Treatment options | Prognosis for a basal cell carcinoma

Treatment options

The gold standard of basal cell carcinoma treatment is still surgical removal. This treatment is associated with the lowest relapse rate. The basalioma is usually cut out by the dermatologist under local anaesthetic.

It is important here that an area up to 5mm in size, i.e. healthy tissue, around the tumour is also removed. This so-called cut edge is examined histologically (mircoscopically) and must not degenerate any degenerated cells to ensure that the tumour is completely removed. Nevertheless, a recurrence of the malignant tumour can never be 100% ruled out.

In addition to surgical removal, there are other treatment options, which are usually only used if the location of the basal cell carcinoma (e.g. in the eye), the size or condition of the patient (a general condition that prohibits surgery) or certain previous illnesses make surgical removal impossible. Radiation with soft X-rays can be used for large and non-operable tumours. Scraping (curettage) with local chemotherapeutic follow-up treatment may also be an option.

A kind of icing (cryotherapy), as known from wart treatment, is also an option. Relatively new and only approved for the treatment of superficial basaliomas is the treatment in the form of a cream which the patient himself regularly applies to the basalioma. The active ingredient Imiquimod activates the body’s own immune system, which is then supposed to specifically recognize and eliminate the tumor cells.

Laser surgery or photodynamic therapy, which uses light rays to damage degenerated cancer cells in a targeted manner, are also available as options. The drug Vismodegib, which is administered in tablet form, has been on the market since 2013 and has an antitumoral effect. It is mainly used in advanced stages of basal cell carcinoma or when the cancer has already spread (metastasized).

Forms of basal cell carcinoma that grow aggressively and have a higher tendency to metastasize are for example Basalioma terebrans or Basilioma exulcerans. In the case of metastasis in other organs, systemic (whole body) chemotherapy must be administered. Depending on which organ is affected, the prognosis is far less good than for a localised basal cell carcinoma.

Even with successful treatment of the basal cell carcinoma, a recurrence (relapse) is relatively frequent in this skin cancer disease. The most frequent recurrence is in the first two years after removal of the original tumour. For this reason, affected persons should have themselves examined by a dermatologist at least once a year for the three following years. In addition, the patient himself should regularly and carefully examine the affected area and other particularly susceptible parts of the face.

Summary

As a rule, basaliomas have a good prognosis, since metastasis occurs in less than 1% of patients. Nevertheless, early detection and treatment is of great importance, as otherwise the tumour will grow into surrounding tissue (bone, soft tissue). On the one hand, this makes removal more difficult, and on the other hand it causes a great deal of disfigurement after removal.

Since the basal cell carcinoma occurs mainly in the face, the psychological burden of this disfigurement is enormous for many patients. Regular follow-up by the patient himself and by the dermatologist is also very important, as the basal cell carcinoma has a relatively high recurrence rate.