Nodular basal cell carcinoma
Last Updated: 2023-07-07
Author(s): Anzengruber F., Navarini A.
ICD11: 2C32.0
Last Updated: 2023-07-07
Author(s): Anzengruber F., Navarini A.
ICD11: 2C32.0
Most common basal cell carcinoma (approx. 60%), which is notable for its nodular appearance.
Slowly growing, erythematous or skin-coloured, sharply demarcated, shiny, dermal, indolent, partially pigmented nodule. The marginal area shows telangiectasia as well as a pearl cord-like rim. A central depression up to ulceration (ulcus rodens) is often visible.
Almost exclusively on the head, zygomatic region, bridge of the nose, inner corner of the eye, pinna, capillitium.
Resembling solid basal cell carcinoma.
|
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 |
- Excision
- 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
- Cryotherapy
- Laser therapy
- Photodynamic therapy
- Imiquimod cream 5%, daily 5x/week for a total of 6 weeks.
- Useful in superficial and in Gorlin syndrome.
- Disadvantage: no control whether basal cell carcinoma has been completely removed.
- Cure rate: approx. 81% (for superficial basal cell carcinoma).
- 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.
- Indicated for use in metastatic basal cell carcinoma.
- Intralesional application of Dz13, a DNAzyme that targets JUN mRNA.
- Itraconazole has successfully disrupted the hedgehog signalling pathway in single cases.
