European consensus-based interdisciplinary guideline for diagnosis and treatment of basal cell carcinoma—update 2023
- Study type
- Clinical guideline
- Study name
- EADO/EDF/ESTRO/UEMS/EADV BCC 2023
- Design
- European interdisciplinary guideline based on expert consensus
- Source
- European Journal of Cancer · 2023
In plain words
Basal cell carcinoma is the most common skin cancer in white-skinned people. This European guideline explains that in most cases the main treatment is complete removal of the tumour by surgery, and that for low-risk, superficial lesions, creams, destructive methods or photodynamic therapy can sometimes be used. In advanced or difficult cases, a multidisciplinary team decides, and drugs such as vismodegib, sonidegib or cemiplimab may be used. High-risk patients or people with Gorlin syndrome need regular, long-term check-ups and follow-up.
Key guideline recommendations
BCCs are divided, according to the new EADO clinical classification, into "easy-to-treat" (common) and "difficult-to-treat" categories.
Diagnosis is based on clinical-dermoscopic features, but histopathological confirmation is mandatory in equivocal lesions.
The first-line treatment of BCC is complete surgery.
Micrographically controlled surgery should be offered for high-risk and recurrent BCC and for BCC in critical anatomical sites.
Topical treatments and destructive methods may be considered in patients with low-risk superficial BCC.
Photodynamic therapy is an effective treatment for low-risk superficial and nodular BCCs.
The management of "difficult-to-treat" BCCs should be discussed at a multidisciplinary tumour board.
Hedgehog pathway inhibitors (HHIs), i.e. vismodegib or sonidegib, should be offered to patients with locally advanced and metastatic BCC.
Immunotherapy with anti-PD1 antibodies (cemiplimab) is second-line treatment in patients whose disease has progressed or who have a contraindication to or intolerance of HHI therapy.
Radiotherapy is a valid alternative in patients who are not candidates for surgery or decline it, particularly elderly patients.
Electrochemotherapy can be offered when surgery or radiotherapy is contraindicated.
In patients with Gorlin syndrome, regular skin examinations are needed to detect and treat BCCs at an early stage.
Long-term follow-up is recommended in patients with high-risk BCC, multiple BCCs and Gorlin syndrome.
Study population
This document is a guideline and did not enrol patients. The target population is patients with basal cell carcinoma (BCC), who according to the new EADO clinical classification are divided into "easy-to-treat" (common) and "difficult-to-treat" categories.
Endpoints
According to the abstract, this guideline provides recommendations on the diagnosis and treatment of basal cell carcinoma. No clinical study endpoint is defined.
Safety and side effects
No safety or adverse event data are reported in the abstract.
Clinical significance and place in guidelines
This guideline provides an up-to-date, consensus-based framework for the diagnosis and treatment of BCC in Europe and emphasises surgery as first-line treatment, micrographically controlled surgery in high-risk cases, the use of HHIs in locally advanced or metastatic disease and cemiplimab as second-line treatment. The abstract does not mention levels of evidence or grades of recommendation; the status of national guidelines should be checked separately.
Limitations
The abstract does not report levels of evidence, grades of recommendation, doses or details of the guideline development methodology; these should be checked in the full text of the paper. The recommendations are based on expert consensus.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.