Search

For the management of basal cell carcinoma, the primary performance of a risk stratification, which is decisive for the further diagnostic and therapeutic steps, is becoming increasingly important.Various non-invasive methods are available to confirm the clinical diagnosis. Histological confirmation of the diagnosis is recommended in unclear cases. In poorly displaced lesions, preoperative cross-sectional imaging of the tumor area should be performed to exclude osseous infiltration.The gold standard in treatment remains surgery, which should be performed by means of micrographically controlled surgery if possible. In addition, there are other therapeutic methods such as radiotherapy or a number of topical therapy options (photodynamic therapy, cryotherapy or application of 5-fluorouracil or imiquimod), which can be used in certain cases. Also for advanced or metastatic basal cell carcinoma, effective drugs are available in the form of the hedgehog inhibitors, for which there is now several years of application experience with regard to efficacy and handling of adverse events. With the PD-1 inhibitor cemiplimab, a further therapeutic option for non-operable or metastatic tumors has been available since June 2021.The most important preventive measure is consistent textile or chemical UV protection in already affected individuals. In addition, nicotinamide and celecoxib can be used orally for prevention. For follow-up, the current S2k guideline recommends regular self-monitoring and standardized medical check-ups., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Aim of Study: We present the current standard in diagnosis and treatment of basal cell carcinoma. Useful procedures for clinical management should be derived from this., Methods: A systematic literature search was carried out in the PubMed online database. The collected information was analyzed and evaluated. An overall concept was created from the gained knowledge., Results: Basal cell carcinoma is the most common tumor in humans and its incidence is expected to increase in the future. When managing the disease, a one-dimensional orientation towards the clinical or histological subtype is not sufficient because of the heterogeneity of the tumor. The primary implementation of risk stratification, which is decisive for the further diagnostic and therapeutic steps, is becoming increasingly important. The gold standard in treatment continues to be the surgical procedure, which should be carried out using micrographically controlled surgery if possible. In addition, there are other therapeutic methods such as radiotherapy or a number of topical therapy options (photodynamic therapy, cryotherapy, application of 5-fluorouracil or imiquimod), which can be used in certain cases. Hedgehog inhibitors are also effective drugs for advanced or metastatic basal cell carcinoma. Practitioners have gained several years of experience with regard to effectiveness and handling of adverse events. With the PD-1 inhibitor cemiplimab, another therapeutic option for inoperable or metastatic tumors has been available since June 2021., Conclusion: Basal cell carcinoma will continue to gain in relevance in daily dermatological practice in the coming years. A structured approach to the assessment of the existing risk category of the tumor and the subsequent determination of the optimal therapy regimen are of central importance. Advanced or metastatic tumors no longer represent a hopeless situation for the patient. With long-termhedgehog therapy, an adapted dosage scheme can avoid discontinuation of therapy due to side effects. The therapeutic potential of the PD-1 inhibitor cemiplimab can also be used with the side effect profile known from other types of skin cancer., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: The advantages and disadvantages of the nationwide skin cancer screening which was introduced in 2008 are regularly discussed., Objectives: Do missed skin cancer screenings change the tumor depths?, Methods: Evaluation and analysis of office data from the second quarters of 2019, 2020 and 2021 were compared using the one-way analysis of variance (ANOVA) with Welch's F test., Results: There was a significant increase in the tumor thickness in squamous cell carcinoma and basal cell carcinoma, while there was only a tendency due to the small amount of data available for malignant melanoma., Conclusions: The results of the analysis emphasize the importance of the skin cancer screening as a method of early detection and reduction of mutilating operations and expensive immunotherapies by the prompt detection of malignant tumors., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: Outdoor workers are occupationally exposed to significantly higher ultraviolet (UV) doses than the rest of the population. Recent data show a doubling of basal cell carcinoma (BCC) risk in outdoor workers with high occupational UV exposure., Objectives: To examine the stability and robustness of BCC risk estimators., Methods: Sensitivity analyses to test model assumptions considering socioeconomic status, influence of matching procedure, gender and latency, regional differences (east/west), urban/rural cases/controls, and dual diagnoses (squamous cell carcinoma [SCC]/actinic keratoses grade III [AKIII]/Bowen disease [BD] and BCC) were performed., Results: BCC risk was consistently higher for high occupationally UV-exposed individuals than for intermediate UV-exposed individuals, regardless of matching procedure, latency, regional differences (east/west), urban/rural recruitment of cases/controls, and dual diagnoses (SCC/AKIII/BD and BCC), sex, and socioeconomic status., Conclusion: The risk estimator for the association between exposure to solar UV radiation at work and the risk of developing BCC showed a high degree of stability and robustness for all variables investigated. The analyses support the recently published findings on the doubling of BCC risk in outdoor workers with high occupational UV exposure.

Basal cell carcinoma is the most common type of cancer in Central Europe and has a high medical relevance. Due to its high tendency of recurrence, an important parameter in the planning of therapy is the risk of recurrence. After clinical and histological diagnosis, the majority of tumors are treated surgically, although radiation and topical procedures are also possible therapeutic alternatives in certain constellations. Hedgehog inhibitors, a completely new class of substances, have recently been approved for rare metastatic and locally advanced diseases, thus significantly expanding the range of treatments. This article provides an overview of the current guideline-based diagnosis and therapy of basal cell carcinomas in Germany.

Introduction: Skin malignancies are typically localised in areas of the head that are exposed to the sun. Basal cell carcinomas (BCC) are the most frequent malignancies on the facial skin. Their incidence is raising - due to demographic changes. As regards strategies for resection and reconstruction, the eyelids and the periorbital region are extremely complex and have to be treated in an interdisciplinary context. The aim of the present investigation was to analyse the results of interdisciplinary treatment of periorbital and eyelid non-melanotic malignoma., Materials and Methods: All treated non-melanotic malignancies of the eyelid/periorbital region were analysed in a pilot study from September 2017 until July 2019. Patients were treated by an ophthalmologist and a maxillofacial plastic surgeon. The clinical and pathological parameters were collected in a databank. In all interdisciplinary cases, the tumour localisation, histology, R-status and the reconstructive strategy were analysed., Results: Out of 349 patients, 14 were analysed as they were treated with an interdisciplinary approach. The youngest was 12, the oldest 98 years old. There were 6 women (average age 80.3 years) and 8 men (average age 65.3 years). BCC (n = 10) were the most frequent malignancy; 3 patients suffered from squamous cell carcinoma. Actinic keratosis was diagnosed in one case. In all patients, complete resection (R0) was certified by histopathological examination. The reconstruction was performed immediately in 6 cases, and the reconstruction strategy was accomplished after definitive histology (at least two step procedures) in 8 cases. Only one patient had three resections before starting the reconstruction procedure., Discussion: Surgical treatment of malignancies of the eyelid or periorbital non-melanotic malignancies can be an interdisciplinary challenge. BCC is the most frequent entity. These critically localised BCC present with extremely deep infiltration, followed by subtotal or total eyelid resection, often including bony structures. The reconstruction is extremely complex in such cases and requires the whole plastic reconstructive repertoire of both medical disciplines., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Georg Thieme Verlag KG Stuttgart · New York.)

Background: Skin diseases affect 30-70% of the world population, and globally, skin cancer rates are continuously increasing. In this respect, prevention programs and early detection of skin diseases are of particular importance., Objectives: To screen sewer workers for skin diseases with regard to their work-related risk., Methods: Employees of the municipal utilities in Munich (Münchner Stadtentwässerung) underwent a whole-body examination of the skin, conducted by two dermatologists. In addition, all employees completed a paper-based questionnaire on risk behavior and preventive measures., Results: We examined 81 employees (79 men, 2 women, mean age 45.7 ± 9.5 years). Skin lesions in need of treatment were found in 30.9% (n = 25): the most frequent diagnosis was mycosis pedis (16.1%). In addition, one employee was diagnosed with basal cell carcinoma and two with actinic keratoses. According to the questionnaire, 43.5% of the employees had undergone a physician-led skin cancer screening in the past, whereas sun-protection practices were rarely applied., Conclusion: According to our findings, employee skin cancer screening seems to be beneficial for the detection of work-related skin diseases and is associated with a high participation rate. Furthermore, the study suggests that sewer workers have a high rate of mycosis pedis, possibly a work-related effect.

A cystic lesion of the lid margin was excised suspecting basal cell carcinoma. On histology, black-turquoise pigment was seen in the dermis adjacent to the basal cell carcinoma. It was pronounced perivascular, intracellular in macrophages and fibroblasts, but also extracellular as free pigment in the tissue, compatible with an eyelid line tattoo. Typical tissue reactions to tattoo ink, meibomian gland dysfunction after lid margin tattoo, as well as inflammatory reactions in the retina and choroid associated with tattoos distant from the eye are discussed. The correlation of lid tumors and lid margin tattoos seems coincidental., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (Georg Thieme Verlag KG Stuttgart · New York.)

Non-melanoma skin cancer (NMSC) is the most common malignancy of the light-skinned population with an enormous socioeconomic impact. Historically known as incurable under the term noli me tangere (transl. do not touch me), today various non-melanocytic cutaneous neoplasms are grouped as NMSC. The most common of these, basal cell carcinoma, squamous cell carcinoma and actinic keratoses as carcinomas in situ, are increasingly called keratinocyte carcinoma. Today, the pathogenesis and risk factors of NMSC are relatively well understood, which has led to multiple treatment options, the recognition of NMSC as an occupational disease in Germany and a variety of prevention approaches. Although there is largely general consensus in the dermatological world, knowledge of affected high-risk groups in NMSC and prevention is still very low. The development of target group-oriented awareness and prevention campaigns are therefore urgently needed.

The treatment options for basal cell carcinoma (BCC) have recently been augmented with the introduction of novel chemotherapeutic drugs. New S2 guidelines on the disease have also been published. The aim of this article is to present a comprehensive state of the art description of the features of ocular BCC and an overview of the various therapeutic options. Particular emphasis is placed on the clinical signs, the diagnostic tools to identify periocular BCC and interpretation of the different histopathological subtypes. Tumor staging, TNM classification, interdisciplinary tumor conference reviews as well as psycho-oncological services play an important role in patients with pronounced periocular BCC. Surgical removal with a histological R0 resection is an important component of therapy options in this disease and includes the microsurgical excision into healthy tissue and the subsequent covering of the defect. A special focus of this article is the treatment of locally extensive and metastasized BCC.

Background: Basal cell carcinoma (BCC) is the most common skin cancer in fair-skinned individuals. Although lymph node or visceral metastases are observed in less than 0.5 % of all cases, BCC can have a fatal course due to its highly invasive growth pattern., Objectives: To provide a comprehensive update on diagnosis, treatment, and prevention of BCC., Materials and Methods: We review the current literature and recommendations of the German guidelines on treatment and prevention of skin cancer. The most pertinent developments are summarized in this review article., Results: The use of optical coherence tomography and reflectance confocal microscopy can significantly improve the diagnosis of BCC compared with clinical assessment and dermoscopy alone. Mohs micrographic surgery remains the therapeutic gold standard for tumors in the head and facial area and tumors with high-risk features. The application of imiquimod, 5‑fluorouracil, or photodynamic therapy should be restricted to low-risk superficial tumors. Topical inhibitors of the sonic hedgehog (SHH) pathway are currently being evaluated in early clinical trials. In contrast, vismodegib and sonidegib have been approved for the systemic treatment of locally advanced and metastatic BCC with good response rates. The most common adverse events of both agents are muscle cramps, dysgeusia, diffuse alopecia, weight loss, and fatigue. In an Australian phase III trial, oral nicotinamide (vitamin B3) reduced the occurrence of new BCC by 20 % in skin cancer patients., Conclusions: Targeted therapy with SHH inhibitors has improved the prognosis of locally advanced and metastatic BCC, albeit at the cost of a significant number of adverse events.

Background: Basal cell carcinoma (BCC) is the most common type of skin cancer in Germany. So far, it is unclear whether regional variations exist in the health care of the BCC., Objectives: Analysis of regional variations in health care (e. g., skin cancer screening) and their causes using the example of BCC., Materials and Methods: Qualitative and quantitative analysis of the regional health care situation of BCC based on three studies was undertaken. These studies include the analysis of n = 7015 histopathological indications whose average tumor thickness is regarded as a characteristic of the quality of care, and a secondary data analysis of GK insured (n = 6.1 million DAK-insured persons), and a nationwide survey (FORSA) of n = 1004 participants focusing on the use of skin cancer screening., Results: Analysis of the histopathological examination showed regional variations in average tumor depth of penetration. These are associated with the rural/urban characteristics of the region and individual sociodemographic indicators (e. g., employment sector or education). The results for age- and gender-specific use (DAK data) showed higher participation rates regarding skin cancer screening in western than in eastern federal states (Bundesländer). Moreover, it was revealed that the trend for using skin cancer screening was higher in urban than in rural areas. The results of population-related surveys confirm this trend., Conclusion: Although it is not possible to compare the studies directly, all three showed an association between city/state and the use of skin cancer screenings. In addition, sociodemographic characteristics that are related to the quality of health care were identified.

Basal cell carcinoma is the most common skin cancer of the eyelid. It most frequently occurs on the lower eyelid and the medial canthus. Although metastases appear only very rarely, basal cell carcinoma is locally destructive if left untreated. Nowadays several surgical and nonsurgical treatments can be used to remove or destroy basal cell carcinomas. The selection of optimal treatment depends on the initial individual situation as well as the age and the general condition of the patient. The "gold standard" method for the treatment of basal cell carcinomas is surgical removal with subsequent histological examination. Because of the complex anatomical characteristics of the medial canthus and the lateral nasal root region, basal cell carcinomas of this area present great challenges for any treatment method. These characteristics also explain the higher rates of incomplete removal and greater risk of recurrence, with in depth extension of the tumor. Additionally, surgical removal of the tumor from the medial canthus area often results in extended tissue defects. The plastic covering of these defects can be achieved by various reconstruction procedures., (Georg Thieme Verlag KG Stuttgart · New York.)

Background: Bazex's syndrome is a rare paraneoplasia that is usually associated with cancer., Diagnosis: Characteristic for the disease are diffuse, psoriasis-like, acral erythema, distal hyperkeratosis and onychodystrophy. Differential diagnoses comprise psoriasis, eczema and tinea., Case Report: We present the case of a 73-year-old man with acral hyperkeratosis, onychodystrophy, and diffuse palmar erythema. Gastric carcinoma was diagnosed by gastroscopy. After a gastrectomy was performed, regression of the skin lesions that the patient had been suffering from for more than 6 years was observed, confirming the diagnosis of Bazex's syndrome.

Basal cell carcinoma is the most common malignant tumor of the periocular region with local aggressive growth and extensive destruction. The histological subtypes of periocular basalioma, the recurrence rates and resection border relationships were analyzed and the results were compared with basaliomas from other body regions. The results of gender and age distribution, histological subtypes, recurrence rates and resection border relationships were evaluated using the χ(2)-test. The results showed a significantly higher recurrence rate (p < 0.01) for the periocular region compared to other body regions and the incidence of periocular basalioma was higher in women (p < 0.05). In addition the rarer histological subtypes were more commonly found in this region compared to other body regions (p < 0.01).

Background: Incidence of malignant skin lesions is rising in Switzerland. We wanted to assess the frequency of patients with suspicious skin lesions in daily practice. Furthermore, we asked for diagnostic certainty and the need of further education in skin cancer., Methods: Survey with 1212 GPs in the canton of Zurich, descriptive analysis, regression analysis., Results: Response rate 41,4%. 23,2% of the GPs saw daily/weekly patients with suspicious skin lesions, another 34,8% monthly. 79,0% reported need for further education in skin cancer. This need was lower in urban GPs and in GPs with higher diagnostic certainty., Conclusions: GPs saw relatively often patients with suspicious skin lesions. Despite high diagnostic certainty, there was a clear need for further education in skin cancer.

Due to the low incidence of penile cancer in Europe and North America and often decentralised patient management, data on the treatment of penile cancer are very rare. Nevertheless, recently relevant data have become available for the improvement of the therapy especially for the primary tumours. Penile conserving surgery is becoming more important for early tumour stages. The management of lymph nodes plays a key role for the successful treatment of patients with penile cancer. An invasive lymph node staging is recommended for all patients with primary pT1G2 or higher tumours. Neoadjuvant chemotherapy followed by salvage lymphadenectomy has shown promising results in patients with large and/or fixed inguinal lymph node metastases. Due to the results of recent studies, cisplatin/taxan-based chemotherapy regimens have to be recommended., (© Georg Thieme Verlag KG Stuttgart · New York.)

Whenever a dentist is dealing with abscess formation in the oral and maxillofacial region, it is mostly from dental origins. However, sometimes uncommon (co-)factors are present and responsible for major complications. Many general conditions or medications can significantly influence the course of an inflammation. It might spread faster and wider and also be resistant to "correct" therapy. This case report should raise awareness about general conditions supporting inflammation and demonstrate the importance of interdisciplinary treatment in these situations. A 76-year-old patient was referred to the maxillofacial surgery clinic after extraction of two teeth resulted in therapy-resistant painful swelling. Her dentist already had initiated "standard" therapy including Ponstan® (mefenamic acid) and Clamoxyl® (amoxicillin) without success. Initial blood testing came back with severe agranulocytosis. Immediately all potentially myelosuppressing drugs were stopped while myelosupporting drugs were prescribed. Under close interdisciplinary treatment conditions, healing was then uneventful without the necessity of surgical intervention. The challenge in inflammation treatment is to identify patients with uncommonly severe, fast-progressing, or therapy-resistant disease as early as possible. Further examination including blood workup for several medical parameters is indispensable in those patients.

Background: The occurrence of neoplasms in injury scars--as consequence of occupational accidents--may lead to compensation according to the statutory accident insurance regulations. According to newer regulatory attempts in occupational dermatology, certain criteria have to be met before the diagnosis of a neoplasm induced by a scar is accepted and compensation is due., Material and Methods: Based on a retrospective analysis of 217 dermatological claim files between 2007 and 2009 of the IPA (including 22 follow-ups), medical opinions on neoplasms developing in possible occupational scars were re-evaluated using criteria of the German social accident insurance and the Bamberg medical bulletin, part II (Bamberger Merkblatt, BM II) to see how well they qualified for recognition as an occupational or accident-related disorder., Results: Three cases were identified where a neoplasm was suspected of having developed in an occupationally-related scar. One of the insured events entitled for compensation. Following the guidelines of the BM II, this case was approved as an occupational disease secondary to injuries with resultant reduction in earning capacity, whereas the others did not meet the requirements., Conclusions: Two problems in evaluating malignant tumors in occupational scars are the long latency period and the documentation of a scar. The tumor excision specimen should be histologically re-examined to document the presence of an associated scar.

A 64-year-old patient presented with bronzed, sun-damaged skin presented with numerous light and dark brown macules, mainly with sharply demarcated with irregular borders, present. Dermatoscopy showed a faint, light and dark brown network, fingerprint-like structures and irregular, sharp, moth-eaten borders in most lesions. In contrast, one dark-brown and bluish, asymmetrical flat plaque on the patient's right arm showed blue-grey globules, blue ovoid structures and leaf-like areas. Histology revealed a pigmented superficial basal cell carcinoma. Dermatoscopy allowed filtering out the malignant lesion easily despite the large number of solar lentigines and some melanocytic nevi because of the characteristic dermoscopic criteria and the "ugly duckling sign".

Graft-versus-host disease (GvHD) remains one of the major complications after allogeneic stem cell transplantation (SCT) and is responsible for morbidity, mortality and decrease in quality of life of patients after SCT. The most important preventive approach is the selection of a donor with best possible HLA compatibility between donor and recipient. Basic prophylaxis of acute GvHD begins already prior to transplantation and usually consists of cyclosporine with or without methotrexate. In the past few years, many new therapies have been introduced for the treatment of acute and chronic GvHD. Extracorporeal photopheresis (ECP), for example, represents a promising treatment option for acute and chronic GvHD with very few side effects. For chronic GvHD mTOR inhibitors (sirolimus, everolimus) may replace calcineurin-inhibitors with the advantage of not inducing malignant skin tumors. Guidelines are available ort he management of acute and chronic GvHD. While pathophysiology, classification and skin manifestations of GvHD have been already presented in the first part of this article, this second part covers the prognosis, prevention and treatment of GvHD.

33-year-old woman with a red-brown plaque on the temple. The slightly raised skin tumor with well-defined margins had appeared 3 years earlier, slowly enlarging and finally changing in color. Digital enhancement revealed a vascular pattern with hairpin-like and twisted fine capillaries. Often, there were light halos and slate-gray granules (melanophages) around the vessels. Biopsy of the tumor demonstrated hyperplasia of the epidermis and normal basaloid keratinocytes partially extending into the dermis. Inflammatory cells and melanophages were present in the papillary dermis, surrounding dilated vessels. Histopathological diagnosis revealed an irritated seborrheic keratosis.

The skin is the most affected organ by cancer. The incidence rates of skin cancer are steadily increasing, both for melanoma and non-melanoma skin cancers (squamous cell carcinoma, basal cell carcinoma). Over 90 % of the death cases from skin cancers attribute to melanoma. Survival from melanoma is strongly related to tumour thickness. Therefore early detection is the most important step to improve prognosis. In the last years a number of new non invasive techniques for the early diagnosis of melanoma have been developed which are superior to the naked eye examination. In this overview article we present some non-invasive diagnostic techniques like total body photography, digital dermoscopy and confocal microscopy which in addition to dermoscopy assist the dermatologist in differentiating nevi from early melanomas.Non-melanoma skin cancer can be prevented by accurate sun protection. Early squamous cell carcinomas and basal cell carcinomas can be treated either invasively or non-invasively with excellent prognosis.

Brooke-Spiegler syndrome is a rare, autosomal dominant disease characterized by multiple skin appendage tumors caused by various mutations in the CYLD gene on chromosome 16q12-q13. We describe a family, in which we performed a molecular-genetic examination and found a new mutation in exon 19 in the CYLD gene leading to a frameshift. It is important to be aware of this syndrome and its pathogenesis as its phenotypic features can vary so that apparently different diseases are caused by the same genetic defect. In addition, there may be malignant transformation of the generally benign tumors, so that a timely diagnosis is essential for appropriate monitoring and therapy.

Although basal cell carcinoma is extremely common, it only rarely occurs on the nipple. Men are affected more often than women. Basal cell carcinoma of the nipple-areola complex may be more aggressive as metastases to regional lymph nodes have been reported. We report a basal cell carcinoma of the nipple with features of a fibroepithelioma of Pinkus in a man and review the literature.

Desmoplastic neurotropic melanoma is an exceedingly rare variant of the malignant melanomas. Since the initial description, only about 500 cases have been reported in the literature. These melanomas mostly occur on the head, neck, and face, and a wide local excision of the tumor is probably the most important prognostic factor. Therefore, in most cases the tumor resections result in large tissue defects. To gain a good cosmetic result, tissue movement using flaps or grafts will most likely be required to cover the defect. In this paper, a 79-year-old patient with a basal cell carcinoma and desmoplastic melanoma on the scalp is described, and the therapeutic procedure is discussed.

Background: Nevus sebaceus (NS) is a congenital hamartomatous lesion, usually involving the scalp or the face. Various benign and malignant neoplasms can develop in association with NS, the most common being trichoblastoma, syringocystadenoma papilliferum, viral warts and basal cell carcinoma (BCC)., Patients and Methods: We retrospectively examined the clinical and histopathological records of 15 NS cases with an associated tumor which were diagnosed between 1996 and 2004., Results: All cases were adults and 3 of them had more than one tumor. Six cases had BCC, which is a higher incidence of malignant tumor association with NS, than that reported in last years. Trichoblastoma was observed in 3 cases and was the most common benign tumor in our series. Filiform, hyperkeratotic, pigmented, pedunculated and/or eroded papulonodular changes were major clinical signs of secondary tumors on NS in our series., Conclusion: Clinical features are not sufficient enough to make an exact diagnosis of benign or malignant secondary tumors. Though prophylactic excision for NS is done less in last years, especially adult patients should closely be followed for any new changes evoking tumor development on this congenital lesion.