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A Non-Healing Facial Lesion

Francesca Cheung, MD CCFP, is a family physician with a special interest in dermatology. She received the Diploma in Practical Dermatology from the Department of Dermatology at Cardiff University in Wales, UK. She is practising at the Lynde Centre for Dermatology in Markham, Ontario and works closely with Dr. Charles Lynde, MD FRCPC, an experienced dermatologist. In addition to providing direct patient care, she acts as a sub-investigator in multiple clinical studies involving psoriasis, onychomycosis, and acne.

Abstract
Basal cell carcinoma (BCC) is a type of non-melanoma skin cancer that arises from basal cells found in the lower layer of the epidermis. It is the most common type of skin cancer in humans, but they rarely metastasize. If BCC is left untreated and progresses, it may lead to significant morbidity and cosmetic disgurement. In nearly all cases, the recommended treatment modality for BCC is surgery. Small and superficial BCC may respond to local immune-modulating therapies. For tumors that are more difficult to treat or those in which tissue preservation is essential, Mohs micrographic surgery should be considered. Radiation therapy can be used for advanced and extended BCC and in those patients for whom surgery is contraindicated. Photodynamic therapy is usually used as an adjunct in BCCs with poorly defined border, in cases which oculoplastic surgery will be extensive or difficult, or in recurrent BCCs with tissue atrophy or scar formation. Oral vismodegib has been approved for the treatment of adult patients with locally advanced basal cell carcinoma who are not candidates for surgery or radiation and for those with metastatic disease. The prognosis for BCC is generally great with 100% survival rate for localized cases.
Keywords: Basal cell carcinoma, Nonmelanoma skin cancer, Hedgehog intracellular signalling pathway, Imiquimod 5% cream, 5-Fluorouracil 5% cream.