Prognosis and Survival in Basal Cell Carcinoma: Key Factors for Clinical Management and Skin Cancer Outcomes

The basal cell carcinoma (BCC) is the most common type of skin cancer, particularly in populations with fair skin. Although its prognosis is generally favorable due to its low mortality rate, BCC can cause significant morbidity through local tissue destruction. Understanding the factors that influence survival and clinical management of BCC is crucial for optimizing treatment outcomes and improving patients' quality of life.

Factors Influencing Prognosis and Survival

The management of BCC is based on a series of prognostic factors that determine the most appropriate therapeutic strategy. Classifying BCCs into "easy to treat" and "difficult to treat" is fundamental for guiding treatment. "Easy to treat" BCCs are primarily diagnosed through clinicodermatoscopic characteristics, while "difficult to treat" cases require histopathological confirmation, especially in high-risk areas [1].

Surgical treatment remains the gold standard for BCC, with microscopically controlled surgery recommended for high-risk, recurrent BCCs, or those located in critical anatomical sites. Topical therapies and destructive approaches are options for low-risk superficial BCCs [2]. In cases of locally advanced or metastatic BCC, Hedgehog pathway inhibitors, such as vismodegib, have shown promising results [3].

Advanced age and the presence of comorbidities, such as dementia, also influence survival. A recent study suggests that active treatment of BCC in individuals over 90 years old may improve survival, although conservative options may be preferable in patients with dementia or those over 93 years old [4].

Conclusions

The management of basal cell carcinoma requires careful evaluation of prognostic factors to determine the most appropriate therapeutic approach. Surgery remains the primary treatment, but alternative therapies, such as Hedgehog pathway inhibitors, offer options for advanced cases. The patient's age and comorbidities are important considerations that can influence treatment decisions and the life expectancy of the patient. Ongoing research and the development of treatment guidelines specific to patient subgroups are essential for improving clinical outcomes and skin cancer survival.

Referencias

• [1] Diagnosis and treatment of basal cell carcinoma: European consensus-based interdisciplinary guidelines.
• [2] Basal Cell Carcinoma Review.
• [3] A comprehensive review of the role of the hedgehog pathway and vismodegib in the management of basal cell carcinoma.
• [4] Clinical outcomes of the management of basal cell carcinomas in individuals aged 90 years and over: a retrospective cohort study.

Created 13/1/2025