Cystic basal cell carcinoma

Synonym (s)

Cystic basal cell carcinoma.

Definition

Histological special form of basal cell carcinoma.

Etiopathogenesis

Predilection sites: Eyelids, cheeks, nose, ears

Clinical features

Skin-coloured, soft-palpable, glassy papule usually only up to 0.5cm in diameter with telangiectasia.

Diagnosis

Anamnesis (risk factors)
Clinic
Biopsy

Dermatopathology

Cystic and adenoid structures, basaloid tumour cell strands.

Therapy

Therapy of 1st choice according to Lebwohl	Evidence level
Curettage and electrodesiccation	B
Surgical excision	B
Moh's surgery (micrographically controlled)	B
Cryotherapy	B

Therapy of the 2nd choice after Lebwohl
Radiation therapy	B

Therapy of the 3rd choice according to Lebwohl
Interferon intralesional	B
Retinoids	D
Imiquimod	A
Photodynamic therapy	A
5-Fluorouracil	A
CO² laser	D
PEG-interleukin 2	D
NSAIDs	D
Ingenol mebutate	D
Vismodegib	A
Intralesional interleukin application	D
Systemic chemotherapy	D

Operative therapy
- Excision

The gold standard of basal cell carcinoma therapy
- Especially infiltrative growing and sclerodermiform basal cell carcinomas should be surgically excised.

- In the case of incomplete resection, re-excision should be performed except in well justified cases.

- Cure rate depends on tumour diameter, histological type and safety margin.

	BCC Ø < 2 cm		Infiltrative BCC
Safety distance	3 mm	4-5 mm	3 mm	5 mm	13-15 mm
Likelihood of tumour remnants remaining	15%	5%	34%	18%	5%

Source: Hauschild, A. (2016). Long version of the guideline "Basal cell carcinoma of the skin". Awmf.org. Retrieved 30 May 2016, from http://www.awmf.org/leitlinien/detail/ll/032-021.html

- Micrographic control (Moh's surgery) should be performed on "problem sites" in the face, in recurrent tumours and depending on the histological type. Type. Recurrence rate: 2-12%.

- Curettage with/without electrodesiccation

Recurrence rate: 3-19%
- Cryotherapy

Mostly for superficial basal cell carcinomas.
Aesthetic results are worse.
Cure rates: 4-17%
- Laser therapy

- Photodynamic therapy

Cure rates: 72-100%
- Imiquimod cream 5% daily 5x/week for a total of 6 weeks.

- Useful in superficial and in Gorlin syndrome.

Cure rate: approx. 80-84% (for superficial basal cell carcinoma).
5-Fluorouracil (5% in cream), applied topically daily for four to six weeks
- Disadvantage: no control whether basal cell carcinoma has been completely removed.

- Cure rate: approx. 81% (for superficial basal cell carcinoma).

Radiation therapy
- Unless surgical (re-)excision is possible.

- Contraindicated: in Gorlin syndrome.

- Radiotherapy alone: 84-96% remission.

- Single doses between 2.0 and 3.0 Gy performed.

- Total doses of 60 to 70 Gy.

- Patients with basal cell carcinoma syndrome (Gorlin-Goltz) should not be treated with ionising radiation.

Hedgehog inhibitor (#Vismodegib)
- Indicated for use in metastatic basal cell carcinoma.

Experimental therapies
- Intralesional application of Dz13, a DNAzyme that targets JUN mRNA.

- Itraconazole has successfully disrupted the hedgehog signalling pathway in single cases.

References

Clark CM, Furniss M, Mackay-Wiggan JM. Basal cell carcinoma: an evidence-based treatment update. Am J Clin Dermatol 2014;15:197-216.
Kwasniak LA, Garcia-Zuazaga J. Basal cell carcinoma: evidence-based medicine and review of treatment modalities. Int J Dermatol 2011;50:645-58.
3.Hauschild, A. (2016). Langfassung der Leitlinie "Basalzellkarzinom der Haut". Awmf.org. Retrieved 30 May 2016, from http://www.awmf.org/leitlinien/detail/ll/032-021.html