Therapy of a basalioma

How is the basal cell carcinoma treated?

There are several possibilities for the therapy of a basal cell carcinoma. The fact that basal cell carcinomas have a low metastasis rate of 0.03% and thus “in principle do not form metastases” (and that therefore only one affected part of the body needs to be treated locally) is of great importance for therapy planning. However, they can still grow into surrounding tissue and destroy it.

Therefore, basaliomas are potentially very dangerous and should be removed as soon as possible. Which of the different methods of removal is used depends on various factors such as:. In general, however, surgery is the therapy of choice, as it offers the best chance of complete recovery.

  • Age and general condition of the patient and
  • Characteristics of the tumour such as its (location, growth form and extent)

The therapy of first choice is the microscopically controlled surgical removal of the basal cell carcinoma. Basal cell carcinoma surgery can usually be performed on an outpatient basis by a dermatologist, so the patient does not normally need to be admitted to hospital as an inpatient. Since the operation is a rather minor procedure, at least if the basal cell carcinoma is detected at an early stage, it can usually be performed under local anaesthesia.

When excising the skin tumour, it is important to remove not only the tumour tissue but also part of the surrounding tissue in order to ensure that the tumour is completely free of tumour and to reduce the risk of the tumour returning (recurrence). In this procedure, the tumour tissue is excised sparingly, with a margin of 2-4mm. Often the edge of the excised basal cell carcinoma is examined again under the microscope to see if there are still tumour cells in the margin.

If this is the case, a second operation is performed to remove the tumour completely. If the basal cell carcinoma is already in a very advanced stage and has therefore assumed a larger size, surgical removal can sometimes lead to the formation of scars. Depending on the location, these can lead to (mainly cosmetic) impairments, which is why sometimes a further operation is followed by a skin transplant.

Radiotherapy for a basal cell carcinoma

The operation of a basalioma is not always possible. This is the case, for example, if a surgical intervention is inoperable because of the proximity of the basal cell carcinoma to other structures. In most cases, this is a basal cell carcinoma of the face or a basal cell carcinoma that has remained undetected for a longer period of time and has grown far into the depths.

Thus, other options for therapy are also available. The second choice is usually radiation therapy (radiotherapy), as it has similarly good results as surgery. However, its major disadvantage is that it has a large number of side effects.

Furthermore, it is not possible to examine the tissue for tumour cells and thus not be sure whether the basal cell carcinoma has actually disappeared completely. Therefore, the recurrence rate after radiation therapy is higher than after surgery. Another advantage is that there is no damage to the skin, as there is no scarring and therefore better cosmetic results are achieved.

The standard technique here is irradiation with superficial X-rays. Depending on the size of the tumour, a safety margin of 0.5-1.5 cm is maintained here as well. Risk organs in the irradiation field (e.g. eye, auricle, etc.)

are protected with a lead cover. The dose, i.e. the strength of the X-ray radiation, varies between 1.8-5 Gray, depending on the size and growth behavior of the tumor tissue. Radiotherapy usually requires several sessions.