Basal cell carcinoma (BCC) is the most common malignant tumour in white populations. Multidisciplinary experts from European Association of Dermato-Oncology (EADO), European Dermatology Forum, European Society for Radiotherapy and Oncology (ESTRO), Union Européenne des Médecins Spécialistes, and the European Academy of Dermatology and Venereology developed updated recommendations on diagnosis and treatment of BCC. BCCs were categorised into 'easy-to-treat' (common) and 'difficult-to-treat' according to the new EADO clinical classification. Diagnosis is based on clinico-dermatoscopic features, although histopathological confirmation is mandatory in equivocal lesions. The first-line treatment of BCC is complete surgery. Micrographically controlled surgery shall be offered in high-risk and recurrent BCC, and BCC located on critical anatomical sites. Topical therapies and destructive approaches can be considered in patients with low-risk superficial BCC. Photodynamic therapy is an effective treatment for superficial and low-risk nodular BCCs. Management of 'difficult-to-treat' BCCs should be discussed by a multidisciplinary tumour board. Hedgehog inhibitors (HHIs), vismodegib or sonidegib, should be offered to patients with locally advanced and metastatic BCC. Immunotherapy with anti-PD1 antibodies (cemiplimab) is a second-line treatment in patients with a progression of disease, contraindication, or intolerance to HHI therapy. Radiotherapy represents a valid alternative in patients who are not candidates for or decline surgery, especially elderly patients. Electrochemotherapy may be offered when surgery or radiotherapy is contraindicated. In Gorlin patients, regular skin examinations are required to diagnose and treat BCCs at an early stage. Long-term follow-up is recommended in patients with high-risk BCC, multiple BCCs, and Gorlin syndrome.

1st Department of Dermatology Aristotle University Thessaloniki Greece

1st Department of Dermatology Venereology National and Kapodistrian University of Athens School of Medicine Andreas Sygros Hospital Athens Greece

2nd Department of Dermatology Aristotle University Medical School Papageorgiou General Hospital Thessaloniki Greece

Aix Marseille University Dermatology and Skin Cancer Department APHM Marseille France

Centre for Cell Biology and Cutaneous Research Blizard Institute Barts and the London School of Medicine and Dentistry Queen Mary University of London London UK

Centre for Dermatooncology Department of Dermatology Eberhard Karls University Tuebingen Germany

Coimbra Hospital and Universitary Centre Coimbra Portugal

Department of Biotechnological and Applied Clinical Sciences University of L'Aquila L'Aquila Italy

Department of Dermatology and Venereology University Hospital Center Zagreb Croatia

Department of Dermatology Erasme Hospital Université Libre de Bruxelles Brussels Belgium

Department of Dermatology Faculty of Medicine Military Medical Academy Belgrade Serbia

Department of Dermatology Hospital Clínic de Barcelona University of Barcelona IDIBAPS Barcelona and CIBERER Barcelona Spain

Department of Dermatology Instituto Valenciano de Oncologia Valencia Spain

Department of Dermatology Medical University of Vienna Austria

Department of Dermatology Skin Cancer Center Ruhr University Bochum 44791 Bochum Germany

Department of Dermatology University Hospital Ghent Ghent Belgium

Department of Dermatology University Hospital Zurich and University Zurich Switzerland

Department of Dermatology University of Kiel Kiel Germany

Department of Dermatology Venereology and Allergology University Hospital Frankfurt Germany

Department of Dermatovenereology 3rd Faculty of Medicine Charles University Prague Czech Republic

Department of Oncologic Dermatology Elias University Hospital Bucharest Carol Davila University of Medicine and Pharmacy Bucharest Bucharest Romania

Department of Oncology Odense University Hospital Denmark

Dermatology Clinic University of Trieste Trieste Italy

Dermatology Department Saint Louis Hospital Paris France

Dermatology Medicine School University of Seville University Hospital Virgen Macarena Seville Spain

Fondazione Policlinico Universitario A Gemelli IRCCS UOC di Radioterapia Dipartimento di Scienze Radiologiche Radioterapiche ed Ematologiche Rome Italy

GROW School for Oncology and Reproduction Maastricht University Maastricht Netherlands; Department of Dermatology Maastricht University Medical Centre Maastricht Netherlands

Institute of Dermatology Catholic University of the Sacred Heart Rome Italy; Fondazione Policlinico Universitario A Gemelli IRCCS Rome Italy

Mount Vernon Cancer Centre Northwood UK

Twin Research and Genetic Epidemiology Unit School of Basic and Medical Biosciences King's College London London SE1 7EH UK

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