How should I approach the management of a patient with a superficial BCC that is not amenable to surgical excision?

For a patient with a superficial basal cell carcinoma (BCC) that is not suitable for surgical excision, the management approach should prioritise effective non-surgical treatments such as topical therapies. Topical imiquimod 5% cream is a recommended first-line treatment option in this scenario, as it has demonstrated efficacy in treating superficial BCCs, including larger lesions, by stimulating local immune response to clear tumour cells (Lacarrubba et al., 2011). This aligns with UK clinical practice which supports the use of topical treatments when surgery is contraindicated or not feasible ².

Other non-surgical options include photodynamic therapy and radiotherapy, but topical imiquimod is often preferred for superficial lesions due to its favourable side effect profile and ease of application ². Regular follow-up is essential to monitor treatment response and detect any recurrence early ².

In summary, for superficial BCCs unsuitable for surgery, initiate topical imiquimod 5% cream with appropriate patient education and arrange close clinical surveillance to ensure complete tumour clearance and manage any adverse effects (Lacarrubba et al., 2011; ²).