal/index.php.FIGURE 163-7 Advanced sclerosing BCC on the cheek of a man,causing ectropion (the eyelid is being pulled down by the sclerotic skinchanges). (With permission from Usatine RP, Moy RL, Tobinick EL,Siegel DM. Skin Surgery: A Practical Guide. 1998, St. Louis: Mosby. )PROVIDER RESOURCEBritish Journal of Dermatology (1999;141:415–423) for specifiguidelines for managing BCC—http://www.bad.org.uk/healthcare/guidelines/Basal_Cell_Carcinoma.pdf.FIGURE 163-8 Basal cell nevus syndrome with multiple nevoid BCCson the face and neck of a young woman. This is a rare autosomal dominantcondition. (Courtesy of the University of Texas Health SciencesCenter, Division of Dermatology.)