Sclerodermiform basal cell carcinoma
Last Updated: 2020-06-11
ICD11: -
Last Updated: 2020-06-11
Author(s): Anzengruber F., Navarini A.
ICD11: -
Keloid basal cell carcinoma, fibrosing basal cell carcinoma, morphea-like basal cell carcinoma, morpheiform basal cell carcinoma, sclerosing basal cell carcinoma.
Clinically "scar-like" aspect.
Atrophic, slightly raised, scarred, partly keloid-like, rarely ulcerating, yellowish, wax- or ivory-coloured, blurred, coarse plaque with telangiectasias. There is an increased tendency to infiltrate deep structures.
Especially nose, forehead or cheeks.
A connective tissue, fiibromatous reaction surrounds the tumor cell dressings. Unlike other BCC forms, the typical palisade position is usually missing.
Increased risk of relapse.
Always use Moh's Surgery with sclerodermiform BCC, otherwise a very large safety distance must be chosen.
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 Lebwol |
|
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 |
Intraläsionale Interleukin Applikation |
D |
Systemische Chemotherapie |
D |
Operative Therapie
· Exzision
BCC Ø < 2 cm |
Infiltratives BCC |
||||
Safe distance |
3 mm |
4-5 mm |
3 mm |
5 mm |
13-15 mm |
Tumor remains are likely to 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
· Micrographic control (Moh's surgery) should be performed at "problem localizations" in the face, in recurrent tumors and depending on the histolog. type. Recurrence rate: 2-12%.
· Curettage with/without electrodesiccation.
· Intralesional application of Dz13, a DNA enzyme targeting JUN mRNA.
· Itraconazole has successfully interrupted the hedgehog signaling pathway in individual cases.
· In metastatic basal cell carcinoma the application is indicated.
· If surgical (post-)excision is not possible.
· Contraindicated: in 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.
· Disadvantage: no check whether basal cell carcinoma has been completely removed.
· Healing rate: approx. 81% (for superficial basal cell carcinoma).
· Imiquimod (Aldara®) cream 5% daily 5x/week for a total of 6 weeks.
· Useful for superficial and Gorlin syndrome.
· Laser treatment
· Photodynamic Therapy
· Cryotherapy
· In particular infiltrative and sclerodermiform basal cell carcinomas should be surgically excised.
· In case of incomplete resection, a post-excision should be performed - except in well-founded cases.
· Healing rate depends on tumor diameter, histological type and safety distance.
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