Original ResearchDiagnosis and treatment of basal cell carcinoma: European consensus–based interdisciplinary guidelines
Section snippets
Societies in charge
These guidelines were developed on behalf of the European Dermatology Forum (EDF), as decided at the EDF meeting in January 2017. The European Association of Dermato-Oncology (EADO) coordinated the authors’ contributions within its Guideline Program in Oncology (GPO). The responsible editor is Jean Jacques Grob (senior author), and the coordinator of the guideline is Ketty Peris (first author). To guarantee the interdisciplinary character of these guidelines, they were developed in cooperation
Primary therapy
Most primary BCCs can be easily treated by surgery or by non-surgical methods for certain subtypes. BCCs with high risk of recurrence need to be treated more aggressively. Risk of recurrences increases with tumour size, poorly defined margins, aggressive histological subtype or previous recurrences. Certain tumours can be locally advanced with destruction of adjacent tissues or difficult to treat for other reasons which might need discussion regarding appropriate therapy in a multidisciplinary
When should we still consider surgery for difficult-to-treat BCC?
Surgery can be considered as a primary therapeutic option, as a palliative option and also following a neoadjuvant approach attempting to reduce the extent of the surgical procedure. The appropriate management should be carefully planned in a skin cancer multidisciplinary board wherein the potential strategies on surgical excision, reconstruction, tissue preservation, indications for prosthesis and radiotherapy are discussed. Appropriate imaging to determine the extent of the tumour is
Radiotherapy of BCC
During recent decades, radiotherapy has been reported as a valid alternative to surgery. The risk of developing a radiotherapy-induced secondary skin cancer is negligible using required radiation doses to treat cutaneous carcinomas. In contrast, a high risk exists in patients treated with lower doses for benign cutaneous conditions [121], [122].
Follow-up
Follow-up should be performed in patients with BCC because of risk of local recurrence (treatment failure), subsequent BCC development (metachronous BCCs) and increased risk of development of other skin cancers (SCC and melanoma) [1], [29], [48].
Diagnosis and management of patients with naevoid basal cell carcinoma syndrome
NBCCS is a rare, autosomal dominant familial cancer syndrome with a high degree of penetrance and variable expression. Its prevalence is estimated at 1 per 40.000–60.000 persons. NBCCS is caused by mutations in the PTCH1 gene, with de novo mutations occurring in about 20%–30% of patients, and more rarely by mutations in SMO, SUFU and PTCH2 [135].
Information for patients
When diagnosing BCC, it is important to explain to patients that these tumours are only locally invasive and will not have any detrimental effects on survival unless in rare high-risk or advanced cases. Even though most tumours are growing slowly, the potential consequences of foregoing treatment should be explained. There may be a need to discuss surgery-associated morbidity as the psychological impact of disfiguring surgery cannot be underestimated. The patient should always be offered
Funding
None.
Conflict of interest statement
K.P. reports grants and personal fees from Almirall and AbbVie, during the conduct of the study, and personal fees from Biogen, Lilly, Celgene, Galderma, Leo Pharma, Novartis, Pierre Fabre, Sanofi, Sandoz, Sun Pharma and Janssen, outside the submitted work. M.C.F. reports personal fees from Roche and Mylan; grants and personal fees from Galderma, during the conduct of the study; grants and personal fees from AbbVie, Almirall, Leo Pharma, Novartis, Sanofi and Union Chimique Belge (UCB); and
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Contributed equally.