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Basal Cell Skin Cancer: Updated NCCN Guidelines Focus on Risk Stratification

By: Kayci Reyer
Posted: Thursday, February 1, 2024

The updated National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for basal cell carcinoma, published in the JNCCN–Journal of the National Comprehensive Cancer Network, focus on adjusted risk stratification and treatment option availability. Exposure to radiation plays a key role in the development of this common type of skin cancer—whether it be from sunlight or previous medical therapy.

“Due to the high frequency, basal cell carcinoma occurrences are not typically recorded, and annual rates of incidence can only be estimated,” noted NCCN Guidelines Panel Chair Chrysalyne D. Schmults, MD, of Dana-Farber Cancer Institute, Boston, and colleagues. “Current estimated rates are 2 million Americans affected annually, and this continues to rise.”

The updated NCCN Guidelines outlined several risk factors associated with disease development. Basal cell carcinoma most commonly occurs on skin sites exposed to radiation. Contact with ultraviolet (UV) radiation from the sun is a recognized risk factor, although its impacts are modulated by factors including the timing, pattern, and quantity of sun exposure. UV-A, UV-B, and ionizing radiation are known to increase susceptibility to basal cell carcinoma. Independent risk factors, such as fair skin, red or blonde hair, and light eye color, may increase vulnerability to UV damage. Exposure to radiation therapy, particularly when young, is also associated with an increased risk.

Other updates to the NCCN Guidelines focus on the preliminary workup and primary treatment. The section on primary treatment centers on low-risk and high-risk disease and appropriate therapies for each type. In addition, a new branch in the algorithm points to managing locally advanced basal cell carcinoma, nodal disease, and metastatic disease. Finally, neoadjuvant therapies for locally advanced disease include the category 2B options of the Hedgehog inhibitor vismodegib and the monoclonal antibody cemiplimab-rwlc.

To view the full updated NCCN Guidelines for basal cell skin cancer, visit

Disclosure: For full disclosures of the guideline authors, visit

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