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Was gibt es Neues zum Basalzellkarzinom?

What is new in basal cell carcinoma?

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Zusammenfassung

Hintergrund

Das Basalzellkarzinom (BZK) ist der häufigste Hautkrebs des Menschen. Obwohl lymphogene und hämatogene Metastasierung nur selten beobachtet werden, kann es durch sein lokal aggressives Wachstum funktionelle und kosmetische Beschwerden verursachen.

Fragestellung

Es wird aktuellen Entwicklungen in Diagnostik, Therapie und Prävention des BZK nachgegangen.

Material und Methode

Die aktuelle Literatur inklusive der Empfehlungen deutschsprachiger Leitlinien wird zusammengefasst und die wichtigsten Neuerungen werden in einem Übersichtsbeitrag dargestellt.

Ergebnisse

In der Diagnostik ergeben sich v. a. durch den Einsatz nicht-invasiver Untersuchungstechniken wie der optischen Kohärenztomographie oder konfokalen Laserscanmikroskopie neue Möglichkeiten. Die operative Entfernung mittels mikroskopisch kontrollierter Chirurgie bleibt der therapeutische Goldstandard von Tumoren im Kopf- und Gesichtsbereich. Bei Inoperabilität bietet die Bestrahlung mit schnellen Elektronen oder Röntgenstrahlen eine gute Alternative. Imiquimod, 5‑Fluorouracil oder photodynamische Therapie sollten BZKs vom oberflächlichen Typ vorbehalten sein. Topische Inhibitoren des Sonic-Hedgehog-(SHH)-Signalwegs sind aktuell in der frühen klinischen Entwicklung. Hingegen sind mit Vismodegib und Sonidegib zwei Inhibitoren zur Systemtherapie des lokal fortgeschrittenen oder metastasierten BZK mit sehr guten Ansprechraten zugelassen. Allerdings werden sie häufig von Nebenwirkungen wie Muskelkrämpfen, Geschmacksstörungen und Gewichtsverlust begleitet. In einer australischen Phase-III-Studie reduzierte orales Nikotinamid (Vitamin B3) das Auftreten von neuen BZKs um 20 % bei Hautkrebs-vorbelasteten Patienten.

Schlussfolgerung

Durch zielgerichtete Therapie gegen den SHH-Signalweg hat sich die Prognose des fortgeschrittenen BZK deutlich verbessert, allerdings mit der Folge von nicht unbeträchtlichen Nebenwirkungen.

Abstract

Background

Basal cell carcinoma (BCC) is the most common skin cancer in fair-skinned individuals. Although lymph node or visceral metastases are observed in less than 0.5 % of all cases, BCC can have a fatal course due to its highly invasive growth pattern.

Objectives

To provide a comprehensive update on diagnosis, treatment, and prevention of BCC.

Materials and methods

We review the current literature and recommendations of the German guidelines on treatment and prevention of skin cancer. The most pertinent developments are summarized in this review article.

Results

The use of optical coherence tomography and reflectance confocal microscopy can significantly improve the diagnosis of BCC compared with clinical assessment and dermoscopy alone. Mohs micrographic surgery remains the therapeutic gold standard for tumors in the head and facial area and tumors with high-risk features. The application of imiquimod, 5‑fluorouracil, or photodynamic therapy should be restricted to low-risk superficial tumors. Topical inhibitors of the sonic hedgehog (SHH) pathway are currently being evaluated in early clinical trials. In contrast, vismodegib and sonidegib have been approved for the systemic treatment of locally advanced and metastatic BCC with good response rates. The most common adverse events of both agents are muscle cramps, dysgeusia, diffuse alopecia, weight loss, and fatigue. In an Australian phase III trial, oral nicotinamide (vitamin B3) reduced the occurrence of new BCC by 20 % in skin cancer patients.

Conclusions

Targeted therapy with SHH inhibitors has improved the prognosis of locally advanced and metastatic BCC, albeit at the cost of a significant number of adverse events.

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Authors and Affiliations

  1. Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München (LMU), Frauenlobstr. 9–11, 80337, München, Deutschland

    M. Heppt,  T. von Braunmühl &  C. Berking

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  1. M. Heppt
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  2. T. von Braunmühl
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  3. C. Berking
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Corresponding author

Correspondence to C. Berking.

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Interessenkonflikt

M. Heppt gibt an, dass kein Interessenkonflikt besteht. T. von Braunmühl hat Vortragshonorare erhalten von Agfa HealthCare GmbH, Almirall-Hermal, Leo Pharma, Roche Pharma, und Leihgeräte für klinische Studien wurden von Agfa HealthCare GmbH, Mavig GmbH und Michelson Diagnostics Ltd. zur Verfügung gestellt. C. Berking hat Berater- und Vortragshonorare erhalten von Almirall-Hermal, Biofrontera, Galderma, Leo Pharma und ISDIN.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Heppt, M., von Braunmühl, T. & Berking, C. Was gibt es Neues zum Basalzellkarzinom?. Hautarzt 67, 876–883 (2016). https://doi.org/10.1007/s00105-016-3880-5

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  • DOI: https://doi.org/10.1007/s00105-016-3880-5

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