Institute of Dermatology, Catholic University of the Sacred Heart, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
Eur J Cancer. 2023 Oct;192:113254. doi: 10.1016/j.ejca.2023.113254. Epub 2023 Jul 28.
Basal cell carcinoma (BCC) is the most common malignant tumour in white populations. Multidisciplinary experts from European Association of Dermato-Oncology (EADO), European Dermatology Forum, European Society for Radiotherapy and Oncology (ESTRO), Union Européenne des Médecins Spécialistes, and the European Academy of Dermatology and Venereology developed updated recommendations on diagnosis and treatment of BCC. BCCs were categorised into 'easy-to-treat' (common) and 'difficult-to-treat' according to the new EADO clinical classification. Diagnosis is based on clinico-dermatoscopic features, although histopathological confirmation is mandatory in equivocal lesions. The first-line treatment of BCC is complete surgery. Micrographically controlled surgery shall be offered in high-risk and recurrent BCC, and BCC located on critical anatomical sites. Topical therapies and destructive approaches can be considered in patients with low-risk superficial BCC. Photodynamic therapy is an effective treatment for superficial and low-risk nodular BCCs. Management of 'difficult-to-treat' BCCs should be discussed by a multidisciplinary tumour board. Hedgehog inhibitors (HHIs), vismodegib or sonidegib, should be offered to patients with locally advanced and metastatic BCC. Immunotherapy with anti-PD1 antibodies (cemiplimab) is a second-line treatment in patients with a progression of disease, contraindication, or intolerance to HHI therapy. Radiotherapy represents a valid alternative in patients who are not candidates for or decline surgery, especially elderly patients. Electrochemotherapy may be offered when surgery or radiotherapy is contraindicated. In Gorlin patients, regular skin examinations are required to diagnose and treat BCCs at an early stage. Long-term follow-up is recommended in patients with high-risk BCC, multiple BCCs, and Gorlin syndrome.
基底细胞癌（BCC）是白人中最常见的恶性肿瘤。欧洲皮肤病肿瘤学会（EADO）、欧洲皮肤病学会、欧洲放射肿瘤学会和肿瘤学学会（ESTRO）、欧洲医师协会和欧洲皮肤病学会和性病学会的多学科专家制定了关于 BCC 诊断和治疗的更新建议。根据 EADO 的新临床分类，BCC 分为“易于治疗”（常见）和“难以治疗”。诊断基于临床皮肤镜特征，尽管在可疑病变中必须进行组织病理学确认。BCC 的一线治疗是完全手术。在高危和复发性 BCC 以及位于关键解剖部位的 BCC 中，应提供显微镜下控制的手术。对于低危浅表 BCC，可考虑局部治疗和破坏性方法。光动力疗法是治疗浅表和低危结节性 BCC 的有效方法。应由多学科肿瘤委员会讨论“难以治疗”的 BCC 管理。对于局部晚期和转移性 BCC 患者，应提供 Hedgehog 抑制剂（HHI）、维莫德吉或索尼德吉。对于疾病进展、HHI 治疗禁忌或不耐受的患者，抗 PD1 抗体（西米普利单抗）免疫治疗是二线治疗。对于不能手术或拒绝手术的患者，放射治疗是一种有效的替代方法，特别是老年患者。当手术或放疗禁忌时，可提供电化学疗法。在 Gorlin 患者中，需要定期进行皮肤检查以早期诊断和治疗 BCC。对于高危 BCC、多发 BCC 和 Gorlin 综合征患者，建议进行长期随访。
