Sclerodermiform basal cell carcinoma

Last Updated: 2020-06-11

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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.

  • Medical history.
  • Clinical features.
  • Biopsy.

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.

 

  • 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.

  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