By the time patients present to Darrell S. Rigel, MD, with advanced basal cell carcinoma (BCC), their lesions are likely to be too large or too numerous to be curable with a simple surgical solution. “You get to a point where there are just positive margins or the lesion is so large that it’s going to require inpatient treatment,” he says. “Because of the complexity, it’s important to build a multidisciplinary team to assess the patient, create a treatment plan, and optimize ongoing management.” Find out how to build a strong team and what each member can contribute.

What risks do patients with the highest stage advanced BCC have for metastasis or death? Chrysalyne D. Schmults, MD, and her team at Brigham and Women’s Hospital in Boston, Massachusetts, developed a new staging system to help answer that question. Here, she shares insights on tumor classification, its implication for treatment, and the ground rules for creating an effective tumor review board.

Darrell S. Rigel, MD, talks through the pros, cons, and unknowns of established medications such as Hedgehog inhibitors and newly FDA-approved drugs such as cemiplimab (Libtayo; Sanofi and Regeneron Pharmaceuticals). Get the latest on dosing, drug holidays, tolerability, and long-term disease management.

Chrysalyne D. Schmults, MD, provides talking points on assessing which patients are ideal candidates for surgery and, when surgery is not an option, matching medications to the needs and quality of life concerns for the individual patient. She offers best-practice guidance for optimizing treatment choices that address challenges surrounding extended durability, reduction of adverse effects, and improvement in rates of occurrence of progression.

In the world of medical oncologist Ann W. Silk, MD, MS a 30% response rate can be good news. So can drugs that can limit side effects to address a discontinuation rate that may be as high as 30%. Silk discusses the mechanisms of action of existing and new tools, such as immunotherapy, and recommendations for how physicians can maximize their effectiveness in a clinical setting.

Darrell S. Rigel, MD, MS, FAAD vision of the future treatment innovations for would include medications based on better-targeted immune pathways, effective ways to treat metastatic BCC, and a vaccine to prevent advanced BCC from developing. Rigel addresses these and other developments he sees or would like to see on the horizon.

Is timing everything? Chrysalyne D. Schmults, MD, FAAD looks to a future where clinicians have a better understanding of the “how” and “when” of using hedgehog inhibitors and anti-PD1 medication. Here are the questions she’d like to see answered in upcoming research.

Among other things, it is about what happens before the scalpel that Ann W. Silk, MD, MS would like to see more research into advanced BCC treatment. Neoadjuvant therapies show promise in helping patients avoid or downgrade surgery, as she explains here. Silk also delves into other areas of research that offer new potential for treating advanced BCC.