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BCC After Topical Treatment — SCE Dermatology MCQ

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HardSkin CancerBCC After Topical TreatmentSCE Dermatology

A biopsy-proven superficial BCC on the trunk was treated with imiquimod. Twelve weeks after treatment, dermoscopy remains suspicious and repeat biopsy confirms persistent BCC. What is the most appropriate next step?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Offer surgical excision after assessing whether standard or Mohs surgery is indicated

Explanation lettering: C = shown as A · E = shown as B · A = shown as C · B = shown as E

B is correct. Histologically persistent BCC after a completed topical course represents treatment failure and should be managed definitively, usually by standard excision for a low-risk truncal lesion. Mohs is not automatic; it depends on site, borders, subtype, recurrence and tissue-conservation needs. Repeating imiquimod without reassessing cure risks delay, observation conflicts with biopsy-proven persistence, corticosteroid does not treat tumour, and systemic retinoid is not treatment for a solitary residual BCC. Histological clearance, rather than treatment inflammation, is the relevant endpoint.

Reference: BAD basal cell carcinoma guidance: https://www.bad.org.uk/pils/basal-cell-carcinoma