Basal cell carcinoma

Abstract

Summary Basal cell carcinoma is the commonest malignancy in Caucasians with incidence rates of 300 per 100,000 reported in the USA. Rates are increasing at over 10% per year leading to a lifetime risk of 30%. Although mortality is low, the disease is responsible for considerable morbidity and places a substantial burden on health service provision in the UK. Furthermore, lesions may recur and patients often develop multiple tumours giving major implications for treatment and follow-up. Four main types of basal cell carcinoma are seen: nodulo-ulcerative; pigmented; morpheaform and superficial. Diagnosis is by histological evaluation although many tumours have a characteristic clinical appearance. The differential diagnosis is large. Identified risk factors include male gender, skin type 1, red/blonde hair and increasing age. Patients with basal cell carcinoma are more likely to develop malignant melanoma and squamous cell carcinoma but it is still unclear whether there is a link with internal malignancy. The main treatment modalities are surgery and radiotherapy. Each has advantages and disadvantages. The choice of treatment depends on many factors. Principles of treatment include identification of high-risk patients to enable early detection, complete removal of the lesion, and careful follow-up to detect recurrence or new lesions. Approximately 10% of tumours recur, depending on site, size and treatment modality. Metastatic basal cell carcinoma and the association of ultraviolet radiation to basal cell carcinoma risk are reviewed.

Metastatic basal cell carcinoma presenting with unilateral upper extremity edema and lymphatic spread

“…Other features of MBCC include initial size larger than 3.0 cm, tumor thickness more than 1.0 cm, and local ulceration. 5,10 MBCC most commonly involves the lymphatic system, lungs, bone, and skin. Evidently, BCC rarely metastasizes because of its dependence on surrounding stroma, as demonstrated by the inability to transplant BCC without surrounding tissue into other humans or animals.…”

BCC Update – Diagnostik und Therapie

“…Hintergrund Die Wahrscheinlichkeit im Laufe seines Lebens ein BCC zu entwickeln, liegt für Kaukasier bei 30 % [1]. Der Tumor kann in jedem Alter auftreten, die höchste Inzidenz wird aber ab einem Alter von über 40 Jahren verzeichnet [2].…”

Standardtherapie von Hauttumoren gemäß Leitlinien

“…Aufgrund dessen und des oft langsamen Wachstums, das nicht selten erst in fortgeschrittenen Stadien zu einem Therapiewunsch von Patienten, Angehörigen oder Pflegekräfte führt, liegt die wahre Inzidenz vermutlich sehr viel höher. Bezogen auf die Lebenszeit haben hellhäutige Menschen ein Risiko von etwa 30%, im Laufe ihres Lebens ein Basalzellkarzinom zu entwickeln [19]. Mit Blick auf das übliche Freizeitverhalten und die teilweise exzessive unkritische Sonnenexposition ist in Zukunft mit einer weiteren Zunahme der Inzidenz zu rechnen.…”