Basal Cell Carcinoma: Therapy

General measures

  • Strive to maintain normal weight! Determine BMI (body mass index) or body composition using electrical impedance analysis.
    • Falling below the BMI lower limit (from the age of 45: 22; from the age of 55: 23; from the age of 65: 24) → Participation in a medically supervised program for the underweight.
  • Nicotine restriction (refraining from tobacco use).
  • Limited alcohol consumption (men: max. 25 g alcohol per day; women: max. 12 g alcohol per day).
  • Review of permanent medication due topossible effect on the existing disease.
  • Avoidance of environmental stress:
    • UV radiation
    • Occupational contact with carcinogens such as arsenic.
  • Full body inspection (skin of the entire body): check yourself regularly (independent of follow-up examinations).

Regular control examinations

Follow-up appointments are based on individual risk factors:

  • Follow-up appointments based on risk of recurrence: full body inspection.
    • Low risk of recurrence (primary, clearly definable and/or superficial) basal cell carcinoma): after 6 months, then 1 time annually
    • High risk of recurrence (multiple tumors, lfBZK, mBZK, syndromes): every 3 months; if no new disease for 2 years, then 1 time per year.
  • R1 situation (microscopic residual tumor), local recurrence (local recurrence of tumor), terebrans ulcer (tumor grows early into depth and infiltrates adjacent structures such as cartilage), basosquamous BCC, immunosuppression, genetic predisposition, and/or multiple BCCs in the history: whole body inspection.
    • Year 1-3: 3- to 6-monthly
    • Year 3 to 10 (if necessary, for life): 6- to 12-monthly.

Conventional non-surgical therapy methods

All of the nonoperative procedures listed below are expected to have a higher recurrence rate (tumor recurrence) compared with complete surgical removal of the tumor:

  • Curettage (scraping, scraping out) – used in individual cases of basal cell carcinoma (BCC) in the extremities or trunk.
  • Photodynamic therapy (PDT) using methyl-5-amino-4-oxopentanoate – in this form of therapy, so-called photosensitizers are first applied to the affected skin area, then this area is intensively irradiated with light; can be performed in individual cases in superficial basal cell carcinoma (sBZK); indications: thin basal cell carcinoma (BZK); superficial-multicentric BZK resp. When other therapies are considered less appropriatePhotodynamic therapy with methyl aminolevulinate (MAL-PDT) versus fluorouracil or imiquimod: Cosmetic outcome was slightly better with MAL-PDT than with imiquimod or fluorouracil, but the efficacy of MAL-PDT therapy was lower than that of the comparator therapies.
  • Cryotherapy (cold therapy) – intralesional application of liquid nitrogen; indications: superficial BCC on the trunk or extremities when contraindications (contraindications) to excisional or topical procedures (surgical excision or local therapy) are present.
  • Laser therapy (ablative laser systems (CO2, Erbium:YAG) – Indications: Low-risk BCC; superficial basal cell carcinoma; remission rate 78.6%.
  • Electrochemotherapy (ECT): combination of chemotherapy and a procedure in which plate electrodes are attached to tumors and current pulses of 1,000 to 1,300 volts are delivered to tissues under local or general anesthesia – for local tumor control; in a small study, 31 of 34 lesions (91%) disappeared completely, two responded partially, and one had no response.Conclusion: further study is needed.

Vaccinations

The following vaccinations are advised:

  • Flu vaccination
  • Pneumococcal vaccination

Regular checkups

  • Regular participation in the follow-up examinations.

Nutritional medicine

  • Nutritional counseling based on nutritional analysis
  • Nutritional recommendations according to a mixed diet, taking into account the general knowledge of nutrition in a tumor disease. This means:
    • Consume only limited energy-rich foods.
    • moderate total fat absorption
    • Little red meat (pork, beef, lamb, veal) and sausages
    • Once or twice a week fresh sea fish, ie fatty marine fish (omega-3 fatty acids) such as salmon, herring, mackerel.
    • High-fiber diet (whole grains, vegetables).
    • Daily total of 5 servings of fresh vegetables and fruits (≥ 400 g; 3 servings of vegetables and 2 servings of fruit).
    • Reduce consumption of smoked and cured foods, because they contain nitrate or nitrite as a component of curing salt. Their preparation produces compounds (nitrosamines), which are risk factors for various tumor diseases.
    • Refrain from polluted foods such as offal and wild mushrooms.
    • Do not eat moldy food
  • Observe the following special dietary recommendations:
  • Selection of appropriate food based on the nutritional analysis
  • See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
  • Detailed information on nutritional medicine you will receive from us.

Sports Medicine

  • Endurance training (cardio training) and strength training (muscle training).
    • In general, endurance training on a bicycle ergometer can be recommended, which is performed according to the principle of interval training. This means that load phases lasting 1 to 3 minutes alternate with rest phases also lasting 1 to 3 minutes. The training should be performed at about 80% of the maximum heart rate for a total of 30 minutes.
  • Preparation of a fitness or training plan with suitable sports disciplines based on a medical check (health check or athlete check).
  • Detailed information on sports medicine you will receive from us.

Psychotherapy