Article information
Abstract
Numerous therapeutic options are now available for the treatment of basal cell carcinoma. However, few randomized controlled trials with 5-year follow-up have compared the effectiveness of the different treatments. Such a comparison is difficult, probably because efficacy depends on several factors: those related to the tumor, the patient, the technique, and the dermatologist's experience. We first describe the available therapeutic options, including certain innovative treatments. We have divided them into 2 main groups—surgical and nonsurgical—and focus on the indications, advantages, and disadvantages of each one, as well as on the cure and recurrence rates. Then, based on the evidence reviewed, we attempt to provide an outline of the therapeutic strategies recommended in basal cell carcinoma, and the approach to be used in specific situations. We also describe our own experience.
Keywords:
Carcinoma
Basal cell
Skin cancer
Treatment
Surgery
Resumen
El arsenal terapéutico para el tratamiento de los carcinomas basocelulares hoy en día es muy amplio. No obstante, existen pocos estudios controlados, aleatorizados con seguimiento a 5 años que comparen la eficacia de los diferentes tratamientos. Esto es difícil, debido probablemente a que la eficacia de los mismos depende de varios factores: los derivados del propio tumor, del paciente, de la técnica y del manejo de ella hecho por el dermatólogo. Describiremos en primer lugar las opciones terapéuticas con las que contamos, incluyendo además algunos tratamientos innovadores, dividiéndolas en dos grupos principales: quirúrgicos y no quirúrgicos, enfatizando en las indicaciones, ventajas y desventajas de cada tipo, así como las tasas de curación y recurrencia de los mismos. Posteriormente con las evidencias presentadas intentaremos, de manera esquemática, exponer las estrategias terapéuticas recomendadas en cada caso, las actitudes a adoptar en determinadas situaciones así como nuestra propia experiencia.
Palabras clave:
Carcinoma
Basocelular
Cáncer de piel
Tratamiento
Cirugía
Full text is only aviable in PDF
References
[1.]
A. Jemal, R. Siegel, E. Ward, Y. Hao, J. Xu, T. Murray, et al.
Cancer statistics 2008.
CA Cancer J Clin, 58 (2008), pp. 71-96
[2.]
Técnicas avanzadas de Investigación en Servicios de Salud (TAISS). Aproximación a la incidencia de cáncer de piel en cuatro provincias españolas. Versión 1. 26 de marzo del 2007.
[3.]
I. Bielsa, X. Soria, M. Esteve, C. Ferrándiz.
Skin Cancer Study Group of Barcelonès Nord. Population-based incidence of basal cell carcinoma in a Spanish Mediterranean area.
Br J Dermatol, 161 (2009), pp. 1341-1346
[4.]
F.J. Bath-Hextall, W. Perkins, J. Bong, H.C. Williams.
Interventions for basal cell carcinoma of the skin.
Cochrane Database Syst Rev, (2007),
[5.]
L. Ríos-Buceta, A. Picoto.
Cirugía de Mohs.
Actas Dermosifiliogr, 94 (2003), pp. 503-523
[6.]
NCCN Clinical Practice Guidelines in Oncology TM v.1.2009. Basal Cell and Squamous Cell Skin Cancers. National Comprehensive Cancer Network, Inc. [Cited 26/11/2008]. Available from: http://www.nccn.org.
[7.]
A. Kimyai-Asadi, L.H. Goldberg, M.H. Jih.
Accuracy of serial transverse cross-sections in detecting residual basal cell carcinoma at the surgical margins of an elliptical excision specimen.
J Am Acad Dermatol, 53 (2005), pp. 469-474
[8.]
S.Y. Su, F. Giorlando, E.W. Ek, T. Dieu.
Incomplete excision of basal cell carcinoma: a prospective trial.
Plast Reconstr Surg, 120 (2007), pp. 1240-1248
[9.]
F.F. Liu, E. Maki, P. Warde, D. Payne, P. Fitzpatrick.
A management approach to incompletely excised basal cell carcinomas of skin.
Int J Radiat Oncol Biol Phys, 20 (1991), pp. 423-428
[10.]
L. Ríos-Buceta.
Management of basal cell carcinomas with positive margins.
Actas Dermosifiliogr, 98 (2007), pp. 679-687
[11.]
H. Breuninger, K. Dietz.
Prediction of subclinical tumor infiltration in basal cell carcinoma.
J Dermatol Surg Oncol, 17 (1991), pp. 574-578
[12.]
R.W. Griffiths, S.K. Suvarna, J. Stone.
Basal cell carcinoma histological clearance margins: an analysis of 1539 conventionally excised tumours. Wider still and deeper?.
J Plast Reconstr Aesthet Surg, 60 (2007), pp. 41-47
[13.]
A. Kimyai-Asadi, M. Alam, L.H. Goldberg, S.R. Peterson, S. Silapunt, M.H. Jih.
Efficacy of narrow-margin excision of well-demarcated primary facial basal cell carcinomas.
J Am Acad Dermatol, 53 (2005), pp. 464-468
[14.]
G. Burg, R.D. Hirsch, B. Konz, O. Braun-Falco.
Histographic surgery: accuracy of visual assessment of the margins of basal-cell epithelioma.
J Dermatol Surg, 1 (1975), pp. 21-24
[15.]
D.P. Goldberg.
Assessment and surgical treatment of basal cell skin cancer.
Clin Plast Surg, 24 (1997), pp. 673-686
[16.]
K. Mosterd, G.A. Krekels, F.H. Nieman, J.U. Ostertag, B.A. Essers, C.D. Dirksen, et al.
Surgical excision versus Mohs’ micrographic surgery for primary and recurrent basal-cell carcinoma of the face: a prospective randomised controlled trial with 5-years’ follow-up.
Lancet Oncol, 9 (2008), pp. 1149-1156
[17.]
R.W. Griffiths, S.K. Suvarna, J. Stone.
Do basal cell carcinomas recur after complete conventional surgical excision?.
Br J Plast Surg, 58 (2005), pp. 795-805
[18.]
G. Staub, M. Revol, P. May, J.C. Bayol, O. Verola, J.M. Servant.
Excision skin margin and recurrence rate of skin cancer: a prospective study of 844 cases.
Ann Chir Plast Esthet, 53 (2008), pp. 389-398
[19.]
M.K. Silverman, A.W. Kopf, R.S. Bart, C.M. Grin, M.S. Levenstein.
Recurrence rates of treated basal cell carcinomas. Part 3: Surgical excision.
J Dermatol Surg Oncol, 18 (1992), pp. 471-476
[20.]
N.A. Swanson.
Mohs surgery. Technique, indications, applications, and the future.
Arch Dermatol, 119 (1983), pp. 761-773
[21.]
M.K. Silverman, A.W. Kopf, C.M. Grin, R.S. Bart, M.J. Levenstein.
Recurrence rates of treated basal cell carcinomas. Part 1: Overview.
J Dermatol Surg Oncol, 17 (1991), pp. 713-718
[22.]
T. Alonso, P. Sánchez, A. González, J. Ingelmo, I. Ruiz, S. Delgado, et al.
Cirugía Micrográfica de Mohs: nuestros primeros cien pacientes.
Actas Dermosifiliogr, 99 (2008), pp. 275-280
[23.]
N.W. Smeets, D.I. Kuijpers, P. Nelemans, J.U. Ostertag, M.E. Verhaegh, G.A. Krekels, et al.
HA. Mohs’ micrographic surgery for treatment of basal cell carcinoma of the face-results of a retrospective study and review of the literature.
Br J Dermatol, 151 (2004), pp. 141-147
[24.]
E.P. Tierney, C.W. Hanke.
Cost effectiveness of Mohs micrographic surgery: review of the literature.
J Drugs Dermatol, 8 (2009), pp. 914-922
[25.]
E. Dachów-Siwiéc.
Cryosurgery in the treatment of skin cancers: Indications and Management.
Clin Dermatol, 8 (1990), pp. 80-85
[26.]
E. Guevara-Gutiérrez, C. García-Silva.
Curetaje y Criocirugía en el tratamiento del carcinoma basocelular: resultado del seguimiento a cinco años.
Piel, 16 (2001), pp. 439-443
[27.]
P.J.A. Holt.
Cryotherapy for skin cancer: results over a 5-year period using liquid nitrogen spray cryosurgery.
Br J Dermatol, 119 (1988), pp. 231-240
[28.]
G. Gaitanis, K. Nomikos, E. Vava, E. Alexopoulos, I. Bassukas.
Immunocryosurgery for basal cell carcinoma: results of a pilot, prospective, open-label study of cryosurgery during continued imiquimod application.
J Eur Acad Dermatol Venereol, 23 (2009), pp. 1427-1431
[29.]
W.F. Spiller, R.F. Spiller.
Treatment of basal cell epithelioma by curettage and electrodesiccation.
J Am Acad Dermatol, 11 (1984), pp. 808-814
[30.]
C. Julian, P.W. Bowers, C. Pritchard.
A comparative study of the effects of disposable and Volkmann spoon curettes in the treatment of basal cell carcinoma.
Br J Dermatol, 161 (2009), pp. 1407-1409
[32.]
L.R. Braathen, R.M. Szeimies, N. Basset-Seguin, R. Bissonnette, P. Foley, D. Pariser, et al.
Guidelines on the use of photodynamic therapy for nonmelanoma skin cancer: An international consensus.
J Am Acad Dermatol, 56 (2007), pp. 125-143
[33.]
N. Basset-Seguin, S.H. Ibbotson, L. Emtestam, M. Tarstedt, C. Morton, M. Maroti, et al.
Topical methyl aminolaevulinate photodynamic therapy versus cryotherapy for superficial basal cell carcinoma: a 5 year randomized trial.
Eur J Dermatol, 18 (2008), pp. 547-553
[34.]
L.E. Rhodes, M. de Rie, Y. Enström, R. Groves, T. Morken, V. Goulden, et al.
Photodynamic therapy using topical methyl aminolevulinate vs surgery for nodular basal cell carcinoma: results of a multicenter randomized prospective trial.
Arch Dermatol, 140 (2004), pp. 17-23
[35.]
M.F. Avril, A. Auperin, A. Margulis, A. Gerbaulet, P. Duvillard, E. Benhamou, et al.
Basal cell carcinoma of the face: surgery or radiotherapy? Results of a randomized study.
Br J Cancer, 76 (1997), pp. 100-106
[36.]
H. Gollnick, C.G. Barona, R.G. Frank, T. Ruzicka, M. Megahed, J. Maus, et al.
Recurrence rate of superficial basal cell carcinoma following treatment with imiquimod 5% cream: conclusion of a 5-year long-term follow-up study in Europe.
Eur J Dermatol, 18 (2008), pp. 677-682
[37.]
T.K. Eigentler, A. Kamin, B.M. Weide, H. Breuninger, U.M. Caroli, M. Möhrle, et al.
A phase III, randomized, open label study to evaluate the safety and efficacy of imiquimod 5% cream applied thrice weekly for 8 and 12 weeks in the treatment of low-risk nodular basal cell carcinoma.
J Am Acad Dermatol, 57 (2007), pp. 616-621
[38.]
D.K. Tillman, M.T. Carroll.
A 36-month clinical experience of the effectiveness of curettage and imiquimod 5% cream in the treatment of basal cell carcinoma.
J Drugs Dermatol, 7 (2008), pp. S7-S14
[39.]
S.M. Shah, N. Konnikov, L.M. Duncan, Z.S. Tannous.
The effect of 595 nm pulsed dye laser on superficial and nodular basal cell carcinomas.
Lasers Surg Med, 41 (2009), pp. 417-422
[40.]
K. Moskalik, A. Kozlov, E. Demin, E. Boiko.
The efficacy of facial skin cancer treatment with high-energy pulsed neodymium and Nd:YAG lasers.
Photomed Laser Surg, 27 (2009), pp. 345-349
[41.]
S. McGillis, H. Fein.
Topical treatment strategies for nonmelanoma skin cancer precursor lesions.
Semin Cutan Med Surg, 23 (2004), pp. 174-183
[42.]
E.K. Orenberg, B.H. Miller, H.T. Greenway, J.A. Koperski, N. Lowe, T. Rosen, et al.
The effect of intralesional 5-fluorouracil therapeutic implant (MPI 5003) for treatment of basal cell carcinoma.
J Am Acad Dermatol, 27 (1992), pp. 723-728
[43.]
W.E. Love, J.D. Bernhard, J.S. Bordeaux.
Topical imiquimod or fluorouracil therapy for basal and squamous cell carcinoma: a systematic review.
Arch Dermatol, 145 (2009), pp. 1431-1438
[44.]
K. Gross, L. Kircik, G. Kricorian.
5% 5-Fluorouracil cream for the treatment of small superficial Basal cell carcinoma: efficacy, tolerability, cosmetic outcome, and patient satisfaction.
Dermatol Surg, 33 (2007), pp. 433-439
[45.]
J.A. Neville, E. Welch, D.J. Leffell.
Management of nonmelanoma skin cancer in 2007.
Nat Clin Pract Oncol, 4 (2007), pp. 462-469
[46.]
L. Anasagasti-Angulo, Y. García-Vega, S. Barcelona-Perez, P. López-Saura, I. Bello-Rivero.
Treatment of advanced, recurrent, resistant to previous treatments basal and squamous cell skin carcinomas with a synergistic formulation of interferons. Open, prospective study.
BMC Cancer, 9 (2009), pp. 262
[47.]
D.D. Von Hoff, P.M. LoRusso, C.M. Rudin, J.C. Reddy, R.L. Yauch, R. Tibes, et al.
Inhibition of the hedgehog pathway in advanced basalcell carcinoma.
N Engl J Med, 361 (2009), pp. 1164-1172
[48.]
J.K. Chen, J. Taipale, M.K. Cooper, P.A. Beachy.
Inhibition of hedgehog signaling by direct binding of cyclopamine to Smoothened.
Genes Dev, 16 (2002), pp. 2743-2748
[49.]
P.K. Nair, S.J. Melnick, S.F. Wnuk, M. Rapp, E. Escalon, C. Ramachandran.
Isolation and characterization of an anticancer catechol compound from Semecarpus anacardium.
J Ethnopharmacol, 122 (2009), pp. 450-456
[50.]
Talens E, Ocampo O, de la Paz D, Estrada H, Tica P, de la Cruz R. Anacardium occidentale (Linn.) Cashew nut extract (De BCC) in the treatment of basal cell carcinoma. 12th World Congress on Cancers of the Skin. Tel Aviv, 2009.
[51.]
M.R. Thissen, M.H. Neumann, L.J. Schouten.
A systematic review of treatment modalities for primary basal cell carcinomas.
Arch Dermatol, 135 (1999), pp. 1177-1183
[52.]
D.E. Rowe, R.J. Carroll, C.L. Day.
Long-term recurrence rates in previously untreated (primary) basal cell carcinoma: implications for patient follow-up.
J Dermatol Surg Oncol, 15 (1989), pp. 315-328
[53.]
D.E. Rowe, R.J. Carroll, C.L. Day.
Mohs surgery is the treatment of choice for recurrent (previously treated) basal cell carcinoma.
J Dermatol Surg Oncol, 15 (1989), pp. 424-431
[54.]
K. Mosterd, A.H. Arits, M.R. Thissen, N.W. Kelleners-Smeets.
Histology-based treatment of basal cell carcinoma.
Acta Derm Venereol, 89 (2009), pp. 454-458
Copyright © 2010. Academia Española de Dermatología y Venereología and Elsevier España, S.L.
