Sclerodermiform basal cell carcinoma

Always use Moh's Surgery with sclerodermiform BCC, otherwise a very large safety distance must be chosen.

Operative Therapie

·         Exzision

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.

• Experimental Therapies

  ·         Intralesional application of Dz13, a DNA enzyme targeting JUN mRNA. 

  ·         Itraconazole has successfully interrupted the hedgehog signaling pathway in individual cases.

   

   

• Hedgehog Inhibitor (#Vismodegib)

  ·         In metastatic basal cell carcinoma the application is indicated.

• Radiotherapy

  ·         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.

• Healing rate: approx. 80-84% (for superficial basal cell carcinomas).
• 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).

• Healing rates: 72-100%.

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

  ·         Useful for superficial and Gorlin syndrome.

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

  ·         Laser treatment

  ·         Photodynamic Therapy

• Recurrence rate: 3-19%. 

  ·         Cryotherapy

• The gold standard of basal cell carcinoma therapy. 

  ·         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.