What is the recommended treatment for a papular lesion consistent with basal cell carcinoma?

The recommended treatment for a papular lesion consistent with basal cell carcinoma is local excision. This approach involves surgically removing the lesion along with a margin of surrounding healthy skin to ensure that all cancerous cells are eradicated. Local excision is effective because basal cell carcinoma, while typically slow-growing and less likely to metastasize compared to other skin cancers, can still invade local tissues, making complete removal crucial for treatment success and to prevent recurrence.

This method allows for both diagnosis and treatment in one procedure, particularly if the lesion is suspicious and initial biopsy may not be necessary. Local excision is well-supported by clinical guidelines as a first-line treatment for basal cell carcinoma, especially for lesions that are superficial or nodular in appearance, which is common for this type of skin cancer.

On the other hand, treatments like topical tacrolimus or podophyllin resin are generally reserved for specific conditions or superficial lesions and are not standard treatments for basal cell carcinoma. A shave biopsy may be used for diagnosis, but it does not provide complete removal of the cancerous lesion, which is crucial in managing basal cell carcinoma effectively.