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Eur J Cancer. 2019 Jul 6;118:10-34. doi: 10.1016/j.ejca.2019.06.003. [Epub ahead of print]

Diagnosis and treatment of basal cell carcinoma: European consensus-based interdisciplinary guidelines.

Author information

1
Institute of Dermatology, Catholic University of the Sacred Heart, Italy; Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy. Electronic address: ketty.peris@unicatt.it.
2
Department of Dermatology, University of L'Aquila, L'Aquila, Italy.
3
Centre for Dermatooncology, Department of Dermatology, Eberhard-Karls University, Tuebingen, Germany.
4
Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Germany.
5
Department of Oncology, Odense University Hospital, Denmark.
6
Dermatology Department, Saint-Louis Hospital, Paris, France.
7
Twin Research and Genetic Epidemiology Unit, School of Basic & Medical Biosciences, King's College London, London, SE1 7EH, UK.
8
Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
9
Department of Dermatology, University Hospital Zurich and University Zurich, Switzerland.
10
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.
11
Department of Dermatology, University of Kiel, Kiel, Germany.
12
Department of Dermatology, Medical University of Vienna, Austria.
13
Department of Dermatology, University of Copenhagen, Bispebjerg Hospital, Copenhagen, Denmark.
14
Department of Dermatology, Hospital Clínic de Barcelona (Melanoma Unit), University of Barcelona, IDIBAPS, Barcelona & CIBERER, Barcelona, Spain.
15
Department of Oncology, University of Oxford, Old Road Campus, Oxford, OX3 9DU, UK.
16
Stirling Community Hospital, Stirling, UK.
17
Department of Dermatology, Instituto Valenciano de Oncologia, Valencia, Spain.
18
1(st) Department of Dermatology- Venereology, National and Kapodistrian University of Athens, School of Medicine, Andreas Sygros Hospital, Athens, Greece.
19
Clinic for Dermatology and Allergology, Klinikum Vest GmbH Teaching Hospital, Recklinghausen, Germany.
20
Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche Ed Ematologiche, Rome, Italy.
21
Second Department of Dermatology, Aristotle University Medical School, Papageorgiou General Hospital, Thessaloniki, Greece.
22
Dermatology Clinic, University of Trieste, Trieste, Italy.
23
Cancer Institute, Gustave Roussy Cancer Campus, Grand Paris, 94805, Villejuif, France.
24
University Department of Dermatology, Marseille, France.

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.

KEYWORDS:

Basal cell carcinoma; Classification; Destructive therapy; Guidelines; Hedgehog inhibitors; Immunotherapy; Photodynamic therapy; Radiotherapy; Surgical therapy; Topical therapy

PMID:
31288208
DOI:
10.1016/j.ejca.2019.06.003

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