nCurrent FDA-approved hedgehog pathway inhibitors include vismodegib and sonidegib. oIf no further skin cancers are identified in the first 2 years, then less ...
NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®)
Basal Cell Skin Cancer Version 2.2016 NCCN.org
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Version 2.2016, 05/18/16 © National Comprehensive Cancer Network, Inc. 2016, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®.
Printed by Paul Nghiem on 5/30/2016 10:21:34 AM. For personal use only. Not approved for distribution. Copyright © 2016 National Comprehensive Cancer Network, Inc., All Rights Reserved.
NCCN Guidelines Version 2.2016 Panel Members Basal Cell Skin Cancer * Christopher K. Bichakjian, MD/Chair ϖ University of Michigan Comprehensive Cancer Center
Thomas Olencki, DO/Vice-Chair † The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute Sumaira Z. Aasi, MD ϖ Stanford Cancer Institute Murad Alam, MD ϖ ¶ ζ Robert H. Lurie Comprehensive Cancer Center of Northwestern University James S. Andersen, MD ¶ City of Hope Comprehensive Cancer Center Daniel Berg, MD ϖ Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance Glen M. Bowen, MD ϖ Huntsman Cancer Institute at the University of Utah Richard T. Cheney, MD ≠ Roswell Park Cancer Institute Gregory A. Daniels, MD, PhD † ‡ Þ UC San Diego Moores Cancer Center
Roy C. Grekin, MD ϖ ¶ UCSF Helen Diller Family Comprehensive Cancer Center Kenneth Grossman, MD, PhD † Huntsman Cancer Institute at the University of Utah Susan A. Higgins, MD, MS § Yale Cancer Center/Smilow Cancer Hospital Alan L. Ho, MD, PhD † Memorial Sloan Kettering Cancer Center Karl D. Lewis, MD † University of Colorado Cancer Center Daniel D. Lydiatt, MD, DDS ¶ ζ Fred & Pamela Buffett Cancer Center Kishwer S. Nehal, MD ϖ ¶ Memorial Sloan Kettering Cancer Center Paul Nghiem, MD, PhD ϖ Fred Hutchinson Cancer Research Center/ Seattle Cancer Care Alliance Elise A. Olsen, MD ϖ Duke Cancer Institute Chrysalyne D. Schmults, MD ϖ ¶ Dana-Farber/Brigham and Women’s Cancer Center Massachusetts General Hospital Cancer Center
L. Frank Glass, MD ϖ ≠ Moffitt Cancer Center
NCCN Anita Engh, PhD Karin G. Hoffmann, RN, CCM
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NCCN Guidelines Index Basal Cell TOC Discussion
Aleksandar Sekulic, MD, PhD ϖ Mayo Clinic Cancer Center Ashok R. Shaha, MD ¶ ζ Memorial Sloan Kettering Cancer Center Wade L. Thorstad, MD § Siteman Cancer Center at BarnesJewish Hospital and Washington University School of Medicine Malika Tuli, MD ϖ St. Jude Children’s Research Hospital/ University of Tennessee Health Science Center Marshall M. Urist, MD ¶ University of Alabama at Birmingham Comprehensive Cancer Center Timothy S. Wang, MD ϖ The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Sandra L. Wong, MD, MS ¶ University of Michigan Comprehensive Cancer Center John A. Zic, MD ϖ Vanderbilt-Ingram Cancer Center ϖ Dermatology ф Diagnostic/Interventional radiology ¶ Surgery/Surgical oncology ζOtolaryngology ≠ Pathology/Dermatopathology † Medical oncology Þ Internal medicine § Radiotherapy/Radiation oncology ‡ Hematology/Hematology oncology * Discussion Section Writing Committee
NCCN Guidelines Panel Disclosures
Version 2.2016, 05/18/16 © National Comprehensive Cancer Network, Inc. 2016, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®.
Printed by Paul Nghiem on 5/30/2016 10:21:34 AM. For personal use only. Not approved for distribution. Copyright © 2016 National Comprehensive Cancer Network, Inc., All Rights Reserved.
NCCN Guidelines Version 2.2016 Table of Contents Basal Cell Skin Cancer NCCN Basal Cell Skin Cancer Panel Members Summary of the Guidelines Updates Basal Cell Skin Cancer (BCC) BCC Clinical Presentation, Workup, and Risk Status (BCC-1) BCC Primary and Adjuvant Treatments • Low Risk (BCC-2) • High Risk (BCC-3)
BCC Follow-up and Recurrence (BCC-4) BCC Risk Factors for Recurrence (BCC-A) Principles of Treatment for Basal Cell Skin Cancer (BCC-B) Principles of Radiation Therapy for Basal Cell Skin Cancer (BCC-C)
NCCN Guidelines Index Basal Cell TOC Discussion
Clinical Trials: NCCN believes that the best management for any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. To find clinical trials online at NCCN Member Institutions, click here: nccn.org/clinical_trials/physician.html. NCCN Categories of Evidence and Consensus: All recommendations are category 2A unless otherwise specified. See NCCN Categories of Evidence and Consensus.
The NCCN Guidelines® are a statement of evidence and consensus of the authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult the NCCN Guidelines is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient’s care or treatment. The National Comprehensive Cancer Network® (NCCN®) makes no representations or warranties of any kind regarding their content, use or application and disclaims any responsibility for their application or use in any way. The NCCN Guidelines are copyrighted by National Comprehensive Cancer Network®. All rights reserved. The NCCN Guidelines and the illustrations herein may not be reproduced in any form without the express written permission of NCCN. ©2016. Version 2.2016, 05/18/16 © National Comprehensive Cancer Network, Inc. 2016, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®.
Printed by Paul Nghiem on 5/30/2016 10:21:34 AM. For personal use only. Not approved for distribution. Copyright © 2016 National Comprehensive Cancer Network, Inc., All Rights Reserved.
NCCN Guidelines Version 2.2016 Updates Basal Cell Skin Cancer
NCCN Guidelines Index Basal Cell TOC Discussion
Updates in Version 2.2016 of the NCCN Guidelines for Basal Cell Skin Cancer from Version 1.2016 include: MS-1 • The discussion section was updated to reflect the changes in the algorithm. Updates in Version 1.2016 of the NCCN Guidelines for Basal Cell Skin Cancer from Version 1.2015 include: Basal Cell Skin Cancer BCC-2 • For “Primary treatment of low-risk basal cell skin cancer” under “Curettage and electrodesiccation”: Bullet 1 statement: “In non-hair bearing areas” revised: “Excluding terminal hair-bearing areas, such as the scalp, pubic and axillary regions, and beard area in men.” Bullet 2 statement: “If adipose reached, surgical excision should generally be performed,” an arrow was added pointing directly to “Standard excision.” BCC-3 • Under “Adjuvant Treatment”: For “Standard excision” when margins are positive, a statement was modified: “If residual disease is present, and further surgery and RT are contraindicated, consider multidisciplinary tumor board consultation (consider vismodegib a hedegehog pathway inhibitor or clinical trial)” For “Mohs or resection” as primary treatment when margins are positive, a statement was modified: “RT and/or multidisciplinary tumor board consultation (consider a hedgehog pathway inhibitor or clinical trial)” Footnote “n” added: “Current FDA approved hedgehog pathway inhibitors include vismodegib and sonidegib.” BCC-4 • Under “Recurrence”: “Regional” was removed and statement “Surgery and/or RT” was added to revised: “Nodal or distant metastases” Statement revised: “Multidisciplinary tumor board consultation (consider a hedgehog pathway inhibitor vismodegib or clinical trials)” • Footnote “n” is new to this page: “Current FDA-approved hedgehog pathway inhibitors include vismodegib and sonidegib.” • Footnote “o” is new to this page: “If no further skin cancers are identified in the first 2 years, then less frequent follow-up may be appropriate.” BCC-A • Footnote “1”: Was added to “Area M
