The first 60 days: Basal cell carcinoma
Basal cell carcinoma is the most common cancer of all, caused by sun exposure and almost never life-threatening. Nearly all are removed surgically; the rare advanced cases are treated with drugs that block the hedgehog signalling pathway, and with immunotherapy if those fail. Below, week by week, is what OnCo's record of Basal cell carcinoma says about the first two months: the order is typical, the timing is yours to ask about. Sections appear only where the record has something to say. Orientation, not medical advice.
What happens now
Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.
Ask which of these were tested and what the results were; see the report reader for what each value means.
These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.
- SurgeonNamed in the standard of care for: Low-risk, High-risk or recurrent, Locally advanced or metastatic.
- Medical oncologistNamed in the standard of care for: Low-risk, High-risk or recurrent, Locally advanced or metastatic.
- Clinical oncologist (radiotherapy)Named in the standard of care for: High-risk or recurrent, Locally advanced or metastatic.
A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.
Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.
Mohs micrographic surgery or excision with complete margin assessment; radiotherapy if surgery not feasible.
Vismodegib or sonidegib; cemiplimab after hedgehog-inhibitor failure or intolerance; multidisciplinary review for surgery/radiotherapy after response.
Standard excision with 4 mm margin, curettage and electrodesiccation, or topical imiquimod / 5-FU / photodynamic therapy for superficial lesions.
Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example Histologic subtype and high-risk location, PTCH1 / SMO / SUFU alterations, Perineural invasion, Germline PTCH1), and what were the results?These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Recognised subtypes for this cancer include Nodular, Superficial, Infiltrative / morphoeic.
- Is germline (inherited) genetic testing recommended for me or my family?Inherited variants can change treatment and matter for relatives.
Low-risk
- For my situation (low-risk), which of the standard options do you recommend and why?Guideline options include: Standard excision with 4 mm margin, curettage and electrodesiccation, or topical imiquimod / 5-FU / photodynamic therapy for superficial lesions.
- Am I a candidate for Fluorouracil (5-FU), and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
High-risk or recurrent
- For my situation (high-risk or recurrent), which of the standard options do you recommend and why?Guideline options include: Mohs micrographic surgery or excision with complete margin assessment; radiotherapy if surgery not feasible.
Locally advanced or metastatic
- For my situation (locally advanced or metastatic), which of the standard options do you recommend and why?Guideline options include: Vismodegib or sonidegib; cemiplimab after hedgehog-inhibitor failure or intolerance; multidisciplinary review for surgery/radiotherapy after response.
- Am I a candidate for Vismodegib, Sonidegib, Cemiplimab, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
Any stage
- Are there clinical trials I could join, for example of Cemiplimab, Vismodegib?Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Supportive care improves quality of life and helps patients complete treatment.
- I read that “Hedgehog-inhibitor tolerability leads most patients to stop within a year”. How does that affect my plan?Open problems are where trials and second opinions matter most.
- I read that “Resistance via SMO mutations has no approved next-in-class agent”. How does that affect my plan?Open problems are where trials and second opinions matter most.
Trials open now for this cancer in OnCo, largest phase first. Joining a trial is a decision like any other: ask what the comparison arm is, whether a placebo is used, and what happens if you leave. The cancer page searches ClinicalTrials.gov live for more.
- Efficacy and Safety of Patidegib Gel 2% for Preventing Basal Cell Carcinomas on the Face of Adults With Gorlin SyndromePhase 3 · active · NCT06050122A Multicenter, Randomized, Double Blind, Vehicle-controlled, Phase 3 Efficacy and Safety Study of Patidegib Gel 2% for the Reduction of Disease Burden of Persistently Developing Basal Cell Carcinomas (BCCs) in Subjects With Gorlin Syndrome
- Clinical Trial to Evaluate BO-112 in Patients With Basal Cell Carcinoma (BCC)Phase 2 · active · NCT06422936SPOTLIGHT 204: A Multicenter, Phase 2b, Open-label, Non-randomized, Clinical Trial to Evaluate Safety, Tolerability and Preliminary Efficacy of Intra-lesional BO-112 in Patients With Resectable Primary Low and High Risk Basal Cell Carcinoma
- L19IL2 or L19TNF or L19IL2/TNF in Patients With Basal Cell Carcinoma (BCC)Phase 2 · recruiting · NCT07227350A Phase 2 Controlled Randomized Study of the Efficacy of L19IL2 or L19TNF or L19IL2/L19TNF Intralesional Injections for the Treatment of Locally Advanced Basal Cell Carcinoma (LaBCC)
- L19IL2/TNF in Patients With Basal Cell CarcinomaPhase 2 · recruiting · NCT07227870A Phase 2 Study of Intratumoral Administration of L19IL2/L19TNF in Locally Advanced Basal Cell Carcinoma Patients Progressing or Intolerant to Systemic Treatment.
- To Assess the Safety and Efficacy of SP-002 with Vismodegib for the Treatment of Locally Advanced Basal Cell CarcinomaPhase 2 · recruiting · NCT06344052A Phase 2 Study to Assess the Efficacy of SP-002 with Vismodegib for the Treatment of Locally Advanced Basal Cell Carcinoma
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
- Basal cell carcinoma: the full pageBasal cell carcinoma is the most common cancer of all, caused by sun exposure and almost never life-threatening. Nearly all are removed surgically; the rare advanced cases are treated with drugs that block the hedgehog signalling pathway, and with immunotherapy if those fail.
- One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
- Treatment sequencingWhich treatment tends to follow which, line by line.
- NavigatorStandard of care for your stage, what you have tried, and trials near you.
- Cancer stem cell theory and phenotypic plasticity: The idea that a tumour is organised like a tissue, with a small pool of stem-like cells that renew it and a bulk that cannot, so killing the bulk shrinks the tumour but the stem-like cells regrow it.
- Immune-related adverse events (irAEs): Immune-related adverse events (irAEs) are the autoimmune side effects of checkpoint inhibitors: colitis, thyroid problems, rash, hepatitis, pneumonitis.
Every term links to the glossary.