Cutaneous Basal Cell Carcinoma Clinical Practice Guidelines (2019)

German Cancer Society and the German Society of Dermatology

Reviewed and summarized by Medscape editors

February 04, 2019

The guidelines on cutaneous basal cell carcinoma were released on December 28, 2018, by the German Cancer Society and the German Society of Dermatology.[1]

The guidelines contain the following recommendations, based on strong consensus, on the diagnosis of basal cell carcinomas (BCCs):

In a patient with multiple BCCs occurring before the age of 20 years, a diagnostic workup should be performed to rule out a genetic syndrome (eg, Gorlin‐Goltz syndrome, basal cell nevus syndrome, Bazex‐Dupré‐Christol syndrome, Rombo syndrome).

Examination of the patient without additional tools is suitable for making a suspected clinical diagnosis.

Following the diagnosis of BCC, a total-body skin examination should be performed or recommended.

Dermoscopy may contribute to improving the reliability of the clinical diagnosis of BCC.

Confocal laser microscopy may be useful in the diagnosis of BCC.

Optical coherence tomography may be useful in the diagnosis of BCC.

Confocal laser microscopy and optical coherence tomography may be useful in assessing the effect of topical therapies for BCC.

If there is clinical suspicion of osseous infiltration, computed tomography (CT) and/or contrast‐enhanced magnetic resonance imaging (MRI) should be performed to assess the extent of intraosseous tumor spread.

If orbital invasion is clinically suspected, CT of the orbit should be performed to assess bone destruction, and contrast‐enhanced MRI of the orbit performed to assess intraorbital tumor spread.

If metastasis is clinically suspected, cross‐sectional imaging studies should be performed, and the primary histology should be reevaluated.

If basal cell carcinoma syndrome is suspected, imaging studies to rule out additional malignancies and to detect associated abnormalities should be done, using MRI in order to prevent radiation‐induced neoplasms.

The diagnosis of BCC should be confirmed by histological examination of the excised specimen following a biopsy and/or therapeutic excision, depending on the size of the tumor and the therapeutic approach. Exceptions may be made for multiple superficial tumors or in the case of basal cell carcinoma syndrome.

Subclinical spread can be assessed with sufficient certainty only histologically; this applies to the sclerosing subtype in particular, which is histologically characterized by fibrosis. The highest accuracy for histological detection of subclinical spread is achieved by microscopically controlled surgery.

During tissue processing, the potential inhomogeneity of tumors should be taken into account. If necessary, serial sections should be examined.

The histopathological diagnosis is performed on routine hematoxylin and eosin (H&E)–stained sections; only in rare, specific situations are special stains or immunohistology useful.

In addition to the diagnosis, the dermatopathology report should include information on the vertical tumor diameter (tumor thickness) and the excision margins. Moreover, the report should contain—if applicable—information about the histological subtype, in particular if there is evidence of infiltrative growth (narrow strands) and/or fibrosing/sclerosing or perineural growth.

For more information, see Basal Cell Carcinoma. For more Clinical Practice Guidelines, please go to Guidelines.

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