Aktuelles Management des Basalzellkarzinoms

Was ist neu?

Einteilung und Risikostratifizierung Zunehmende Bedeutung gewinnt die primäre Durchführung einer Risikostratifizierung, die für die weiteren diagnostischen und therapeutischen Schritte maßgeblich ist.

Diagnostik Zur Sicherung der klinischen Diagnose stehen verschiedene non-invasive Verfahren zur Verfügung. Eine histologische Diagnosesicherung wird in unklaren Fällen empfohlen. Bei schlecht verschieblichen Läsionen sollte eine präoperative Schnittbildgebung des Tumorareals erfolgen zum Ausschluss einer ossären Infiltration.

Therapie Goldstandard in der Behandlung bleibt weiterhin das operative Vorgehen, welches möglichst mittels mikrografisch kontrollierter Chirurgie erfolgen sollte. Daneben existieren weitere Therapieverfahren wie die Radiotherapie oder eine Reihe an topischen Therapieoptionen (photodynamische Therapie, Kryotherapie oder Applikation von 5-Fluoruracil bzw. Imiquimod), die in bestimmten Fällen zur Anwendung kommen können. Auch für fortgeschrittene oder metastasierte Basalzellkarzinome stehen mit den Hedgehog-Inhibitoren wirksame Medikamente zur Verfügung, für die inzwischen eine mehrjährige Anwendungserfahrung hinsichtlich Wirksamkeit und Umgang mit unerwünschten Ereignissen vorliegt. Mit dem PD-1-Inhibitor Cemiplimab steht seit Juni 2021 eine weitere therapeutische Option für nicht operable oder metastasierte Tumoren bereit.

Prävention und Nachsorge Wichtigste Maßnahme ist ein konsequenter textiler oder chemischer UV-Schutz bei bereits betroffenen Personen. Darüber hinaus können Nicotinamid und Celecoxib oral zur Prävention eingesetzt werden. Zur Nachsorge werden von der aktuellen S2k-Leitlinie regelmäßigen Selbstkontrollen und standardisierte ärztliche Kontrolluntersuchungen empfohlen.

Abstract

For the management of basal cell carcinoma, the primary performance of a risk stratification, which is decisive for the further diagnostic and therapeutic steps, is becoming increasingly important.

Various non-invasive methods are available to confirm the clinical diagnosis. Histological confirmation of the diagnosis is recommended in unclear cases. In poorly displaced lesions, preoperative cross-sectional imaging of the tumor area should be performed to exclude osseous infiltration.

The gold standard in treatment remains surgery, which should be performed by means of micrographically controlled surgery if possible. In addition, there are other therapeutic methods such as radiotherapy or a number of topical therapy options (photodynamic therapy, cryotherapy or application of 5-fluorouracil or imiquimod), which can be used in certain cases. Also for advanced or metastatic basal cell carcinoma, effective drugs are available in the form of the hedgehog inhibitors, for which there is now several years of application experience with regard to efficacy and handling of adverse events. With the PD-1 inhibitor cemiplimab, a further therapeutic option for non-operable or metastatic tumors has been available since June 2021.

The most important preventive measure is consistent textile or chemical UV protection in already affected individuals. In addition, nicotinamide and celecoxib can be used orally for prevention. For follow-up, the current S2k guideline recommends regular self-monitoring and standardized medical check-ups.

Schlüsselwörter

Basalzellkarzinom - Dermatologie - Risikostratifizierung - Management - Therapieoptionen

Keywords

Basal cell carcinoma - dermatology - risk stratification - management - therapy options

Publication History

Article published online:
23 August 2023

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