The basal cell carcinoma (BCC) form of skin cancer is the most common human cancer. Although deaths are rare, the incidence of BCC is rising by around 10% each year in white populations, with an estimated 1m cases diagnosed each year in the US alone. 

The disease is also affecting more younger people, with dermatologists expected to see a 50% increase in cases by 2050. This, together with an ageing population and the fact that patients often develop more BCCs once they’ve had one, means that surgery to remove lesions may be stretching under-pressure healthcare systems.

Although excisional surgery remains the gold standard for most common types of BCC, many other topical interventions are available.

Informing national and international guidelines

In 2006, Professor Fiona Bath-Hextall led the Cochrane systematic review of interventions for BCC, which was the first of its kind. Not only did the review highlight the need for a randomised controlled trial to compare imiquimod 5% cream versus excisional surgery for treating low-risk superficial and nodular BCC, but it also informed both national and international guidelines on BCC treatments. 

The results of the trial have been published in the Lancet Oncology and show that despite imiquimod being inferior to surgery, it represents a treatment option that some patients may prefer. 

This original BCC review was updated in 2007 and 2016, with an intermediary update published in Evidence Based Dermatology. This review has been highly cited and has been informing practice guidelines worldwide.