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Alternative Behandlungsoptionen beim Basalzellkarzinom am Auge

Alternative treatment options for periorbital basal cell carcinoma

  • 61 Accesses

Zusammenfassung

Hintergrund

Neuste Entwicklungen, aber auch ältere Verfahren bieten, soweit die mikrographisch kontrollierte Chirurgie nicht zum Einsatz kommen kann, alternative Therapieverfahren beim Basalzellkarzinom an.

Ziel

Dargestellt werden alternative Therapieoptionen bei periokulären Basalzellkarzinomen.

Methoden

Es erfolgen eine Literaturrecherche sowie eine strukturierte Darstellung und Bewertung der Ergebnisse.

Ergebnisse

Die mikrographisch kontrollierte Chirurgie ist der Goldstandard der Therapie der Basalzellkarzinome. Wenn die Chirurgie aus verschiedensten Gründen nicht erfolgen kann, werden andere Verfahren benötigt. Die alternativen Behandlungsoptionen beim Basalzellkarzinom lassen sich in 3 Gruppen unterteilen: Behandlungsoptionen für lokal fortgeschrittene Basalzellkarzinome bzw. für metastasierte Basalzellkarzinome, topische Verfahren für kleine und oberflächliche Basalkarzinome sowie prophylaktische Maßnahmen. Während die Bestrahlung und die Systemtherapie bei lokal fortgeschrittenen Basalzellkarzinomen Sinn ergeben und im Tumorboard besprochen werden, können kleine und oberflächliche Befunde topisch behandelt werden. Eine Prophylaxe kann bei einer vorherigen Basalzellkarzinomhistorie durchgeführt werden. Gerade Systemtherapiekombinationen, aber auch ein neoadjuvanter oder adjuvanter Ansatz vor oder nach der Chirurgie sind weitere Erfolg versprechende Möglichkeiten, die beim lokal fortgeschrittenen Basalzellkarzinom den Behandlungsstandard weiter verbessern können.

Schlussfolgerung

Alternative Behandlungsoptionen beim periokulären Basalzellkarzinom existieren. Allerdings ist deren Einsatz ausschließlich indiziert, wenn die mikroskopisch kontrollierte Exzision mit anschließender okuloplastischer Rekonstruktion nicht möglich ist. Nahezu zwingend nach den nationalen Leitlinien ist eine vorherige Vorstellung in einem geeigneten Tumorboard.

Abstract

Background

Latest developments as well as established procedures offer alternative treatment approaches to basal cell carcinoma (BCC) when micrographically controlled surgical removal is not a valid option.

Objective

Alternative treatment options for periorbital BCC are presented.

Methods

A literature search was carried out and a structured display and analysis of the results are given.

Results

Micrographically controlled surgical removal represents the gold standard in treatment of BCC. When for various reasons surgical removal is not a valid option, other procedures are required. The alternative treatment options can be divided into three main groups: treatment options for locally advanced or metastasized BCC, topical approaches for small and superficial BCC and prophylactic measures. While radiotherapy and systemic therapy are suitable for locally advanced BCC and are discussed in a tumor board, small and superficial BCC can be treated by topical medication. In cases of a previous BCC history, a prophylactic treatment can be considered. Combinations of systemic treatment and also neoadjuvant or adjuvant approaches before and after surgery are promising options for a successful outcome, which can further improve the standard treatment for locally advanced BCC.

Conclusion

Alternative treatment options for periocular BCC are available; however, the use is only indicated when microscopically controlled excision with subsequent oculoplastic reconstruction is not possible. According to the national guidelines a prior presentation to a suitable tumor board is practically compulsory.

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Förderung

Die Arbeit wurde zum Teil unterstützt durch OnkoTher‑H, EU, ESF/14-BM-A55-0001/18, der Damp Stiftung 2017-05 und der Dermatologischen Gesellschaft Mecklenburg-Vorpommern (S. E.).

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Correspondence to PD Dr. med. Vinodh Kakkassery.

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Interessenkonflikt

V. Kakkassery hat Vortragshonorare von der Firma Roche, Bayer, Allergan und Novartis sowie Beratungshonorare von der Firma Roche und Novartis erhalten. S. Emmert, I.A. Adamietz, G. Kovács, A.M. Jünemann, C. Otte, M. Zimbelmann, A. Brosig, S. Grisanti und L.M. Heindl geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien. Für Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts, über die Patienten zu identifizieren sind, liegt von ihnen und/oder ihren gesetzlichen Vertretern eine schriftliche Einwilligung vor.

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Kakkassery, V., Emmert, S., Adamietz, I.A. et al. Alternative Behandlungsoptionen beim Basalzellkarzinom am Auge. Ophthalmologe 117, 113–123 (2020). https://doi.org/10.1007/s00347-019-01021-4

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Schlüsselwörter

  • Bestrahlung
  • Tumorboard
  • Hedgehog-Inhibitoren
  • Topische Therapie
  • Prophylaxe

Keywords

  • Irradiation
  • Tumor board
  • Hedgehog protein inhibitors
  • Topical treatment
  • Prophylaxis