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Dtsch Arztebl Int. 2014 May 30;111(22):389-95. doi: 10.3238/arztebl.2014.0389.

Basal cell carcinoma-treatments for the commonest skin cancer.

Author information

1
Clinic and Policlinic for Dermatology and Allergology, Ludwig Maximilian University of Munich (LMU), Department of Dermatology, Allergology and Venerology, University Medical Center Schleswig-Holstein, Kiel, Department of Radiotherapy, University Medical Center Regensburg, Germany, Department of Oral and Maxillofacial Radiology, Clinic for Oral and Craniomaxillofacial Surgery, Ludwig-Maximilians University of Munich (LMU), Department of Dermatology and Allergology, Hannover Skin Cancer Center, Hannover Medical School.

Abstract

BACKGROUND:

With an incidence of 70 to over 800 new cases per 100 000 persons per year, basal cell carcinoma (BCC) is a very common disease, accounting for about 80% of all cases of non-melanoma skin cancer. It very rarely metastasizes. A variety of treatments are available for the different subtypes and stages of BCC.

METHOD:

This review is based on pertinent literature retrieved by a selective search in the Medline database, as well as the American Cancer Society guidelines on BCC and the German guidelines on BCC and skin cancer prevention.

RESULTS:

The gold standard of treatment is surgical excision with histological control of excision margins, which has a 5-year recurrence rate of less than 3% on the face. For superficial BCC, approved medications such as imiquimod (total remission rate, 82-90%) and topical 5-fluorouracil (80%) are available, as is photodynamic therapy (71-87%). Other ablative methods (laser, cryosurgery) are applicable in some cases. Radiotherapy is an alternative treatment for invasive, inoperable BCC, with 5-year tumor control rates of 89-96%. Recently, drugs that inhibit an intracellular signaling pathway have become available for the treatment of locally advanced or metastatic BCC. Phase I and II clinical trials revealed that vismodegib was associated with objective response rates of 30-55% and tumor control rates of 80-90%. This drug was approved on the basis of a non-randomized trial with no control arm. It has side effects ranging from muscle cramps (71%) and hair loss (65%) to taste disturbances (55%) and birth defects.

CONCLUSION:

The established, standard treatments are generally highly effective. Vismodegib is a newly approved treatment option for locally advanced BCC that is not amenable to either surgery or radiotherapy.

PMID:
24980564
PMCID:
PMC4078227
DOI:
10.3238/arztebl.2014.0389
[Indexed for MEDLINE]
Free PMC Article
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