Medical and Surgical Management of Multifocal Superficial Basal Cell Carcinoma

Background: Multifocal superficial basal cell carcinoma (sBCC) is a subtype of BCC characterized by subclinical extension of noncontiguous tumor islands and high recurrence rates. Mohs micrographic surgery (MMS) is the treatment of choice for multifocal sBCC but can invariably result in large defect size when additional stages are required to achieve complete tumor clearance. We aim to review the literature to summarize key advantages, disadvantages, and limitations of surgical and nonsurgical treatment modalities for multifocal sBCC. Materials and Methods: A comprehensive literature review identified 15 studies focusing on the medical and surgical management of multifocal sBCC. Results: Laser and light therapy, electrodesiccation and curettage, and systemic retinoids are viable alternatives to standard excision and MMS for multifocal sBCC. Topical application of 5-fluorouracil (5-FU) and imiquimod have shown promising efficacy, especially as adjunctive therapies following MMS for multifocal sBCC. Discussion: Studies demonstrate that incomplete excisions and recurrences are associated with aggressive histologic subtypes, including multifocal sBCC. Combining MMS with adjuvant imiquimod or 5-FU may enhance outcomes for multifocal sBCC. The high incidence morbidity and economic costs of sBCC necessitate optimizing therapeutic strategies to improve patient outcomes. Further research is needed to refine guidelines and establish standardized management protocols for multifocal sBCC.