1/6/2016 BasalCellCarcinomaMedication:AntineoplasticAgents,Antineoplastics,HedgehogPathwayInhibitor,PhotosensitizingAgent,Topical,KeratolyticA

BasalCellCarcinomaMedication
Author:RobertSBader,MDChiefEditor:WilliamDJames,MDmore...
Updated:Sep15,2015

MedicationSummary
Medicationsusedforthetreatmentofbasalcellcarcinoma(BCC)includeantineoplasticagentssuchas5
fluorouracilandimiquimodthephotosensitizingagentmethylaminolevulinatecreamandtheacetylenicretinoid
tazarotene.

AntineoplasticAgents
ClassSummary
Themostcommonchemotherapeuticagentusedinsuperficialbasalcellcarcinomaistopical5fluorouracil.
Viewfulldruginformation

Fluorouraciltopical(Efudex)
5Fluorouraciltopical5%creamorsolutionisusedtopicallyforthemanagementofsuperficialBCC.Itinterferes
withDNAsynthesisbyblockingmethylationofdeoxyuridylicacidandinhibitingthymidylatesynthetaseand,
subsequently,cellproliferation.
Viewfulldruginformation

Imiquimod(Aldara)
TheprecisemechanismofimiquimodforsuperficialBCCisunknown.Itmayincreasetumorinfiltrationby
lymphocytes,dendriticcells,andmacrophages.ItisindicatedforbiopsyconfirmedprimarynonfacialsuperficialBCC
inadultswithnormalimmunesystems.Additionally,tumorsmustnotexceed2cmindiameteroncertainareasof
thebody.Imiquimodisindicatedonlywhensurgicalmethodsarenotappropriate.
Viewfulldruginformation

Interferonalfa2b(IntronA)
Interferonalfa2bisaproteinproductmanufacturedwithrecombinantDNAtechnology.Themechanismof
antitumoractivityisnotclearlyunderstoodhowever,directantiproliferativeeffectsagainstmalignantcellsand
modulationofhostimmuneresponsemaybeimportant.
AsaninvestigationaldrugfornodularBCC,interferonalfa2bwasusedinarandomized,placebocontrolled
multicenterstudywith172patients.Intralesionalinjectionsof1.5millionUadministered3times/wkfor3wkyielded
an86%completeresponserate,comparedwith29%forplacebo.Asimilarstudydidnotshowefficacyfor
morpheaformoraggressiveBCCs.

Antineoplastics,HedgehogPathwayInhibitor
ClassSummary
TheHedgehogsignalingpathwayisimportantinembryogenesis,butinadults,itismostlyinactive.Signalingis
relayedbykeyproteinsincludingSmoothened(SMO).Hhligandexpressingcancerousepithelialcellsthatare
activatedbytheHhsignalingpathwaymaycausegrowthpromotion.
Viewfulldruginformation

Vismodegib(Erivedge)
VismodegibisaHedgehog(Hh)pathwayinhibitor.VismodegibbindstoandinhibitsSMO,atransmembraneprotein
involvedinHedgehogsignaltransduction.Thisagentisindicatedfortreatmentofadultswithmetastaticbasalcell
carcinomaorwithlocallyadvancedbasalcellcarcinomathathasrecurredfollowingsurgery,orthosewhoarenot
candidatesforsurgeryorradiation.
Viewfulldruginformation

Sonidegib(Odomzo)
SonidegibbindstoandinhibitsSMO,atransmembraneproteininvolvedinHedgehogsignaltransduction.Indicated
foradultswithlocallyadvancedbasalcellcarcinomathathasrecurredfollowingsurgeryorradiationtherapy,or
thosewhoarenotcandidatesforsurgeryorradiationtherapy.

PhotosensitizingAgent,Topical
ClassSummary
Photodynamictherapy(PDT)forbasalcellcarcinomasistheprocessofusingspecificwavelengthsoflightto
photoexciteporphyrinsthathavebeenappliedtoneoplasticandpreneoplasticcells.Thisincreasedenergyisrapidly
absorbedbyadjacenttissueoxygen,causingtheformationofsingletoxygenradicals.Theseradicalsrapidlyreact
withadjacenttissueanddestroyit.
Viewfulldruginformation

Methylaminolevulinate(Metvixia)
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1/6/2016 BasalCellCarcinomaMedication:AntineoplasticAgents,Antineoplastics,HedgehogPathwayInhibitor,PhotosensitizingAgent,Topical,KeratolyticA
Methylaminolevulinatecreamisaporphyrinprecursorusedincombinationwithnarrowband,redlightillumination
fornonhyperkeratotic,nonpigmentedactinickeratoses.Whenusedwithphotodynamictherapy,theaccumulationof
photoactiveporphyrinsproducesaphotodynamicreactionthatresultsinacytotoxicprocessdependentuponthe
simultaneouspresenceofoxygen.

KeratolyticAgents
ClassSummary
Theseagentsdecreasecohesivenessofabnormalhyperproliferativekeratinocytesandmayreducepotentialfor
malignantdegeneration.Itmodulateskeratinocytedifferentiation.
Viewfulldruginformation

Tazarotene(Avage,Fabior,Tazorac)
Tazaroteneisaretinoidprodrugwithanactivemetabolitethatmodulatesdifferentiationandproliferationof
epithelialtissueitalsomayhaveantiinflammatoryandimmunomodulatoryproperties.ItisnotapprovedbytheUS
FoodandDrugAdministrationfortreatingbasalcellcarcinoma.

ContributorInformationandDisclosures
Author
RobertSBader,MDDermatologist,SectionofDermatology,DepartmentofMedicine,BrowardHealthNorth
RobertSBader,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofDermatology,Florida
MedicalAssociation,AmericanSocietyforDermatologicSurgery,AmericanSocietyforMOHSSurgery
Disclosure:Nothingtodisclose.
Coauthor(s)
AndrewScottKennedy,MDPhysicianinChief,RadiationOncology
AndrewScottKennedy,MDisamemberofthefollowingmedicalsocieties:AlphaOmegaAlpha,American
AssociationforCancerResearch,AmericanSocietyforRadiationOncology,RadiologicalSocietyofNorth
America,AmericasHepatoPancreatoBiliaryAssociation,AmericanSocietyofClinicalOncology
Disclosure:Nothingtodisclose.
LuigiSantacroce,MDAssistantProfessor,MedicalSchool,StateUniversityatBari,Italy
Disclosure:Nothingtodisclose.
LauraDiomedeUniversityofBariSchoolofMedicine,Italy
Disclosure:Nothingtodisclose.
SpecialtyEditorBoard
FranciscoTalavera,PharmD,PhDAdjunctAssistantProfessor,UniversityofNebraskaMedicalCenterCollege
ofPharmacyEditorinChief,MedscapeDrugReference
Disclosure:ReceivedsalaryfromMedscapeforemployment.for:Medscape.
ChiefEditor
WilliamDJames,MDPaulRGrossProfessorofDermatology,ViceChairman,ResidencyProgramDirector,
DepartmentofDermatology,UniversityofPennsylvaniaSchoolofMedicine
WilliamDJames,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofDermatology,
SocietyforInvestigativeDermatology
Disclosure:Nothingtodisclose.
Acknowledgements
SanjivSAgarwala,MDChiefofOncologyandHematology,StLuke'sCancerCenter,StLuke'sHospitaland
HealthNetworkProfessor,TempleUniversitySchoolofMedicine
SanjivSAgarwala,MDisamemberofthefollowingmedicalsocieties:AmericanAssociationforCancer
Research,AmericanSocietyforHeadandNeckSurgery,AmericanSocietyofClinicalOncology,Eastern
CooperativeOncologyGroup,andEuropeanSocietyforMedicalOncology
Disclosure:BMSHonorariaSpeakingandteachingNovartisConsultingfeeConsultingMerckConsultingfee
Consulting
MichaelGionoBarakatCaliforniaSurgicalInstitute
Disclosure:Nothingtodisclose.
DanielBerg,MD,FRCP(C)ProfessorofDermatology,DirectorofDermatologicSurgery,Universityof
WashingtonSchoolofMedicine
DanielBerg,MD,FRCP(C)isamemberofthefollowingmedicalsocieties:AlphaOmegaAlpha,American
AcademyofDermatology,AmericanCollegeofMohsMicrographicSurgeryandCutaneousOncology,and
AmericanSocietyforDermatologicSurgery
Disclosure:GenentechHonorariaReviewpanelmembership
GregoryCaputy,MD,PhD,FICSChiefSurgeon,AestheticaPlasticandLaserSurgeryCenter,Inc
GregoryCaputy,MD,PhD,FICSisamemberofthefollowingmedicalsocieties:AmericanSocietyforLaser
MedicineandSurgery,InternationalCollegeofSurgeons,InternationalCollegeofSurgeonsUSSection,Pan
PacificSurgicalAssociation,andWoundHealingSociety
Disclosure:SyneronCorporationSalarySpeakingandteaching
EdwardFChan,MDClinicalAssistantProfessor,DepartmentofDermatology,UniversityofPennsylvania
SchoolofMedicine

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1/6/2016 BasalCellCarcinomaMedication:AntineoplasticAgents,Antineoplastics,HedgehogPathwayInhibitor,PhotosensitizingAgent,Topical,KeratolyticA
EdwardFChan,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofDermatology,
AmericanSocietyofDermatopathology,andSocietyforInvestigativeDermatology
Disclosure:Nothingtodisclose.
RobertACopelandJr,MDChair,Professor,DepartmentofOphthalmology,HowardUniversityCollegeof
Medicine
RobertACopelandJr,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofOphthalmology
Disclosure:Nothingtodisclose.
MarkTDuffy,MD,PhDConsultingStaff,DivisionofOculoplastic,Orbitofacial,LacrimalandReconstructive
Surgery,GreenBayEyeClinic,BayCareClinicMedicalDirector,AdvancedCosmeticSolutions,ABayCare
Clinic
MarkTDuffy,MD,PhDisamemberofthefollowingmedicalsocieties:AmericanAcademyofOphthalmology,
AmericanMedicalAssociation,AmericanSocietyofOphthalmicPlasticandReconstructiveSurgery,SigmaXi,
andSocietyforNeuroscience
Disclosure:AllerganBotoxCosmeticHonorariaSpeakingandteaching
HonVuQDuong,MDClinicalInstructorofOphthalmologyandOphthalmicPathology,WestfieldNevadaEye
andEarSeniorLecturerofNeurosciences:AnatomyandPhysiology,NevadaStateCollege
HonVuQDuong,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofOphthalmology
Disclosure:Nothingtodisclose.
DirkMElston,MDDirector,AckermanAcademyofDermatopathology,NewYork
DirkMElston,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofDermatology
Disclosure:Nothingtodisclose.
JaimeRGarza,MD,DDS,FACSConsultingStaff,PrivatePractice
JaimeRGarza,MD,DDS,FACSisamemberofthefollowingmedicalsocieties:AlphaOmegaAlpha,American
AcademyofOtolaryngologyHeadandNeckSurgery,AmericanCollegeofSurgeons,AmericanSocietyfor
AestheticPlasticSurgery,AmericanSocietyofMaxillofacialSurgeons,TexasMedicalAssociation,andTexas
SocietyofPlasticSurgeons
Disclosure:AllerganNoneSpeakingandteachingLifeCellNoneConsultingGID,Inc.Grant/researchfunds
Other
ShahinJavaheri,MDChief,DepartmentofPlasticSurgery,MartinezVeteransAffairsOutpatientClinic
ConsultingStaff,AdvancedAestheticPlastic&ReconstructiveSurgery
ShahinJavaheri,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofOtolaryngologyHead
andNeckSurgeryandAmericanSocietyofPlasticSurgeons
Disclosure:Nothingtodisclose.
ShangIBrianJiang,MDAssociateClinicalProfessorofMedicineandDermatology,Director,Dermatologicand
MohsMicrographicSurgery,ProgramDirector,UCSDDermatologicandMohsSurgeryFellowship,Universityof
CaliforniaSchoolofMedicine,SanDiego
ShangIBrianJiang,MD,isamemberofthefollowingmedicalsocieties:AmericanAcademyofDermatology,
AmericanCollegeofMohsSurgery,AmericanSocietyforDermatologicSurgery,andAssociationofProfessors
ofDermatology
Disclosure:DUSACorporationGrant/researchfundsPIforIndustrySponsoredClincalTrial
KlausDieterLessnau,MD,FCCPClinicalAssociateProfessorofMedicine,NewYorkUniversitySchoolof
MedicineMedicalDirector,PulmonaryPhysiologyLaboratoryDirectorofResearchinPulmonaryMedicine,
DepartmentofMedicine,SectionofPulmonaryMedicine,LenoxHillHospital
KlausDieterLessnau,MD,FCCPisamemberofthefollowingmedicalsocieties:AmericanCollegeofChest
Physicians,AmericanCollegeofPhysicians,AmericanMedicalAssociation,AmericanThoracicSociety,and
SocietyofCriticalCareMedicine
Disclosure:Nothingtodisclose.
ArlenDMeyers,MD,MBAProfessorofOtolaryngology,Dentistry,andEngineering,UniversityofColorado
SchoolofMedicine
ArlenDMeyers,MD,MBAisamemberofthefollowingmedicalsocieties:AmericanAcademyofFacialPlastic
andReconstructiveSurgery,AmericanAcademyofOtolaryngologyHeadandNeckSurgery,andAmericanHead
andNeckSociety
Disclosure:CovidienCorpConsultingfeeConsultingUSTobaccoCorporationUnrestrictedgiftUnknownAxis
ThreeCorporationOwnershipinterestConsultingOmniBiosciencesOwnershipinterestConsultingSentegra
OwnershipinterestBoardmembershipMedvoyOwnershipinterestManagementpositionCerescanImaging
ConsultingHeadwatersmbConsultingfeeConsultingVenturequestRoyaltyConsulting
MauriceYNahabedian,MD,FACSAssociateProfessor,DepartmentofPlasticSurgery,GeorgetownUniversity
Hospital
MauriceYNahabedian,MD,FACSisamemberofthefollowingmedicalsocieties:AmericanAssociationof
PlasticSurgeons,AmericanCollegeofSurgeons,AmericanSocietyforReconstructiveMicrosurgery,American
SocietyofPlasticSurgeons,JohnsHopkinsMedicalandSurgicalAssociation,andNortheasternSocietyof
PlasticSurgeons
Disclosure:LifecellcorpHonorariaSpeakingandteaching
SamiaNawaz,MBBS,MDAssociateProfessor,DepartmentofPathology,UniversityofColoradoHealth
ScienceCenter
SamiaNawaz,MBBS,MDisamemberofthefollowingmedicalsocieties:AmericanSocietyforClinical
Pathology,AmericanSocietyofCytopathology,andInternationalAcademyofPathology

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1/6/2016 BasalCellCarcinomaMedication:AntineoplasticAgents,Antineoplastics,HedgehogPathwayInhibitor,PhotosensitizingAgent,Topical,KeratolyticA
Disclosure:Nothingtodisclose.
RonWPelton,MD,PhDPrivatePractice,ColoradoSprings,Colorado
RonWPelton,MD,PhDisamemberofthefollowingmedicalsocieties:AmericanAcademyofOphthalmology,
AmericanCollegeofSurgeons,AmericanSocietyofOphthalmicPlasticandReconstructiveSurgery,AO
Foundation,andColoradoMedicalSociety
Disclosure:Nothingtodisclose.
MichaelLRamsey,MDDirector,MohsSurgeryFellowship,CoDirector,ProceduralDermatologyFellowship,
DepartmentofDermatology,GeisingerMedicalCenter
MichaelLRamsey,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofDermatology,
AmericanCollegeofMohsMicrographicSurgeryandCutaneousOncology,andPennsylvaniaAcademyof
Dermatology
Disclosure:Nothingtodisclose.
RanaRofaghaSajjadian,MDClinicalInstructor,DepartmentofDermatology,UniversityofIrvine,California
DivisionofMohsSurgery,DepartmentofDermatology,SouthernCaliforniaPermanenteMedicalGroup
RanaRofaghaSajjadian,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyof
Dermatology,AmericanSocietyforDermatologicSurgery,andAmericanSocietyforMOHSSurgery
Disclosure:Nothingtodisclose.
ThomasMRoy,MDChief,DivisionofPulmonaryDiseasesandCriticalCareMedicine,QuillenMountainHome
VeteransAffairsMedicalCenterProfessor,DepartmentofInternalMedicine,DivisionofPulmonaryMedicine,
FellowshipProgramDirector,EastTennesseeStateUniversity,JamesHQuillenCollegeofMedicine
ThomasMRoy,MDisamemberofthefollowingmedicalsocieties:AmericanCollegeofChestPhysicians,
AmericanCollegeofPhysicians,AmericanMedicalAssociation,AmericanThoracicSociety,SouthernMedical
Association,andWildernessMedicalSociety
Disclosure:Nothingtodisclose.
MSherifSaid,MD,PhDAssociateProfessorofPathology,DirectorofHeadandNeckPathology,Department
ofPathology,UniversityofColoradoSchoolofMedicine
MSherifSaid,MD,PhDisamemberofthefollowingmedicalsocieties:AmericanSocietyforClinicalPathology
andCollegeofAmericanPathologists
Disclosure:Nothingtodisclose.
AliSajjadian,MD,FACSPrivatePractice,NewportBeach,CaliforniaFormerAssistantProfessorofPlastic
Surgery,FormerDirectorofAestheticPlasticSurgerySatelliteCenters,UniversityofPittsburghMedicalCenter
AliSajjadian,MD,FACSisamemberofthefollowingmedicalsocieties:AmericanAcademyofFacialPlastic
andReconstructiveSurgery,AmericanAcademyofOtolaryngologyHeadandNeckSurgery,AmericanCollegeof
Surgeons,AmericanMedicalAssociation,AmericanSocietyofPlasticSurgeons,AmericanSocietyofPlastic
Surgeons,AmericanSocietyofPlasticSurgeons,CaliforniaMedicalAssociation,NortheasternSocietyofPlastic
Surgeons,andPennsylvaniaMedicalSociety
Disclosure:Nothingtodisclose.
NegarSajjadian,MDAssistantProfessorofPediatrics,TehranUniversityofMedicalSciences,ShariatiHospital
Disclosure:Nothingtodisclose.
WayneKarlStadelmann,MDStadelmannPlasticSurgery,PC
WayneKarlStadelmann,MDisamemberofthefollowingmedicalsocieties:AlphaOmegaAlpha,American
CollegeofSurgeons,AmericanSocietyofPlasticSurgeons,NewHampshireMedicalSociety,Northeastern
SocietyofPlasticSurgeons,andPhiBetaKappa
Disclosure:Nothingtodisclose.
KatherineSzyfelbein,MDStaffPhysician,DepartmentofDermatology,BostonUniversity,BostonMedical
Center
Disclosure:Nothingtodisclose.
FranciscoTalavera,PharmD,PhDAdjunctAssistantProfessor,UniversityofNebraskaMedicalCenterCollege
ofPharmacyEditorinChief,MedscapeDrugReference
Disclosure:MedscapeSalaryEmployment
RStanTaylor,MDTheJBHowellProfessorinMelanomaEducationandDetection,Departmentsof
DermatologyandPlasticSurgery,Director,SkinSurgeryandOncologyClinic,UniversityofTexasSouthwestern
MedicalCenter
RStanTaylor,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofDermatology,
AmericanCollegeofMohsSurgery,AmericanDermatologicalAssociation,AmericanMedicalAssociation,
AmericanSocietyforDermatologicSurgery,ChristianMedical&DentalSociety,andSocietyforInvestigative
Dermatology
Disclosure:Nothingtodisclose.
Image1:KellyNelson(Photographer)Publicdomain,viaWikimediaCommons.

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