Cystic basal cell carcinoma

Last Updated: 2020-08-17

Author(s): Anzengruber, Navarini

Cystic basalioma.

Special histological form of basal cell carcinoma.

Predilection sites: eyelids, cheeks, nose, ears.

Skin-coloured, soft-palpable, glassy papules with telangiectasia, usually measuring only 0.5 cm in diameter.

  • Medical history (risk factors)
  • Clinical features
  • Biopsy

Cystic and adenoidal structures, basaloidal tumor cell strands.

 

1st choice therapy by Lebwohl

Level of evidence

Curettage and electrodesiccation

B

Surgical excision

B

Moh's surgery (micrographically controlled)

B
Cryotherapy B
   

2nd choice therapy by Lebwohl

  

Radiotherapy

B
   

3rd choice theraoy by Lebwohl

  

Interferon intralesional 

B

Retinoids

D

Imiquimod

A

Photodynamic therapy

A

5-fluorouracil

A

CO² laser 

D

PEG interleukin 2

D

NSAIDs

D

Ingenol butate 

D
Vismodegib

A

Intralesional Interleukin application 

D

Systemic chemotherapy

D

  • Surgical therapy

    • Excision 

  • The gold standard of basal cell carcinoma therapy

    • Especially infiltrative growing and sclerodermiform basal cell carcinomas should be excised surgically       

    • In case of incomplete resection, a post-excision should be performed, except in well-founded cases.

    • The rate of recovery depends on the tumour diameter, the histological type and the safety margin (see table below).
    • Micrographic control (Moh's surgery) should be performed on "problem localizations" on the face, on recurrent tumors and depending on the histological findings.
      • Recurrence rate: 2-12%.

 

 

BCC Ø < 2 cm

  

Infiltrative BCC

    

Safety margin

3 mm

4-5 mm

3 mm

5 mm

13-15 mm

Likelihood that tumor residue remains

15%

5%

34%

18%

5%

Source: 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

 

  • Curettage with/without electrodesiccation 

    • Recurrence rate: 3-19%.

  • Cryotherapy

    • Especially in superficial basaliomas.
    • Aesthetic results are worse.
    • Healing rates: 4-17%.

  • Laser treatment 

  • Photodynamic therapy 

    • Healing rates: 72-100%.

  • Imiquimod cream 5% daily 5x/week for a total of 6 weeks.

  • Useful for superficial and Gorlin syndrome.
    • Healing rate: approx. 80-84% (for superficial basal cell carcinoma)

  • 5-fluorouracil (5% in cream), topically applied daily for four to six weeks

    • Disadvantage: no check whether basal cell carcinoma has been completely removed.
    • Healing rate: approx. 81% (for superficial basal cell carcinoma).

  • Radiotherapy

    • If surgical (post-)excision is not possible.
    • Contraindicated: for Gorlin syndrome.
    • Radiotherapy alone: 84-96% remission.
    • Single doses between 2.0 and 3.0 Gy.
    • Total doses from 60 to 70 Gy.
    • Patients with basal cell carcinoma syndrome (Gorlin-Goltz) should not be treated with ionizing radiation

  • Hedgehog Inhibitor (Vismodegib)

    • The application is indicated for metastatic basal cell carcinoma.

  • Experimental Therapies

    • Intralesional application of Dz13, a DNA enzyme targeting JUN mRNA.
    • Itraconazole has successfully interrupted the hedgehog signaling pathway in individual cases.
  1. Clark CM, Furniss M, Mackay-Wiggan JM. Basal cell carcinoma: an evidence-based treatment update. Am J Clin Dermatol 2014;15:197-216.
  2. Kwasniak LA, Garcia-Zuazaga J. Basal cell carcinoma: evidence-based medicine and review of treatment modalities. Int J Dermatol 2011;50:645-58. 
  3. 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