Desmoplastisches spinozelluläres Plattenepithelkarzinom

Letztmals aufdatiert: 2019-03-15

Autor(en): -

Aggressive, seltene Variante eines spinozellulären Karzinoms.

  • Anamnese
  • Klinik
  • Ggf. Biopsie
  • Lymphknoten palpation
  • Ggf. Lymphknotensonographie
  • Selbstinspektion.
  • Sonnenschutz.

Therapie der 1. Wahl nach Lebwohl

Evidenzlevel

Kryotherapie

B

Kürettag und Elektrodesikkation

B

Exzision

B

Mikrographisch-kontrollierte Exzision

B

Strahlentherapie

B

   

Therapie der 2. Wahl nach Lebwohl

Evidenzlevel

Imiquimod

A

5-Fluorouracil (topisch)

B

5-Fluorouracil (intraläsional)

B

Bleomycin (intraläsional)

E

Elektrochemotherapy mit Bleomycin

B

Interferon-α (intraläsional)

B

Methotrexat (intraläsional)

D

   

Therapie der 3. Wahl nach Lebwohl

 

Amputation

D

Photodynamische Therapie

B

Retinoide (systemisch)

B

Protein kinase inhibitoren

B

Chemoradation

E

  • Mikroskopisch kontrollierte Chirurgie (Therapie der 1. Wahl gemäss AWMF-Leitlinie): 
  • 3-5 mm Sicherheitsabstand.
  • Heilung mit relativ hoher Sicherheit (95%).
  • Exzision mit konventioneller Histologie.
  • Shave-Exzision mit konventioneller Histologie.

     

    Sofern keine Operation möglich ist, wird die Durchführung einer Strahlentherapie empfohlen:

     

  • Bestrahlungstherapie ED 2 Gy 5x wöchentlich, 50 Gy (R1), 60-65 Gy (R2) und 70-74 Gy (definitiv).

     

  • Alternative Behandlungen

    ·         Kryochirurgie (mit flüssigem Stickstoff, Temperatur: -196 °C): 2x 15 Sekunden.

    ·         Elektrodesikkation.

    ·         Kürettage.

    ·         Kryotherapie.

    ·         Lasertherapie.

    ·         Photodynamische Therapie.

    ·         Imiquimod.

    ·         5-Fluorouracil.

     

  • Sentinel-Lmyphknotenbiopsie/Lymphadenektomie

    ·         Aktuell gibt es keine guten Daten über den prognostischen oder therapeutischen Nutzen einer Sentinel-Lymphkontenbiopsie beim Plattenepithelkarzinom.

    ·         Auch gibt es keine Beweise, dass eine elektive Strahlentherapie oder eine prophylaktische Lymphadenektomie eine bessere Prognose mit sich bringen.

    ·         Eine therapeutische Lymphadenektomie bringt jedoch eine bessere Tumorkontrolle. 

    ·         Bei einem high-risk Plattenepithelkarzinom sollte eine Sentinel-Lymphknotenbiopsie durchgeführt werden.

    ·         Eine adjuvante, systemische Therapie ist nicht indiziert (Phase-III Studien mit 12-cis-Retinoiden und Interfon-α zeigen keine Verbesserung des rezidivfreien Intervalls).

    ·         Chemotherapie:  (Stadium III und IV) bei Pat. < 70 Jahren mit einem Karnofsky-Index > 60%.

    ·         1. Wahl: Cisplatin und 5-Fluorouracil.

    ·         Bei ↓ AZ: Monochemotherapie mit 5-Fluorouracil.

    ·         Alternativ: Cetuximab.

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