Treatment Options for Advanced Basal Cell Skin Cancer 

This article is for people with advanced basal cell skin cancer and their care partners, or anyone who wants to learn more about this condition. The goal of this activity is to help people with advanced basal cell skin cancer engage in shared decision-making with their doctor about treatment options.

You will learn about:

• What advanced basal cell skin cancer is

• Treatment options for advanced basal cell skin cancer and how they work

• Possible side effects of treatment

• Making a treatment plan with your doctor, and questions to ask

Medicines listed in this activity may not be approved by the US Food and Drug Administration (FDA) for basal cell skin cancer but are recommended by the National Comprehensive Cancer Network (NCCN).

Basal cell skin cancer -- also called basal cell carcinoma or BCC -- starts in the basal cells of your outermost layer of skin, the epidermis.

Your skin is made up of 3 layers:

• Epidermis that contains squamous cells, basal cells, and cells called melanocytes

• Dermis, the middle layer that contains follicles for hair growth, oil and sweat glands, and connective tissue for support

• Hypodermis, the deepest layer that's made up of fat and connective tissue

Skin cancer can also start in your squamous cells (squamous cell carcinoma) or in your melanocytes (melanoma). Basal cell and squamous cell carcinoma are the 2 most common types of skin cancer.

Basal cell skin cancer usually affects your skin where it's most exposed to ultraviolet (UV) radiation from sunlight and other sources. But it can also damage your soft tissue, bone, and cartilage (the firm, flexible connective tissue in your ears and nose).

Advanced basal cell skin cancer is cancer that is locally advanced or metastatic. Locally advanced means that the cancer is large or has grown deeper into your skin, underlying tissues, muscles, or nerves and has damaged nearby tissue. Most advanced basal cell skin cancers are locally advanced.

Very rarely, basal cell skin cancer can spread, or metastasize, to nearby lymph nodes and other parts of your body, such as your bones and lungs. This is called metastatic basal cell skin cancer.

Treatment options for advanced basal cell skin cancer that may be used alone or in combination can include:

• Surgery to remove all or as much of the cancer as possible, or to remove tumors (groups of cancer cells) that have spread to other parts of your body

• Radiation therapy that uses high-energy waves (such as x-rays) to kill cancer cells, stop them from making new cells, or shrink tumors. It may also be given after surgery to help slow cancer growth

• Systemic therapy medicines such as chemotherapy (or "chemo"), targeted therapy, or immunotherapy

• Joining a clinical trial

Chemotherapy works to kill cancer cells or stop them from completing their life cycle so they can't increase in number.

Your doctor may recommend topical chemotherapy that you apply to your skin's surface if advanced basal cell skin cancer hasn't spread to other parts of your body. But if cancer is deep or metastatic, chemotherapy given into a vein (intravenously or IV) may be recommended.

Targeted therapy such as vismodegib (Erivedge®) or sonidegib (Odomzo®) works to help to destroy cancer cells or stop them from growing. Your doctor may recommend targeted therapy if advanced basal cell skin cancer has spread deep into the skin or keeps coming back (recurs).

Immunotherapy helps your immune system -- your body's natural defense system -- find and kill cancer cells. Immunotherapy that may be recommended includes cemiplimab-rwlc (Libtayo®).

Different treatments can have different side effects. After surgery, some people may have pain, swelling, scars, or numbness in the area where the surgery was.

Some common side effects that may happen with other treatments can include:

Side effect	Treatment
	Radiation therapy	IV chemotherapy	Targeted therapy	Immunotherapy
Appetite loss, weight change	☑	☑	☑	☑
Hair loss	☑	☑	☑
Fatigue (tiredness)		☑	☑	☑
Diarrhea		☑	☑	☑
Nausea, vomiting		☑	☑
Muscle or joint pain			☑	☑
Skin changes or rash	☑			☑
Mouth sores		☑
Headache, muscle spasms, changed taste, constipation, itching, stomach pain			☑
Changes in certain lab tests				☑

Not all side effects are listed here. Ask your doctor, pharmacist, or healthcare team for a complete list.

Before treatment, ask your doctor about which side effects can happen with each treatment and when you should call your doctor or go to the emergency room because of side effects.

Side effects will be managed differently depending on which treatment caused them. Be sure to tell your doctor about any side effects -- tracking and recording them in a journal or diary can help. Together, you and your doctor can find ways to manage any side effects you have.

No one treatment for advanced basal cell skin cancer is for everyone, so you will make a plan with your doctor that best fits your individual needs. Be sure to talk to your doctor and healthcare team about your goals and personal preferences for your treatment plan.

Questions you can ask your doctor can include:

• What treatments are available, and what are the treatment goals?

• How will I know if treatment is working?

• What are the possible side effects of treatment, and how can they be managed?

• How can I have the best quality of life possible?

• Is there a clinical trial I might be eligible for?

• What should I do if I feel stressed or depressed?

• Where can I find more information and resources?

Congratulations!

You have successfully completed the program: Treatment Options for Advanced Basal Cell Skin Cancer

View Additional Materials on this topic that you may find useful:

Skin Cancer

Skin Cancer -- National Cancer Institute (NIH)

What Is Skin Cancer?

Skin Cancer Treatment