The German S2k guidelines for cutaneous basal cell carcinoma were recently updated to include new developments regarding the epidemiology, diagnosis, and histology of the disease. Commissioned by the Dermatologic Cooperative Oncology Group of the German Cancer Society and the German Society of Dermatology and conducted by Stephan Grabbe, MD, of the Mainz University Medical Center, Germany, the update was published by Lang et al in JDDG–Journal of the German Society of Dermatology.
With its incidence steadily rising in recent decades, basal cell carcinoma is the most common malignant tumor among fair-skinned individuals. In Germany, it is diagnosed at a rate of at least 200 cases per 100,000 persons per year.
The authors strongly recommend a diagnostic workup to rule out a genetic disorder in patients with multiple basal cell carcinomas occurring before the age of 20. If basal cell carcinoma syndrome is suspected, imaging studies using magnetic resonance imaging to rule out additional malignancies and to detect associated abnormalities should be performed to prevent radiation-induced neoplasms.
As the presence of a basal cell carcinoma generally increases the risk of developing other epithelial malignancies, a total-body skin examination should be performed at the time of diagnosis. Dermoscopy, confocal laser microscopy, and optical coherence tomography are noninvasive techniques that may be useful in addition to a visual inspection to aid in rendering a diagnosis. The authors now recommend computed tomography and/or contrast-enhanced magnetic resonance imaging if osseous infiltration or metastasis is suspected.
Diagnosis should be confirmed by histologic examination after a biopsy or therapeutic excision, the guidelines indicate. The authors recommend that the diagnosis be performed on routine hematoxylin and eosin–stained sections alone; special stains and immunohistology should be reserved for “rare, specific situations.”
Disclosure: The study authors' full disclosures can be found at wiley.com.
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