Clinical Scenario 1: A 74-Year-Old Man with Locally Advanced Infiltrative Basal Cell Carcinoma

Jennifer Atlas, MD: Let’s move on to some clinical scenarios. Our first clinical scenario is a 74-year-old White man of Irish descent who presents with a 4.5-cm right auricular lesion. His medical history is significant for hypertension that’s been well controlled with medication, and his biopsy demonstrates a locally advanced infiltrative basal cell carcinoma. Let’s talk about comanagement of these patients with basal cell carcinomas, such as this patient at our institution, and how we comanage this as a team.

Shahab Babakoohi, MD: High-risk or advanced basal cell carcinoma needs a multidisciplinary approach. In our institution, we have a tumor board for cutaneous oncology. In our team, we have dermatologists, medical oncologists, radiation oncologists, surgical oncology, and also a micrographic surgery team. We all work together for advanced patients or high-risk patients to make the best treatment plan for them. We receive many referrals from outside providers. In those cases, almost all the time we already have the pathology diagnosis made by an outside provider. In case that patient is referred to us, we start the diagnosis and management for patients already established in our system. As an oncology dermatologist, I see them. We proceed with the biopsy. We make the diagnosis. If it’s an advanced disease, we’ll inform our medical oncology colleague Dr Atlas. From there, we’ll start working together. A patient is usually discussed in our multidisciplinary tumor board for choosing the best option for management.

Jennifer Atlas, MD: You described it wonderfully. These high-risk basal cell carcinomas truly need a multidisciplinary team and approach. Each patient is going to have their care personalized to not only location but pathologic features of their disease in the context of their age and comorbidities. They’re going to need long-term surveillance and follow-up often with multiple members of the team to ensure the best care is delivered. That’s something we emphasize at our program because we not only want to treat the lesion we’re treating right now, but we also want to help prevent and do excellent surveillance additional lesions that may come, as well as manage toxicity for those who ultimately go on to receive radiation or systemic therapy. Having an interconnected group that can collaborate regularly on challenging cases is crucial to the care of these patients. In this patient, he has a locally advanced cancer that’s in a tough location in the auricular region, and it also has an infiltrator pattern. This is someone we would absolutely want to be treated in a multidisciplinary format because he has multiple high-risk features.

Transcript edited for clarity.