Background: Some cutaneous basal cell carcinomas have a significant potential to recur, disfigure, and metastasize.
Objectives and methods: The identification and selection of treatment of these high risk carcinomas is based on a review of studies of recurrence, giant size, metastasis, and mortality.
Results: Basal cell carcinomas with any of the following: long duration, location in the mid face or ear, larger than 2 cm, with aggressive histologic subtype, previous treatment, neglected, or a history of radiation exposure, should be considered "high risk."
Conclusion: For basal cell carcinomas with this high risk profile, complete excision by margin control or total destruction should be considered.