New German basal cell carcinoma (BCC) guidelines are more alike than unlike U.S. guidelines, sources say, although minor differences exist in areas such as prevention and newer systemic treatments.
Coordinated by Stephan Grabbe, M.D., of the department of dermatology, Mainz University Medical Center in Mainz,
Germany, the guidelines were published in the February 2019 edition of the Journal of the German Society of Dermatology.1
Murad Alam, M.D., says the German guidelines and American Academy of Dermatology (AAD) BCC guidelines published in the January 2018 Journal of the American Academy of Dermatology2 are remarkably similar.
“In terms of diagnosis, therapies, risk stratification, discussion of special cases and even terminology, the two guidelines are almost interchangeable. This suggests a strong international consensus regarding the management of BCC,” Dr. Alam says. He is vice chair of dermatology and professor of dermatology, otolaryngology and surgery at Northwestern University Feinberg School of Medicine, Chicago. He also cochaired the AAD BCC guidelines committee.
For starters, both guideline sets stratify BCCs according to size and location, with lesions in the so-called H zone carrying the highest recurrence risk. The National Comprehensive Cancer Network defines this zone as the central face, eyelids, eyebrows, periorbital skin, nose, lips, chin, mandible, preauricular and post-auricular skin/sulci, temple, ear, genitalia, hands and feet.3
1. Lang BM, Balermpas P, Bauer A, et al. S2k guidelines for cutaneous basal cell carcinoma-part two: treatment, prevention and follow-up. J Dtsch Dermatol Ges. 2019;17:214-230.
2. Bichakjian C, Armstrong A, Baum C, et al. Guidelines of care for the management of basal cell carcinoma. J Am Acad Dermatol. 2018;78:540-559.
3. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: basal cell skin cancer. Version 1.2019. https://www.nccn.org/professionals/physician_gls/pdf/nmsc.pdf. Published August 31, 2018. Accessed September 27, 2019.
4. Tang JY, Ally MS, Chanana AM, et al. Inhibition of the hedgehog pathway in patients with basal-cells nevus syndrome: final results from a multicenter, randomized, double-blind, placebo-controlled, phase 2 trial. Lancet Oncol. 2016;17:1720-1731.
5. Lang BM, Balermpas P, Bauer A, et al. S2k guidelines for cutaneous basal cell carcinoma-part one: epidemiology, genetics and diagnosis. J Dtsch Dermatol Ges. 2019;17:94-103.
6. Chen AC, Martin AJ, Choy B, et al. A phase 3 randomized trial of nicotinamide for skin-cancer chemoprevention. N Engl J Med. 2015;373:1618-1626.