Clinic and Policlinic for Dermatology and Allergology, Ludwig Maximilian University of Munich (LMU), Department of Dermatology, Allergology and Venerology, University Medical Center Schleswig-Holstein, Kiel, Department of Radiotherapy, University Medical Center Regensburg, Germany, Department of Oral and Maxillofacial Radiology, Clinic for Oral and Craniomaxillofacial Surgery, Ludwig-Maximilians University of Munich (LMU), Department of Dermatology and Allergology, Hannover Skin Cancer Center, Hannover Medical School.
Dtsch Arztebl Int. 2014 May 30;111(22):389-95. doi: 10.3238/arztebl.2014.0389.
With an incidence of 70 to over 800 new cases per 100 000 persons per year, basal cell carcinoma (BCC) is a very common disease, accounting for about 80% of all cases of non-melanoma skin cancer. It very rarely metastasizes. A variety of treatments are available for the different subtypes and stages of BCC.
This review is based on pertinent literature retrieved by a selective search in the Medline database, as well as the American Cancer Society guidelines on BCC and the German guidelines on BCC and skin cancer prevention.
The gold standard of treatment is surgical excision with histological control of excision margins, which has a 5-year recurrence rate of less than 3% on the face. For superficial BCC, approved medications such as imiquimod (total remission rate, 82-90%) and topical 5-fluorouracil (80%) are available, as is photodynamic therapy (71-87%). Other ablative methods (laser, cryosurgery) are applicable in some cases. Radiotherapy is an alternative treatment for invasive, inoperable BCC, with 5-year tumor control rates of 89-96%. Recently, drugs that inhibit an intracellular signaling pathway have become available for the treatment of locally advanced or metastatic BCC. Phase I and II clinical trials revealed that vismodegib was associated with objective response rates of 30-55% and tumor control rates of 80-90%. This drug was approved on the basis of a non-randomized trial with no control arm. It has side effects ranging from muscle cramps (71%) and hair loss (65%) to taste disturbances (55%) and birth defects.
The established, standard treatments are generally highly effective. Vismodegib is a newly approved treatment option for locally advanced BCC that is not amenable to either surgery or radiotherapy.
基底细胞癌（BCC）的年发病率为每 10 万人中有 70 至 800 例新发病例，是一种非常常见的疾病，约占所有非黑色素瘤皮肤癌病例的 80%。它很少发生转移。BCC 的不同亚型和阶段有多种治疗方法。
本综述基于在 Medline 数据库中进行选择性搜索检索到的相关文献，以及美国癌症协会关于 BCC 的指南和德国关于 BCC 和皮肤癌预防的指南。
治疗的金标准是手术切除，并对切除边缘进行组织学控制，在面部的 5 年复发率低于 3%。对于浅表性 BCC，有批准的药物可供使用，例如咪喹莫特（总缓解率为 82-90%）和外用 5-氟尿嘧啶（80%），还有光动力疗法（71-87%）。在某些情况下，还可以使用其他消融方法（激光、冷冻疗法）。对于侵袭性、不可手术的 BCC，放射治疗是一种替代治疗方法，5 年肿瘤控制率为 89-96%。最近，用于治疗局部晚期或转移性 BCC 的抑制细胞内信号通路的药物已经问世。I 期和 II 期临床试验显示，维莫德吉的客观缓解率为 30-55%，肿瘤控制率为 80-90%。该药物是基于没有对照组的非随机试验获得批准的。它有从肌肉痉挛（71%）和脱发（65%）到味觉障碍（55%）和出生缺陷等副作用。
既定的标准治疗通常非常有效。维莫德吉是一种新批准的治疗选择，适用于无法手术或放疗的局部晚期 BCC。
