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Basalzellkarzinom beim alten und geriatrischen Patienten

  • Laurenz Schmitt
  • Martin Leverkus
Chapter
Part of the Springer Reference Medizin book series (SRM)

Zusammenfassung

Keratinozytäre Tumoren der Haut sind die häufigsten Tumore des alten Menschen. Die beiden mit weitem Abstand wichtigsten Entitäten sind das Basalzellkarzinom (BZK) und das Plattenepithelkarzinom (PEK). Sie werden auch als nicht-melanozytärer oder „heller“ Hautkrebs bezeichnet. Das Basalzellkarzinom zeigt gerade in der Altersgruppe geriatrischer Patienten eine hohe Inzidenz und kann den Arzt vor eine therapeutische Herausforderung stellen. Bei Hochrisikomerkmalen stellt die operative Therapie mittels mikrografisch kontrollierter Exzision in Lokalanästhesie nach wie vor den Goldstandard dar. In Abhängigkeit des Risikos und der Gesamtkonstellation kommen beim Vorliegen von Niedrigrisikomerkmalen auch alternative lokal destruktive, medikamentöse oder abwartende Therapieverfahren in Betracht. Aufgrund der individuellen Eigendynamik des Basalzellkarzinoms und der Fülle an zum Teil bei alten und geriatrischen Patienten wissenschaftlich noch nicht ausreichend untersuchten Verfahren sollte die Therapie in jedem Fall von einem onkologisch erfahrenen Dermatologen oder in einem Hauttumorzentrum erfolgen.

Literatur

  1. Apalla Z, Sotiriou E, Chovarda E, Lefaki I, Devliotou-Panagiotidou D, Ioannides D (2010) Skin cancer: preventive photodynamic therapy in patients with face and scalp cancerization. A randomized placebo-controlled study. Br J Dermatol 162:171–175CrossRefPubMedGoogle Scholar
  2. Arias Santiago SA, Ruiz Villaverde R, Burkhardt Pérez P, Naranjo Sintes R (2009) Alternative to surgery in basal cell carcinoma in the elderly population: imiquimod 5 % cream. Rev Esp Geriatr Gerontol 44(2):94–97CrossRefPubMedGoogle Scholar
  3. Arits AH, van de Weert MM, Nelemans PJ, Kelleners-Smeets NW (2010) Pain during topical photodynamic therapy: uncomfortable and unpredictable. J Eur Acad Dermatol Venereol 24(12):1452–1457CrossRefPubMedGoogle Scholar
  4. Arits AH, Mosterd K, Essers BA, Spoorenberg E, Sommer A, De Rooij MJ, van Pelt HP, Quaedvlieg PJ, Krekels GA, van Neer PA, Rijzewijk JJ, van Geest AJ, Steijlen PM, Nelemans PJ, Kelleners-Smeets NW (2013) Photodynamic therapy versus topical imiquimod versus topical fluorouracil for treatment of superficial basal-cell carcinoma: a single blind, non-inferiority, randomised controlled trial. Lancet Oncol 14(7):647–654CrossRefPubMedGoogle Scholar
  5. Arits AH, Spoorenberg E, Mosterd K, Nelemans P, Kelleners-Smeets NW, Essers BA (2014) Cost-effectiveness of topical imiquimod and fluorouracil vs. photodynamic therapy for treatment of superficial basal-cell carcinoma. Br J Dermatol 171(6):1501–1507CrossRefPubMedGoogle Scholar
  6. Basset-Seguin N, Hauschild A, Grob JJ, Kunstfeld R, Dréno B, Mortier L, Ascierto PA, Licitra L, Dutriaux C, Thomas L, Jouary T, Meyer N, Guillot B, Dummer R, Fife K, Ernst DS, Williams S, Fittipaldo A, Xynos I, Hansson J (2015) Vismodegib in patients with advanced basal cell carcinoma (STEVIE): a pre-planned interim analysis of an international, open-label trial. Lancet Oncol 16(6):729–736CrossRefPubMedGoogle Scholar
  7. Bath-Hextall F, Bong J, Perkins W, Williams H (2004) Interventions for basal cell carcinoma of the skin: systematic review. BMJ 329(7468):705CrossRefPubMedPubMedCentralGoogle Scholar
  8. Bouhassira J, Bosc R, Greta L, Hersant B, Niddam J, Zehou O, Roudot-Thoraval F, Wolkenstein P, Meningaud JP (2016) Factors associated with postoperative complications in elderly patients with skin cancer: a retrospective study of 241 patients. J Geriatr Oncol. pii: S1879-4068(15)00322-7Google Scholar
  9. Breuninger H, Dietz K (1991) Prediction of subclinical tumor infiltration in basal cell carcinoma. J Dermatol Surg Oncol 17(7):574–578CrossRefPubMedGoogle Scholar
  10. Breuninger H, Konz B, Burg G (2007) Mikroskopisch kontrollierte Chirurgie bei malignen Hauttumoren. Dtsch Ärzteblatt 104(7):A 427–A 432Google Scholar
  11. Christensen E, Mørk C, Skogvoll E (2012) High and sustained efficacy after two sessions of topical 5-aminolaevulinic acid photodynamic therapy for basal cell carcinoma: a prospective, clinical and histological 10-year follow-up study. Br J Dermatol 166(6):1342–1348CrossRefPubMedGoogle Scholar
  12. Deo MS, Kerse N, Vandal AC, Jarrett P (2015) Dermatological disease in the older age group: a cross-sectional study in aged care facilities. BMJ Open 5(12), e009941CrossRefPubMedPubMedCentralGoogle Scholar
  13. Diepgen TL, Mahler V (2002) The epidemiology of skin cancer. Br J Dermatol 146(Suppl 61):1–6CrossRefPubMedGoogle Scholar
  14. Dinehart SM, Dodge R, Stanley WE, Franks HH, Pollack SV (1992) Basal cell carcinoma treated with Mohs surgery. A comparison of 54 younger patients with 1050 older patients. J Dermatol Surg Oncol 18(7):560–566CrossRefPubMedGoogle Scholar
  15. Dubin N, Kopf AW (1983) Multivariate risk score for recurrence of cutaneous basal cell carcinomas. Arch Dermatol 119(5):373–377CrossRefPubMedGoogle Scholar
  16. Euvrard S, Morelon E, Rostaing L, Goffin E, Brocard A, Tromme I, Broeders N, del Marmol V, Chatelet V, Dompmartin A, Kessler M, Serra AL, Hofbauer GF, Pouteil-Noble C, Campistol JM, Kanitakis J, Roux AS, Decullier E, Dantal J (2012) Sirolimus and secondary skin-cancer prevention in kidney transplantation. N Engl J Med 367:329–339CrossRefPubMedGoogle Scholar
  17. Fantini F, Greco A, Del Giovane C, Cesinaro AM, Venturini M, Zane C, Surrenti T, Peris K, Calzavara-Pinton PG (2011) Photodynamic therapy for basal cell carcinoma: clinical and pathological determinants of response. J Eur Acad Dermatol Venereol 25(8):896–901CrossRefPubMedGoogle Scholar
  18. Fosko SW (2015) Counterpoint: limited life expectancy, basal cell carcinoma, health care today, and unintended consequences. J Am Acad Dermatol 73(1):162–164CrossRefPubMedGoogle Scholar
  19. Goppner D, Leverkus M (2011) Basal cell carcinoma: from the molecular understanding of the pathogenesis to targeted therapy of progressive disease. J Skin Cancer 2011:650258PubMedGoogle Scholar
  20. Grachtchouk M, Pero J, Yang SH, Ermilov AN, Michael LE, Wang A, Wilbert D, Patel RM, Ferris J, Diener J, Allen M, Lim S, Syu LJ, Verhaegen M, Dlugosz AA (2011) Basal cell carcinomas in mice arise from hair follicle stem cells and multiple epithelial progenitor populations. J Clin Invest 121:1768–1781CrossRefPubMedPubMedCentralGoogle Scholar
  21. Green A, Whiteman D, Frost C, Battistutta D (1999) Sun exposure, skin cancers and related skin conditions. J Epidemiol 9:S7–S13CrossRefPubMedGoogle Scholar
  22. Griep C, Davelaar J, Scholten AN, Chin A, Leer JW (1995) Electron beam therapy is not inferior to superficial x-ray therapy in the treatment of skin carcinoma. Int J Radiat Oncol Biol Phys 32(5):1347–1350CrossRefPubMedGoogle Scholar
  23. Gross G, Gissmann L, Hillemanns P, Ikenberg H, Kaufmann AM, Petry KU, Pfister H, Schneede P, Schneider A, Smola S (2010) Prevention of HPV-associated neoplasias by vaccination – short version of the German S3 (level 3) guideline. Dtsch Med Wochenschr 135:1083–1086CrossRefPubMedGoogle Scholar
  24. Geer S van der, Martens J, van Roij J, Brand E, Ostertag JU, Verhaegh ME, Neumann HA, Krekels GA (2012) Imiquimod 5 % cream as pretreatment of Mohs micrographic surgery for nodular basal cell carcinoma in the face: a prospective randomized controlled study. Br J Dermatol 167(1):110–115Google Scholar
  25. Har-Shai Y, Sommer A, Gil T, Krausz J, Gal-Or N, Mettanes I, Lavi I, Eyal N, Brizgalin L, Taran A, Har-Shai L, Elmalach I (2016) Intralesional cryosurgery for the treatment of basal cell carcinoma of the lower extremities in elderly subjects: a feasibility study. Int J Dermatol 55(3):342–350CrossRefPubMedGoogle Scholar
  26. Hengge UR, Emmert S (2008) Clinical features of xeroderma pigmentosum. Adv Exp Med Biol 637:10–18CrossRefPubMedGoogle Scholar
  27. Hoorens I, Batteauw A, Van Maele G, Lapiere K, Boone B, Ongenae K (2015) Mohs micrographic surgery for basal cell carcinomas: evaluation of indication criteria and predictive factors of extensive subclinical spread. Br J DermatolGoogle Scholar
  28. Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG) (2013) Vismodegib bei Basalzellkarzinom: Zusatznutzen nicht belegt, PM des IQWiG vom 15.11.2013. https://www.iqwig.de. Zugegriffen am 15.06.2017
  29. Jensen AO, Svaerke C, Farkas D, Pedersen L, Kragballe K, Sorensen HT (2010) Skin cancer risk among solid organ recipients: a nationwide cohort study in Denmark. Acta Derm Venereol 90:474–479CrossRefPubMedGoogle Scholar
  30. Kricker A, Armstrong BK, English DR, Heenan PJ (1995) Does intermittent sun exposure cause basal cell carcinoma? A case-control study in Western Australia. Int J Cancer 60:489–494CrossRefPubMedGoogle Scholar
  31. Leibovitch I, Huilgol SC, Selva D, Richards S, Paver R (2005) Basal cell carcinoma treated with Mohs surgery in Australia II. Outcome at 5-year follow-up. J Am Acad Dermatol 53(3):452–457CrossRefPubMedGoogle Scholar
  32. Leiter U, Garbe C (2008) Epidemiology of melanoma and nonmelanoma skin cancer – the role of sunlight. Adv Exp Med Biol 624:89–103CrossRefPubMedGoogle Scholar
  33. Lindgren G, Larkö O (2014) Cryosurgery of eyelid basal cell carcinomas including 781 cases treated over 30 years. Acta Ophthalmol 92(8):787–792CrossRefPubMedGoogle Scholar
  34. Lovett RD, Perez CA, Shapiro SJ, Garcia DM (1990) External irradiation of epithelial skin cancer. Int J Radiat Oncol Biol Phys 19(2):235–242CrossRefPubMedGoogle Scholar
  35. Madan V, Lear JT, Szeimies RM (2010) Non-melanoma skin cancer. Lancet 375:673–685CrossRefPubMedGoogle Scholar
  36. Manousaridis I, Leverkus M (2013) Malignant epithelial tumors: part II. Therapy and prevention (Review). J Dtsch Dermatol Ges 11(1):9–25PubMedGoogle Scholar
  37. Marks R, Gebauer K, Shumack S, Amies M, Bryden J, Fox TL, Owens ML, Australasian Multicentre Trial Group (2001) Imiquimod 5 % cream in the treatment of superficial basal cell carcinoma: results of a multicenter 6-week dose-response trial. J Am Acad Dermatol 44(5):807–813CrossRefPubMedGoogle Scholar
  38. Miller R (2002) Imiquimod stimulates innate and cell mediated immunity which controls virus infections and tumors. Int J Dermatol 41(Suppl 1):3–6CrossRefPubMedGoogle Scholar
  39. Miller PK, Roenigk RK, Brodland DG, Randle HW (1992) Cutaneous micrographic surgery: Mohs procedure. Mayo Clin Proc 67(10):971–980CrossRefPubMedGoogle Scholar
  40. Neale RE, Davis M, Pandeya N, Whiteman DC, Green AC (2007) Basal cell carcinoma on the trunk is associated with excessive sun exposure. J Am Acad Dermatol 56:380–386CrossRefPubMedGoogle Scholar
  41. Ohson K, DesGroseilliers JP, Weatherhead S, Weatherhead L (2006) Imiquimod 5 % cream use for the treatment of basal cell carcinomas in elderly patients, in long-term care facilities, not amenable to surgical or radiation therapy. J Cutan Med Surg 10(4):201–203CrossRefPubMedGoogle Scholar
  42. Palefsky JM, Giuliano AR, Goldstone S, Moreira ED Jr, Aranda C, Jessen H, Hillman R, Ferris D, Coutlee F, Stoler MH, Marshall JB, Radley D, Vuocolo S, Haupt RM, Guris D, Garner EI (2011) HPV vaccine against anal HPV infection and anal intraepithelial neoplasia. N Engl J Med 365:1576–1585CrossRefPubMedGoogle Scholar
  43. Pampena R, Palmieri T, Kyrgidis A, Ramundo D, Iotti C, Lallas A, Moscarella E, Borsari S, Argenziano G, Longo C (2015) Orthovoltage radiotherapy for nonmelanoma skin cancer (NMSC): comparison between 2 different schedules. J Am Acad Dermatol. pii: S0190-9622(15)02204-5Google Scholar
  44. Pincus L (1992) Das hohe Alter. Piper, München, S 56–57Google Scholar
  45. Qureshi AA, Laden F, Colditz GA, Hunter DJ (2008) Geographic variation and risk of skin cancer in US women. Differences between melanoma, squamous cell carcinoma, and basal cell carcinoma. Arch Intern Med 168:501–507CrossRefPubMedGoogle Scholar
  46. Rhodes LE, de Rie M, Enström Y, Groves R, Morken T, Goulden V, Wong GA, Grob JJ, Varma S, Wolf P (2004) Photodynamic therapy using topical methyl aminolevulinate vs surgery for nodular basal cell carcinoma: results of a multicenter randomized prospective trial. Arch Dermatol 140(1):17–23CrossRefPubMedGoogle Scholar
  47. Rigel DS, Robins P, Friedman RJ (1981) Predicting recurrence of basal-cell carcinomas treated by microscopically controlled excision: a recurrence index score. J Dermatol Surg Oncol 7(10):807–810CrossRefPubMedGoogle Scholar
  48. Roenigk RK, Ratz JL, Bailin PL, Wheeland RG (1986) Trends in the presentation and treatment of basal cell carcinomas. J Dermatol Surg Oncol 12(8):860–865CrossRefPubMedGoogle Scholar
  49. Rowe DE, Carroll RJ, Day CL Jr (1989a) Mohs surgery is the treatment of choice for recurrent (previously treated) basal cell carcinoma. J Dermatol Surg Oncol 15(4):424–431CrossRefPubMedGoogle Scholar
  50. Rowe DE, Carroll RJ, Day CL Jr (1989b) Long-term recurrence rates in previously untreated (primary) basal cell carcinoma: implications for patient follow-up (Review). J Dermatol Surg Oncol 15(3):315–328CrossRefPubMedGoogle Scholar
  51. Rubel DM (2014) Daylight photodynamic therapy with methyl aminolevulinate cream as a convenient, similarly effective, nearly painless alternative to conventional photodynamic therapy in actinic keratosis treatment: a randomized controlled trial. Br J Dermatol 171:1164–1171CrossRefPubMedGoogle Scholar
  52. Russi EG, Pelissero A, Melano A, Fillini C, Vigna-Taglianti R, Gianello L, Lucio F, Settineri N, Santacaterina A, Pontoriero A, Iatì G, Pergolizzi S (2015) Facial basal cell carcinomas in elderly frail patients treated with low total-dose radiotherapy. Anticancer Res 35(9):4949–4953PubMedGoogle Scholar
  53. Samain A, Boullié MC, Duval-Modeste AB, Joly P (2015) Cryosurgery and curettage-cryosurgery for basal cell carcinomas of the mid-face. J Eur Acad Dermatol Venereol 29(7):1291–1296CrossRefPubMedGoogle Scholar
  54. Schulze HJ, Cribier B, Requena L, Reifenberger J, Ferrándiz C, Garcia Diez A, Tebbs V, McRae S (2005) Imiquimod 5 % cream for the treatment of superficial basal cell carcinoma: results from a randomized vehicle-controlled phase III study in Europe. Br J Dermatol 152(5):939–947CrossRefPubMedGoogle Scholar
  55. Shumack S, Robinson J, Kossard S, Golitz L, Greenway H, Schroeter A, Andres K, Amies M, Owens M (2002) Efficacy of topical 5 % imiquimod cream for the treatment of nodular basal cell carcinoma: comparison of dosing regimens. Arch Dermatol 138(9):1165–1171CrossRefPubMedGoogle Scholar
  56. Silverman MK, Kopf AW, Grin CM, Bart RS, Levenstein MJ (1991) Recurrence rates of treated basal cell carcinomas. Part 1: Overview. J Dermatol Surg Oncol 17(9):713–718CrossRefPubMedGoogle Scholar
  57. Silverman MK, Kopf AW, Gladstein AH, Bart RS, Grin CM, Levenstein MJ (1992) Recurrence rates of treated basal cell carcinomas. Part 4: X-ray therapy. J Dermatol Surg Oncol 18(7):549–554CrossRefPubMedGoogle Scholar
  58. Smith SP, Grande DJ (1991) Basal cell carcinoma recurring after radiotherapy: a unique, difficult treatment subclass of recurrent basal cell carcinoma. J Dermatol Surg Oncol 17(1):26–30CrossRefPubMedGoogle Scholar
  59. Stockfleth E, Ulrich C, Hauschild A, Lischner S, Meyer T, Christophers E (2002) Successful treatment of basal cell carcinomas in a nevoid basal cell carcinoma syndrome with topical 5 % imiquimod. Eur J Dermatol 12(6):569–572PubMedGoogle Scholar
  60. Thissen MR, Neumann MH, Schouten LJ (1999) A systematic review of treatment modalities for primary basal cell carcinomas. Arch Dermatol 135(10):1177–1183CrossRefPubMedGoogle Scholar
  61. Tierney EP, Hanke CW (2009) Cost effectiveness of Mohs micrographic surgery: review of the literature. J Drugs Dermatol 8(10):914–922PubMedGoogle Scholar
  62. Ulrich C, Kanitakis J, Stockfleth E, Euvrard S (2008) Skin cancer in organ transplant recipients – where do we stand today? Am J Transplant 8:2192–2198CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Klinik für Dermatologie und AllergologieUniversitätsklinikum AachenAachenDeutschland
  2. 2.AachenDeutschland

Section editors and affiliations

  • Nicolai Härtel
    • 1
  1. 1.Interdisziplinäres TumorzentrumUniversitätsmedizin MannheimMannheimDeutschland

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