Diagnosis and treatment of basal cell carcinoma: European consensus–based interdisciplinary guidelines
Basal cell carcinoma (BCC) is the most common malignant tumour in white populations. Multidisciplinary experts from the European Dermatology Forum, the European Association of Dermato-Oncology and the European Organization of Research and Treatment of Cancer collaborated to develop recommendations o...
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| Veröffentlicht in: | European journal of cancer (1990) Jg. 118; S. 10 - 34 |
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| Hauptverfasser: | , , , , , , , , , , , , , , , , , , , , , , , |
| Format: | Journal Article |
| Sprache: | Englisch |
| Veröffentlicht: |
England
Elsevier Ltd
01.09.2019
Elsevier Science Ltd |
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| ISSN: | 0959-8049, 1879-0852, 1879-0852 |
| Online-Zugang: | Volltext |
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| Abstract | Basal cell carcinoma (BCC) is the most common malignant tumour in white populations. Multidisciplinary experts from the European Dermatology Forum, the European Association of Dermato-Oncology and the European Organization of Research and Treatment of Cancer collaborated to develop recommendations on diagnosis and treatment of BCC. A new classification into ‘easy-to-treat (common) BCC and ‘difficult-to-treat’ BCC is proposed. Diagnosis is based on clinicodermatoscopic features for ‘easy-to-treat’ BCCs. Histopathological confirmation is mandatory in ambiguous lesions and in BCCs located in high-risk areas. The first-line treatment of ‘easy-to-treat’ BCC is complete surgery. Microscopically controlled surgery shall be offered for high-risk BCC, recurrent BCC and BCC in critical anatomical sites. Topical therapies (5% imiquimod, 5% fluorouracil) and destructive approaches (curettage, electrocautery, cryotherapy, laser ablation) should be considered in patients with low-risk superficial BCC. Photodynamic therapy is an effective treatment for superficial BCC and thin nodular BCC. The therapy for a ‘difficult-to-treat’ BCC should preferentially be discussed by a multidisciplinary tumour board. Hedgehog inhibitors, vismodegib or sonidegib, should be offered to patients with locally advanced and metastatic BCCs. Immunotherapy with anti–programmed cell death 1 (PD-1) antibodies is a promising therapeutic option, currently being investigated in clinical trials. Radiotherapy represents a valid alternative to surgery for BCC on the face, especially in elderly patients. In patients with naevoid basal cell carcinoma syndrome (NBCCS), close surveillance and regular skin examinations are required to diagnose and treat BCCs at early stage. Long-term follow-up is recommended in patients with high-risk BCC subtypes, high-risk sites, multiple BCCs and NBCCS.
•Basal cell carcinoma (BCC) is the most common epithelial malignant tumour in white populations.•A new classification into “easy-to-treat” (common) BCC and “difficult-to-treat” BCC is proposed.•Surgery is the first-line therapy in all types of BCCs.•Treatment choice for advanced BCC should be discussed by a multidisciplinary tumour board.•Hedgehog inhibitors are used in "difficult-to-treat" BCC, and immunotherapy is a promising treatment under investigation. |
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| AbstractList | Basal cell carcinoma (BCC) is the most common malignant tumour in white populations. Multidisciplinary experts from the European Dermatology Forum, the European Association of Dermato-Oncology and the European Organization of Research and Treatment of Cancer collaborated to develop recommendations on diagnosis and treatment of BCC. A new classification into 'easy-to-treat (common) BCC and 'difficult-to-treat' BCC is proposed. Diagnosis is based on clinicodermatoscopic features for 'easy-to-treat' BCCs. Histopathological confirmation is mandatory in ambiguous lesions and in BCCs located in high-risk areas. The first-line treatment of 'easy-to-treat' BCC is complete surgery. Microscopically controlled surgery shall be offered for high-risk BCC, recurrent BCC and BCC in critical anatomical sites. Topical therapies (5% imiquimod, 5% fluorouracil) and destructive approaches (curettage, electrocautery, cryotherapy, laser ablation) should be considered in patients with low-risk superficial BCC. Photodynamic therapy is an effective treatment for superficial BCC and thin nodular BCC. The therapy for a 'difficult-to-treat' BCC should preferentially be discussed by a multidisciplinary tumour board. Hedgehog inhibitors, vismodegib or sonidegib, should be offered to patients with locally advanced and metastatic BCCs. Immunotherapy with anti-programmed cell death 1 (PD-1) antibodies is a promising therapeutic option, currently being investigated in clinical trials. Radiotherapy represents a valid alternative to surgery for BCC on the face, especially in elderly patients. In patients with naevoid basal cell carcinoma syndrome (NBCCS), close surveillance and regular skin examinations are required to diagnose and treat BCCs at early stage. Long-term follow-up is recommended in patients with high-risk BCC subtypes, high-risk sites, multiple BCCs and NBCCS. Basal cell carcinoma (BCC) is the most common malignant tumour in white populations. Multidisciplinary experts from the European Dermatology Forum, the European Association of Dermato-Oncology and the European Organization of Research and Treatment of Cancer collaborated to develop recommendations on diagnosis and treatment of BCC. A new classification into 'easy-to-treat (common) BCC and 'difficult-to-treat' BCC is proposed. Diagnosis is based on clinicodermatoscopic features for 'easy-to-treat' BCCs. Histopathological confirmation is mandatory in ambiguous lesions and in BCCs located in high-risk areas. The first-line treatment of 'easy-to-treat' BCC is complete surgery. Microscopically controlled surgery shall be offered for high-risk BCC, recurrent BCC and BCC in critical anatomical sites. Topical therapies (5% imiquimod, 5% fluorouracil) and destructive approaches (curettage, electrocautery, cryotherapy, laser ablation) should be considered in patients with low-risk superficial BCC. Photodynamic therapy is an effective treatment for superficial BCC and thin nodular BCC. The therapy for a 'difficult-to-treat' BCC should preferentially be discussed by a multidisciplinary tumour board. Hedgehog inhibitors, vismodegib or sonidegib, should be offered to patients with locally advanced and metastatic BCCs. Immunotherapy with anti-programmed cell death 1 (PD-1) antibodies is a promising therapeutic option, currently being investigated in clinical trials. Radiotherapy represents a valid alternative to surgery for BCC on the face, especially in elderly patients. In patients with naevoid basal cell carcinoma syndrome (NBCCS), close surveillance and regular skin examinations are required to diagnose and treat BCCs at early stage. Long-term follow-up is recommended in patients with high-risk BCC subtypes, high-risk sites, multiple BCCs and NBCCS.Basal cell carcinoma (BCC) is the most common malignant tumour in white populations. Multidisciplinary experts from the European Dermatology Forum, the European Association of Dermato-Oncology and the European Organization of Research and Treatment of Cancer collaborated to develop recommendations on diagnosis and treatment of BCC. A new classification into 'easy-to-treat (common) BCC and 'difficult-to-treat' BCC is proposed. Diagnosis is based on clinicodermatoscopic features for 'easy-to-treat' BCCs. Histopathological confirmation is mandatory in ambiguous lesions and in BCCs located in high-risk areas. The first-line treatment of 'easy-to-treat' BCC is complete surgery. Microscopically controlled surgery shall be offered for high-risk BCC, recurrent BCC and BCC in critical anatomical sites. Topical therapies (5% imiquimod, 5% fluorouracil) and destructive approaches (curettage, electrocautery, cryotherapy, laser ablation) should be considered in patients with low-risk superficial BCC. Photodynamic therapy is an effective treatment for superficial BCC and thin nodular BCC. The therapy for a 'difficult-to-treat' BCC should preferentially be discussed by a multidisciplinary tumour board. Hedgehog inhibitors, vismodegib or sonidegib, should be offered to patients with locally advanced and metastatic BCCs. Immunotherapy with anti-programmed cell death 1 (PD-1) antibodies is a promising therapeutic option, currently being investigated in clinical trials. Radiotherapy represents a valid alternative to surgery for BCC on the face, especially in elderly patients. In patients with naevoid basal cell carcinoma syndrome (NBCCS), close surveillance and regular skin examinations are required to diagnose and treat BCCs at early stage. Long-term follow-up is recommended in patients with high-risk BCC subtypes, high-risk sites, multiple BCCs and NBCCS. Basal cell carcinoma (BCC) is the most common malignant tumour in white populations. Multidisciplinary experts from the European Dermatology Forum, the European Association of Dermato-Oncology and the European Organization of Research and Treatment of Cancer collaborated to develop recommendations on diagnosis and treatment of BCC. A new classification into ‘easy-to-treat (common) BCC and ‘difficult-to-treat’ BCC is proposed. Diagnosis is based on clinicodermatoscopic features for ‘easy-to-treat’ BCCs. Histopathological confirmation is mandatory in ambiguous lesions and in BCCs located in high-risk areas. The first-line treatment of ‘easy-to-treat’ BCC is complete surgery. Microscopically controlled surgery shall be offered for high-risk BCC, recurrent BCC and BCC in critical anatomical sites. Topical therapies (5% imiquimod, 5% fluorouracil) and destructive approaches (curettage, electrocautery, cryotherapy, laser ablation) should be considered in patients with low-risk superficial BCC. Photodynamic therapy is an effective treatment for superficial BCC and thin nodular BCC. The therapy for a ‘difficult-to-treat’ BCC should preferentially be discussed by a multidisciplinary tumour board. Hedgehog inhibitors, vismodegib or sonidegib, should be offered to patients with locally advanced and metastatic BCCs. Immunotherapy with anti–programmed cell death 1 (PD-1) antibodies is a promising therapeutic option, currently being investigated in clinical trials. Radiotherapy represents a valid alternative to surgery for BCC on the face, especially in elderly patients. In patients with naevoid basal cell carcinoma syndrome (NBCCS), close surveillance and regular skin examinations are required to diagnose and treat BCCs at early stage. Long-term follow-up is recommended in patients with high-risk BCC subtypes, high-risk sites, multiple BCCs and NBCCS. •Basal cell carcinoma (BCC) is the most common epithelial malignant tumour in white populations.•A new classification into “easy-to-treat” (common) BCC and “difficult-to-treat” BCC is proposed.•Surgery is the first-line therapy in all types of BCCs.•Treatment choice for advanced BCC should be discussed by a multidisciplinary tumour board.•Hedgehog inhibitors are used in "difficult-to-treat" BCC, and immunotherapy is a promising treatment under investigation. |
| Author | Bataille, Veronique Middleton, Mark R. Marmol, Veronique del Stratigos, Alexander J. Eggermont, Alexander Höller, Christoph Harwood, Catherine A. Bastholt, Lars Zalaudek, Iris Haedersdal, Merete Szeimies, Rolf-Markus Peris, Ketty Malvehy, Josep Dummer, Reinhard Trakatelli, Myrto Tagliaferri, Luca Grob, Jean Jacques Fargnoli, Maria Concetta Morton, Colin A. Seguin, Nicole Basset Hauschild, Axel Garbe, Claus Nagore, Eduardo Kaufmann, Roland |
| Author_xml | – sequence: 1 givenname: Ketty surname: Peris fullname: Peris, Ketty email: ketty.peris@unicatt.it organization: Institute of Dermatology, Catholic University of the Sacred Heart, Italy – sequence: 2 givenname: Maria Concetta surname: Fargnoli fullname: Fargnoli, Maria Concetta organization: Department of Dermatology, University of L'Aquila, L'Aquila, Italy – sequence: 3 givenname: Claus surname: Garbe fullname: Garbe, Claus organization: Centre for Dermatooncology, Department of Dermatology, Eberhard-Karls University, Tuebingen, Germany – sequence: 4 givenname: Roland surname: Kaufmann fullname: Kaufmann, Roland organization: Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Germany – sequence: 5 givenname: Lars orcidid: 0000-0001-5478-9826 surname: Bastholt fullname: Bastholt, Lars organization: Department of Oncology, Odense University Hospital, Denmark – sequence: 6 givenname: Nicole Basset surname: Seguin fullname: Seguin, Nicole Basset organization: Dermatology Department, Saint-Louis Hospital, Paris, France – sequence: 7 givenname: Veronique surname: Bataille fullname: Bataille, Veronique organization: Twin Research and Genetic Epidemiology Unit, School of Basic & Medical Biosciences, King's College London, London, SE1 7EH, UK – sequence: 8 givenname: Veronique del surname: Marmol fullname: Marmol, Veronique del organization: Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium – sequence: 9 givenname: Reinhard surname: Dummer fullname: Dummer, Reinhard organization: Department of Dermatology, University Hospital Zurich and University Zurich, Switzerland – sequence: 10 givenname: Catherine A. surname: Harwood fullname: Harwood, Catherine A. organization: Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom – sequence: 11 givenname: Axel surname: Hauschild fullname: Hauschild, Axel organization: Department of Dermatology, University of Kiel, Kiel, Germany – sequence: 12 givenname: Christoph surname: Höller fullname: Höller, Christoph organization: Department of Dermatology, Medical University of Vienna, Austria – sequence: 13 givenname: Merete surname: Haedersdal fullname: Haedersdal, Merete organization: Department of Dermatology, University of Copenhagen, Bispebjerg Hospital, Copenhagen, Denmark – sequence: 14 givenname: Josep surname: Malvehy fullname: Malvehy, Josep organization: Department of Dermatology, Hospital Clínic de Barcelona (Melanoma Unit), University of Barcelona, IDIBAPS, Barcelona & CIBERER, Barcelona, Spain – sequence: 15 givenname: Mark R. orcidid: 0000-0003-0167-1685 surname: Middleton fullname: Middleton, Mark R. organization: Department of Oncology, University of Oxford, Old Road Campus, Oxford, OX3 9DU, UK – sequence: 16 givenname: Colin A. surname: Morton fullname: Morton, Colin A. organization: Stirling Community Hospital, Stirling, UK – sequence: 17 givenname: Eduardo orcidid: 0000-0003-3433-8707 surname: Nagore fullname: Nagore, Eduardo organization: Department of Dermatology, Instituto Valenciano de Oncologia, Valencia, Spain – sequence: 18 givenname: Alexander J. surname: Stratigos fullname: Stratigos, Alexander J. organization: 1st Department of Dermatology- Venereology, National and Kapodistrian University of Athens, School of Medicine, Andreas Sygros Hospital, Athens, Greece – sequence: 19 givenname: Rolf-Markus surname: Szeimies fullname: Szeimies, Rolf-Markus organization: Clinic for Dermatology and Allergology, Klinikum Vest GmbH Teaching Hospital, Recklinghausen, Germany – sequence: 20 givenname: Luca surname: Tagliaferri fullname: Tagliaferri, Luca organization: Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche Ed Ematologiche, Rome, Italy – sequence: 21 givenname: Myrto surname: Trakatelli fullname: Trakatelli, Myrto organization: Second Department of Dermatology, Aristotle University Medical School, Papageorgiou General Hospital, Thessaloniki, Greece – sequence: 22 givenname: Iris orcidid: 0000-0002-7878-4955 surname: Zalaudek fullname: Zalaudek, Iris organization: Dermatology Clinic, University of Trieste, Trieste, Italy – sequence: 23 givenname: Alexander surname: Eggermont fullname: Eggermont, Alexander organization: Cancer Institute, Gustave Roussy Cancer Campus, Grand Paris, 94805, Villejuif, France – sequence: 24 givenname: Jean Jacques orcidid: 0000-0002-1014-4062 surname: Grob fullname: Grob, Jean Jacques organization: University Department of Dermatology, Marseille, France |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/31288208$$D View this record in MEDLINE/PubMed |
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| SubjectTerms | 5-Fluorouracil Antibodies Apoptosis Basal cell carcinoma Cancer Carcinoma, Basal Cell - mortality Carcinoma, Basal Cell - pathology Carcinoma, Basal Cell - therapy Cell death Classification Clinical Decision-Making Clinical trials Consensus Cryotherapy Curettage Dermatology Destructive therapy Diagnosis Europe Geriatrics Guidelines Hedgehog inhibitors Humans Imiquimod Immunotherapy Laser ablation Medical diagnosis Medical Oncology - standards Metastases Oncology Patient Selection Patients PD-1 protein Photodynamic therapy Predictive Value of Tests Prognosis Radiation therapy Radiotherapy Risk Risk Assessment Risk Factors Skin Skin cancer Skin Neoplasms - mortality Skin Neoplasms - pathology Skin Neoplasms - therapy Surgery Surgical therapy Topical therapy Tumors |
| Title | Diagnosis and treatment of basal cell carcinoma: European consensus–based interdisciplinary guidelines |
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