Komplikasi Basal Cell Carcinoma

Pasien perlu dimonitor untuk kemungkinan rekurensi dan perkembangan BCC yang baru.
Risiko untuk perkembangan BCC primer berikutnya adalah 36-50%. Pemeriksaan kulit
menyeluruh secara periodic dan konseling mengenai proteksi terhadap matahari
direkomendasikan kepada pasien dengan riwayat BCC. Hal ini penting karena pasien dengan
riwayat BCC akan meningkatkan risiko melanoma.

Komplikasi Squamous Cell Carcinoma

National Comprehensive Cancer Network (NCCN) memaparkan panduan mengenai

faktor risiko berupa rekurensi lokal SCC. Rekurensi lokal dapat terjadi akibat kegagalan
tatalaksana tumor primer secara komplit atau dari metastasis lokal. Rekurensi lokal pada bagian
lesi primer sering mendahului metastasis dan sering ditemukan sebagai indicator pertama dari
sifat agresif biologis dari SCC.

Pada panduan dari NCCN memaparkan pula mengenai metastasis dari SCC. Risiko dari
perkembangan metastasis dari SCC secara umum rendah dengan laju metastasis dalam 5 tahun
adalah 5-85%.

Pasien yang didiagnosis dengan SCC perlu dipertimbangkan adanya peningkatan

perkembangan SCC sekunder. Secara keseluruhan, risiko kumulatif dalam 3 tahun setelah SCC
pertama adalah 18% dan setidaknya meningkat 10 kali lipat insidensinya dibandingkan dengan
insidens SCC pertama.
Compliocations of BCC
With appropriate treatment, the prognosis for most
patients with BCC is excellent. Control rates as high
as 99% have been achieved by MMS. Although tumor
control rates for primary tumors are high, patients
must be monitored for recurrence and development
of new primary BCCs. The risk for development of
a second primary BCC ranges from 36% to 50%.63
Periodic full-body skin examinations and counseling
about sun protection are recommended for any
patient with a history of BCC. This is especially
important because patients with a history of BCC are
at increased risk for melanoma. The prognosis for
patients with recurrent BCC is favorable, although
recurrent tumors are more likely to appear again
and to behave aggressively. Patients with a history of
recurrent disease must be monitored more frequently
for the development of further recurrences and new
primary tumors. An estimated 40% to 50% of patients
with primary BCC will develop at least one or more
further BCCs within 5 years.2 For the rare patient with
metastatic disease, the prognosis is poor, with a mean
survival time of 8 to 10 months without treatment
from the time of diagnosis. Recent clinical trials have
highlighted a potential role of nicotinamide 500 mg
twice a day64 and of the nonsteroidal antiinflammatory
drug celecoxib65 in producing some decrease in
BCC risk.
Complications of SCC
outlines the NCCN’s guidelines regarding
risk factors for local recurrence. Local recurrence may
result from a failure to completely treat the primary
tumor or from local metastasis. Local recurrence at
the site of the primary lesion often precedes metastasis
and is frequently found to be the first indicator of
aggressive biologic behavior in SCC. Local recurrence
rates are considerably lower with microscopically
controlled surgery (Mohs surgery) as compared
to other local treatment modalities.
Table 112-5 outlines the NCCN’s guidelines regarding
risk factors for metastases. The risk of developing
metastasis from SCC is generally low, with a
5-year metastatic rate of 5%, and 85% of metastatic
cases are nodal disease.9,10 However, depending on
patient and tumor characteristics, certain subgroups
of patients are at significantly higher risk for metastasis,
with metastatic rates of up to 30%.9 The incidence
of metastatic SCC in OTRs is significantly
higher than in the general population (8% vs. 0.5%
to 5%), with metastasis developing rapidly after
diagnosis of the primary tumor in a mean of only
1.4 years and a poor prognosis.
After diagnosis of SCC, all patients should be considered
to be at risk for the development of additional
secondary SCC as well as BCC. Overall, the 3-year
cumulative risk of a subsequent SCC after an index
SCC is 18%, at least a 10-fold increase in incidence
compared with the incidence of first tumors in a comparable
general population