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Der Klinikarzt 2016; 45(04): 184-189
DOI: 10.1055/s-0042-105308
Schwerpunkt
© Georg Thieme Verlag Stuttgart · New York

Das kutane Plattenepithelkarzinom – Frühzeitige Diagnose und Therapie sind entscheidend

Cutaneous squamous cell carcinoma – Early diagnosis and treatment are critical for a positive prognosis
Ulrike Leiter
1   Zentrum für Dermato-Onkologie der Universitäts-Hautklinik, Eberhard Karls Universität, Tübingen, Tübingen
,
Claus Garbe
1   Zentrum für Dermato-Onkologie der Universitäts-Hautklinik, Eberhard Karls Universität, Tübingen, Tübingen
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Publication History

Publication Date:
02 May 2016 (online)

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Das Plattenepithelkarzinom (PEK) der Haut zählt zu den häufigsten Krebsarten in der kaukasischen Population und macht 20 % der Hauttumoren aus. Die Diagnose basiert auf der klinischen Untersuchung. Eine Exzision und histologische Sicherung ist in allen klinisch verdächtigen Läsionen erforderlich, um eine prognostische Einschätzung und korrekte Behandlung zu ermöglichen. Die Therapie der ersten Wahl ist die vollständige Exzision mit histologischer Schnittrandkontrolle. Bei Tumoren mit Infiltration tiefer Strukturen sollten CT/MRT-Untersuchungen durchgeführt werden, um die genaue Ausdehnung des Tumors zu ermitteln. Eine Sentinel-Lymphknotenbiopsie (SLNB) wird bei Plattenepithelkarzinomen > 6 mm Tumordicke angewandt, derzeit liegt aber noch keine klare Evidenz bezüglich der prognostischen und therapeutischen Aussagekraft vor. Bei befallenem Lymphknoten wird eine regionäre Lymphknotendissection empfohlen. Die Radiatio kann eine Alternative zur Chirurgie bei inoperablen Plattenepithelkarzinomen oder als adjuvante Therapie darstellen. Im fernmetastasierten Stadium können verschiedene Chemotherapeutika eingesetzt werden, jedoch existiert derzeit kein Standardregime. Für die Nachsorge gibt es ebenfalls kein standardisiertes Schema. Diese sollte sich an dem jeweiligen Risiko für Rezidive bzw. der Entwicklung von weiteren Tumoren orientieren.

The squamous cell carcinoma of the skin (cSCC) is one of the most frequent cancer types and counts for 20% of non-melanoma skin cancer. The diagnosis is based on clinical features and should be confirmed histopathologically to address the prognosis and treatment adequately. The first line treatment of cutaneous SCC is complete surgical excision with histopathological control of excision margins. In tumors with infiltration of deeper structures section imaging techniques are recommended to assess the extent of tumor growth. Although there is no clear evidence of its prognostic or therapeutic value, SLNB is recommended in tumors with a thickness of more than 6 mm. In positive lymph nodes a regional lymphnode dissection is recommended. Radiotherapy can be discussed in inoperable tumors or as an adjuvant therapy. In cSCC with distant metastases various chemotherapeutic agents are used, however, there is no standard regimen. EGFR inhibitors such as cetuximab or erlotinib, can be discussed as second line treatments or within the framework of clinical trials. There is no standardised follow-up schedule for patients with cSCC. A risk adapted follow-up is recommended based on the risk of metastatic spread or development of new lesions.

Key words

Squamous cell carcinoma - skin - treatment
 

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