Alternative treatment options for periocular basal cell carcinoma: a narrative review

Background and Objectives: Alternative treatment approaches to basal cell carcinoma (BCC) are necessary in inoperable BCC. Methods: A summary was created based on an English and German literature searched on PubMed after 2010. Key Content and Findings: This literature review presents the latest developments as well as established procedures that offer alternative treatment approaches to basal cell carcinoma when micrographically controlled surgical removal is not possible. Conclusions: Micrographically controlled surgical removal remains the gold standard in the treatment of BCC. When surgical removal is impossible, other procedures can be chosen. The alternative treatment options can be divided into three main groups: treatment options for locally advanced or metastasized BCC, topical approaches for small and superficial BCC and prophylactic measures. While radiotherapy and systemic therapy are suitable for locally advanced BCC that are discussed in an interdisciplinary tumor board, small and superficial BCC can be treated by topical therapy. In cases of a previous BCC history, a prophylactic treatment can be considered. A combination of systemic treatment and neoadjuvant or adjuvant approaches before or after surgery are promising options for a successful outcome, which can further improve the standard treatment for locally advanced BCC. However, due to the lack of therapy success controls for both treatment options, almost all forms of therapy are inferior to micrographically controlled surgery and should therefore only be used if there are substantial reasons against R0 resection. In this review a literature search on PubMed was carried out and a structured display and analysis of the results are given.