Nodular basal cell carcinoma

Last Updated: 2020-06-11

Author(s): Anzengruber, Navarini

  • Knotty basal cell carcinoma.
  • Basalioma solidum, solid basal cell carcinoma.

Most frequent basal cell carcinoma (approx. 60%), which stands out due to its knot-shaped appearance.

Slowly growing, erythematous or skin-coloured, sharply defined, shiny, coarser, indolent, partly pigmented knot. In the marginal area there are telangiectasias and a pearl-like rim. Often a central depression up to ulceration (ulcer rodens) is visible.

Almost exclusively on the head, zygomatic region, bridge of nose, inner corner of the eye, auricle, capillitium.

Similar to solid basal cell carcinoma.

Therapy of the 1st choice after Lebwohl

level of evidence

Curettage and electrodesiccation 

B
Surgical excision

B

Moh's surgery (micrographically controlled)

B
Cryotherapy

 

B
   

Therapy of the 2nd choice after Lebwohl

  

Radiotherapy

B
   

Therapy of the 3rd choice after Lebwohl

  

Interferon intraläsional

B

Retinoids

D

Imiquimod 

A

Photodynamic therapy 

A

5-fluorouracil 

A

CO² Laser

D

PEG-interleukin 2 

D

NSAIDs

D

Ingenolmebutate 

D

Vismode give

A

Intraläsional interleukin application 

D

Systemic Chemotherapy

D
  • Surgical Therapy 

    ·         Excision

  • The gold standard of basal cell carcinoma therapy.  

    ·        In particular, infiltratively growing and sclerodermiform basal cell carcinomas should be excised surgically. 

    ·         If the resection is incomplete, a post-excision should be performed (except in well-founded cases).

    ·        The cure rate depends on the tumor diameter, the histological type and the safety distance.

 

BCC Ø < 2 cm

  

Infiltrative BCC

    

Safety distance

3 mm

4-5 mm

3 mm

5 mm

13-15 mm

Probability that tumor remnants will remain

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

 

·         A micrographic control (Moh's surgery) should be performed at "problem sites" in the face, in recurrent tumors and depending on the histolog. type. Recurrence rate: 2-12%.

·         Curettage with/without electrodesiccation

  • Recurrence rate: 3-19%.

    ·         Cryotherapy 

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

    ·         Laser therapy 

    ·         Photodynamic Therapy

  • Healing rates: 72-100%..

    ·         Imiquimod (Aldara®) cream 5 % daily 5x/week for a total of 6 weeks. 

    ·         Useful for superficial and gorlin syndromes. 

  • Healing rate: approx. 80-84% (for superficial basaliomas). 
  • 5-Fluorouracil (5% in cream), to be applied topically daily for four to six weeks.  

    ·         Disadvantage: no control whether Basalioma was completely removed.

    ·         Healing rate: approx. 81% (for superficial basaliomas).

  • Radiotherapy 

    ·         If surgical (post-)excision is not possible.

    ·         Contraindicated: for Gorlin syndrome.

    ·         Sole radiotherapy: 84-96% remission. 

    ·         Single doses between 2.0 and 3.0 Gy performed.

    ·         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 metastasized basal cell carcinoma. 

  • Experimental therapies  

    ·        Intraläsional application of Dz13, a DNAzyme that targets 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. 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