|
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 carcinoma.
- 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.
- 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.
- Experimental therapies
- Intralesional application of Dz13, a DNAzyme that targets JUN mRNA.
- Itraconazole has successfully disrupted the hedgehog signalling pathway in single cases.
