New European Guidelines for Diagnosis and Treatment of Basal Cell Carcinoma
Posted: Tuesday, September 10, 2019
New European consensus–based interdisciplinary guidelines for the diagnosis, classification, and treatment of basal cell carcinoma were published recently in the European Journal of Cancer. The guidelines were written by experts from the European Dermatology Forum, the European Association of Dermato-Oncology, and the European Organisation of Research and Treatment of Cancer, including Ketty Peris, MD, of the Institute of Dermatology at Catholic University Fondazione Policlinico Universitario A. Gemelli in Rome, and colleagues.
Easy-to-treat basal cell carcinomas can be diagnosed clinically and by dermatoscopy. As mentioned, the recommended first-line treatment is complete surgery. Physicians should consider topical therapies and destructive approaches such as curettage, electrocautery, cryotherapy, and laser ablation for patients with low-risk superficial carcinomas.
Any ambiguous lesion should be examined via histopathology, and high-risk basal cell carcinomas should also be examined in this way to assess the surgical margins. The guidelines recommend that a multidisciplinary tumor board draw up the therapeutic plan for a difficult-to-treat basal cell carcinoma. Microscopically controlled surgery has yielded high cure rates and allows for complete examination of surgical margins, so it should be a treatment option for high-risk or recurrent basal cell carcinoma and for tumors in cosmetically important or sensitive locations.
Other treatment options for locally advanced and metastatic basal cell carcinomas include the hedgehog inhibitors vismodegib and sonidegib. Anti–PD-1 immunotherapy is currently in clinical trials.
For patients, especially elderly ones, with basal cell carcinoma on the face, radiotherapy represents an alternative to surgery. Photodynamic therapy is effective for treating both superficial and thin nodular basal cell carcinomas.
The authors recommend long-term follow-up for the following patients: those with high-risk basal cell carcinomas, cancer at high-risk sites, those who have already had a recurrence, and those with nevoid basal cell carcinoma syndrome. For patients with low-risk basal cell carcinoma, one follow-up visit should be sufficient.
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