Das Basalzellkarzinom – Diagnostik und Management

Das Basalzellkarzinom ist der häufigste Tumor des hellhäutigen Menschen, die Inzidenzrate (altersstandardisiert nach der europäischen Standardpopulation) beträgt bei 63 (Frauen) bzw. 80 (Männer) pro 100 000 Einwohner pro Jahr in Deutschland. Frühe Tumoren können klinisch schwer zu diagnostizieren sein, hier können nicht-invasive Diagnoseverfahren wie die Dermatoskopie, optische Kohärenztomografie und die konfokale Laserscanmikroskopie bei der Einordnung herangezogen werden. Die klinische Verdachtsdiagnose wird durch die Histologie bestätigt. Die Standardtherapie besteht in einer histologisch gesicherten, kompletten Resektion. Therapeutisch stellen multiple Basalzellkarzinome (wie beim Gorlin-Goltz-Syndrom) oder lokal sehr fortgeschrittene, tief infiltrierende bzw. sehr selten auch metastasierende Basalzellkarzinome ein Problem dar. Bei oberflächlichen Basalzellkarzinomen können nicht-operative Verfahren wie die photodynamische Therapie oder topische Medikamente erwogen werden. Bei lokal inoperablen oder den äußerst selten metastasierenden Basalzellkarzinomen sollten Therapieempfehlungen in einer interdisziplinären Tumorkonferenz erstellt werden. Hier sind eine Systemtherapie mit Hedgehog-Inhibitoren sowie eine Strahlentherapie mögliche Optionen.

Basal cell carcinoma (BCC) is the most common cancer type of fair skinned people. The incidence rate (age standardized according to the European standard population) in Germany is 63/100 000 inhabitants/year for women and 80/100 000/year for men. The diagnosis of early lesions can be difficult, non-invasive diagnostic tools like dermoscopy, optic coherence tomography or confocal laserscannin microscopy can be helpful. The clinical diagnosis should be confirmed histopathologically. The gold standard of primary treatment is the complete excision with histologically confirmed margins. Multiple BCC (i.e. in patients with basal nevus syndrome), or locally advanced or metastatic BCC are therapeutic challenges. Suoperficial BCC can also be treated non-surgically by photodynamic therapy or topically. In inoperable or extremely rare metastatic tumors, management should be discussed in an interdisciplinary tumor board. In these cases, a systemic treatment with hedgehog-inhibitors and radiotherapy can be further options.

Key words

Basal cell carcinoma - local - systemic treatment

• Literatur

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