Basal cell carcinoma medical therapy: Difference between revisions

Jump to navigation Jump to search
No edit summary
 
(41 intermediate revisions by 5 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Basal cell carcinoma}}
{{CMG}} {{AE}}{{M.N}},Saarah T. Alkhairy, M.D.
==Overview==
After the suspicious [[lesion]] is evaluated, the [[medical]] [[therapy]] is divided based on low-risk and high-risk basal cell carcinoma [[patients]]. [[Medical]] [[therapy]] consists of [[topical]] and [[systemic therapy]]. Among [[topical]] [[therapy]] [[imiquimod]], [[photodynamic therapy]], [[5-fluorouracil]] are included. [[Systemic therapy]] consists of [[Sonic hedgehog|sonic hedgehog pathway]] inhibitors like [[vismodegib]], [[sonidegib]].
==Basal Cell Carcinoma Medical Therapy==
Once the suspicious [[lesion]] is evaluated, the [[medical]] [[therapy]] is based upon the low-risk and high-risk basal cell carcinoma [[patients]].
The table below summarizes the characteristics in low-risk and high-risk [[lesions]]<ref>http://www.nccn.org/professionals/physician_gls/PDF/nmsc.pdf</ref>.
{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|'''H&P'''}}
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|'''Low risk'''}}
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|'''high risk'''}}
|-
| '''Location/size'''||Area L < 20 mm; Area M < 10 mm; Area H < 6 mm||Area L ≥ 20 mm; Area M ≥ 10 mm; Area H ≥ 6 mm
|-
| '''Borders'''||Well defined||Poorly defined
|-
| '''Primary vs. recurrent'''||Primary||Recurrent
|-
| '''[[Immunosuppression]]'''||(-)||(+)
|-
| '''Site of prior [[radiation therapy]]'''||(-)||(+)
|-
| '''Subtype'''||[[Nodular]], [[superficial]]||Aggressive [[growth]] pattern
|-
| '''Perineural involvement'''||(-)||(+)
|}
'''Area H''' = “mask areas” of [[face]] ([[central]] [[face]], [[eyelids]], [[eyebrows]], periorbital, [[nose]], [[lips]] [<nowiki/>[[cutaneous]] and vermilion], [[chin]], [[mandible]], preauricular and postauricular [[skin]]/[[Sulci (anatomy)|sulci]], [[temple]], [[ear]]), [[genitalia]], [[hands]], and [[feet]]
'''Area M''' = [[cheeks]], [[forehead]], [[scalp]], [[neck]], and pre-[[tibial]] area
'''Area L''' = [[trunk]] and [[extremities]] (excluding pre-[[tibial]] area, [[hands]], [[feet]], [[nail]] units, and ankles)
The [[Algorithm (medical)|algorithm]] below demonstrates a treatment [[Protocol (natural sciences)|protocol]] for '''low-risk''' [[lesions]]<ref>http://www.nccn.org/professionals/physician_gls/PDF/nmsc.pdf</ref>.
[[Image:Low Risk Basal Cell.jpg|800px]]
The [[algorithm]] below demonstrates a treatment [[Protocol (natural sciences)|protocol]] for '''high-risk''' [[lesions]]<ref>http://www.nccn.org/professionals/physician_gls/PDF/nmsc.pdf</ref>.
[[Image:High Risk Basal Cell.jpg|800px]]
After the primary treatment, a follow-up is performed to evaluate for recurrence of the [[tumor]].
The [[algorithm]] below demonstrates a follow-up [[Protocol (natural sciences)|protocol]]<ref>http://www.nccn.org/professionals/physician_gls/PDF/nmsc.pdf</ref>.


{{Basal cell carcinoma}}
[[Image:Followup Basal Cell.jpg|800px]]


Please help WikiDoc by adding content here. It's easy! Click [[Help:How_to_Edit_a_Page|here]] to learn about editing.
The medical therapy for basal cell carcinoma is divided into<ref name="pmid24980564">{{cite journal |vauthors=Berking C, Hauschild A, Kölbl O, Mast G, Gutzmer R |title=Basal cell carcinoma-treatments for the commonest skin cancer |journal=Dtsch Arztebl Int |volume=111 |issue=22 |pages=389–95 |date=May 2014 |pmid=24980564 |doi=10.3238/arztebl.2014.0389 |url=}}</ref><ref name="pmid14525881">{{cite journal |vauthors=Wong CS, Strange RC, Lear JT |title=Basal cell carcinoma |journal=BMJ |volume=327 |issue=7418 |pages=794–8 |date=October 2003 |pmid=14525881 |pmc=214105 |doi=10.1136/bmj.327.7418.794 |url=}}</ref>:
*Toipcal
*Systemic
'''Topical therapy'''
*[[Imiquimod]]
**It is an [[immunomodulatory]] agent that binds to [[Toll-like receptors|toll-like receptor]] 7 and induces the release of pro-[[inflammatory]] [[cytokines]] including [[IFN-α|IFN]]-alpha, [[TNF-alpha]] and [[IL-12]].  
**It is approved for treatment of small [[superficial]] basal cell carcinoma and is applied nightly five times a week for six weeks.
**The complete [[cure]] rate was around 80%.
*[[Photodynamic therapy]]
**The other available option for basal cell carcinoma is [[photodynamic therapy]] (PDT) with [[Levulinic acid|5-amino levulinic acid]](MAL) or with its methyl [[Esters|ester]] plus red light.
**The MAL [[Cream (pharmaceutical)|cream]] is applied to the [[tumor]] and covered with an [[Occlusive dressing|occlusive]] [[Dressing (medical)|dressing]] for three hours.
**The [[Tumor cell|tumor cells]] then form increasing amounts of [[protoporphyrin IX]], which is stimulated by [[irradiation]] with red [[light]] to form [[reactive oxygen species]] which are in turn [[cytotoxic.]]
**It should be repeated after 1–4 weeks.
**The achieved complete [[remission]] is expected to be 92%.
**The main disadvantages of [[photodynamic therapy]] are the [[pain]] during the [[irradiation]] and the local [[inflammatory]] [[reaction]] ([[erythema]], erosions, [[pustules]], and crusts).
*[[Fluorouracil (topical)|5-fluorouracil]]
**It is a [[cytostatic]] agent which is available as a 5% [[prescription]] [[Cream (pharmaceutical)|cream]] that is designed to be applied twice daily for 3–12 weeks until erosions develop.
'''Systemic therapy'''
*[[Sonic hedgehog|Sonic hedgehog pathway]] inhibitors([[vismodegib]], [[sonidegib]])
**They are markedly [[teratogenic]] and embryotoxic.
**The commonest [[adverse effects]] of [[vismodegib]] include [[muscle cramps]], [[hair loss]], [[Taste alteration|taste disturbances]] and [[weight loss]].
'''Cryotherapy'''
*Small and [[superficial]] basal cell carcinoma is occasionally still treated with [[liquid nitrogen]] (–196°C) either with direct contact or using a [[Spray-on skin|spray]].
*The [[wounds]] may [[Healing|heal]] with either [[hypopigmentation]] or [[scarring]] so making it a major disadvantage.


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


[[Category:Needs content]]
{{WH}}
[[Category:Disease]]
{{WS}}
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Dermatology]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Surgery]]
[[Category:Pathology]]
[[Category:Oncology]]

Latest revision as of 17:09, 4 April 2019

Basal cell carcinoma Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Basal Cell Carcinoma from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

Staging

History and Symptoms

Physical Examination

Laboratory Findings

CT scan

MRI

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Basal cell carcinoma medical therapy On the Web

Most recent articles

cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Basal cell carcinoma medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Basal cell carcinoma medical therapy

CDC on Basal cell carcinoma medical therapy

Basal cell carcinoma medical therapy in the news

Blogs on Basal cell carcinoma medical therapy

Directions to Hospitals Treating Basal cell carcinoma

Risk calculators and risk factors for Basal cell carcinoma medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maneesha Nandimandalam, M.B.B.S.[2],Saarah T. Alkhairy, M.D.

Overview

After the suspicious lesion is evaluated, the medical therapy is divided based on low-risk and high-risk basal cell carcinoma patients. Medical therapy consists of topical and systemic therapy. Among topical therapy imiquimod, photodynamic therapy, 5-fluorouracil are included. Systemic therapy consists of sonic hedgehog pathway inhibitors like vismodegib, sonidegib.

Basal Cell Carcinoma Medical Therapy

Once the suspicious lesion is evaluated, the medical therapy is based upon the low-risk and high-risk basal cell carcinoma patients.

The table below summarizes the characteristics in low-risk and high-risk lesions[1].

H&P Low risk high risk
Location/size Area L < 20 mm; Area M < 10 mm; Area H < 6 mm Area L ≥ 20 mm; Area M ≥ 10 mm; Area H ≥ 6 mm
Borders Well defined Poorly defined
Primary vs. recurrent Primary Recurrent
Immunosuppression (-) (+)
Site of prior radiation therapy (-) (+)
Subtype Nodular, superficial Aggressive growth pattern
Perineural involvement (-) (+)

Area H = “mask areas” of face (central face, eyelids, eyebrows, periorbital, nose, lips [cutaneous and vermilion], chin, mandible, preauricular and postauricular skin/sulci, temple, ear), genitalia, hands, and feet

Area M = cheeks, forehead, scalp, neck, and pre-tibial area

Area L = trunk and extremities (excluding pre-tibial area, hands, feet, nail units, and ankles)


The algorithm below demonstrates a treatment protocol for low-risk lesions[2].

The algorithm below demonstrates a treatment protocol for high-risk lesions[3].

After the primary treatment, a follow-up is performed to evaluate for recurrence of the tumor.

The algorithm below demonstrates a follow-up protocol[4].

The medical therapy for basal cell carcinoma is divided into[5][6]:

  • Toipcal
  • Systemic

Topical therapy

Systemic therapy

Cryotherapy

References

  1. http://www.nccn.org/professionals/physician_gls/PDF/nmsc.pdf
  2. http://www.nccn.org/professionals/physician_gls/PDF/nmsc.pdf
  3. http://www.nccn.org/professionals/physician_gls/PDF/nmsc.pdf
  4. http://www.nccn.org/professionals/physician_gls/PDF/nmsc.pdf
  5. Berking C, Hauschild A, Kölbl O, Mast G, Gutzmer R (May 2014). "Basal cell carcinoma-treatments for the commonest skin cancer". Dtsch Arztebl Int. 111 (22): 389–95. doi:10.3238/arztebl.2014.0389. PMID 24980564.
  6. Wong CS, Strange RC, Lear JT (October 2003). "Basal cell carcinoma". BMJ. 327 (7418): 794–8. doi:10.1136/bmj.327.7418.794. PMC 214105. PMID 14525881.

Template:WH Template:WS