<p>Basal cell carcinoma (BCC) is the most common type of cancer, and its incidence continues to rise. Prevention and early detection through the screening of high-risk individuals may help improve outcomes. This article explores practical evidence-based approaches to the screening and prevention of BCC in the clinical setting.</p>

In the United States, we often refer to the US Preventive Services Task Force (USPSTF) on direction for when to conduct skin cancer screening. Its guidelines do not support routine skin cancer screening in all people because there is not sufficient evidence to support its benefit. However, people at higher risk for developing skin cancers, particularly those with a personal or family history of skin cancer and those who have fair skin, red hair, and/or blue eyes, should undergo BCC screening. As an oncologist, if I see a patient with locally advanced disease, I ensure that they continue regular skin surveillance with their dermatologist. This is important because approximately 40% of patients with a history of keratinocyte carcinoma will develop a second skin cancer, usually another BCC or squamous cell carcinoma (SCC), within the first 5 years, often sooner.

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We frequently tend to stress to patients the importance of preventing melanoma, but, in my mind, it is equally important for BCC and SCC. Preventive measures include applying appropriate sunscreen, avoiding sun exposure when the UV index is highest, and applying sunscreen frequently when going into water. The minimum amount of sunscreen required to protect an average-sized person is equivalent to the amount of fluid in a shot glass. Wearing wide-brimmed hats or UV-rated protective clothing is also helpful and important for individuals who potentially have a higher risk of developing skin cancers. Moreover, it is also very important to avoid indoor tanning. There is strong epidemiologic evidence linking indoor tanning to the development of skin cancers, and the younger the age of use, the earlier skin cancer may develop. Indoor tanning has been declared a human carcinogen by the World Health Organization (WHO), and, in my mind, it should be banned. I think that avoiding indoor tanning completely would go a long way in preventing BCC.

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We consider chemoprevention for patients who have previously had BCC. Several years ago, a clinical trial randomized 386 patients who had a history of at least 2 nonmelanoma skin cancers to oral nicotinamide vs placebo for 1 year. Nicotinamide reduced the incidence of new BCCs by 20% and new SCCs by 30%. There was also a 23% reduction in recurrence risk at 1 year (the time frame that the drug was given) and no evidence of benefit after it was discontinued. In individuals who have had multiple BCCs, I often recommend using nicotinamide, and I tell my patients to continue it beyond 1 year. Another chemoprevention approach is capecitabine, but it is less tolerable.

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I think that an unmet need is acquiring additional prospective data clearly showing that screening saves lives. Additionally, having better chemopreventive agents and legislation to ban tanning is important, and educating the general public about these cancers is also critical.