Cystic basal cell carcinoma
Last Updated: 2023-07-07
Author(s): Anzengruber F., Navarini A.
ICD11: -
Last Updated: 2023-07-07
Author(s): Anzengruber F., Navarini A.
ICD11: -
Cystic basal cell carcinoma.
Histological special form of basal cell carcinoma.
Predilection sites: Eyelids, cheeks, nose, ears
Skin-coloured, soft-palpable, glassy papule usually only up to 0.5cm in diameter with telangiectasia.
Cystic and adenoid structures, basaloid tumour cell strands.
|
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.
