Basal Cell Carcinoma Treatment (2023)

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Effective Options for Early and Advanced BCC

When detected early, most basal cell carcinomas (BCCs) can be treated and cured. Prompt treatment is vital, because as the tumor grows, it becomes more dangerous and potentially disfiguring, requiring more extensive treatment. Certain rare, aggressive forms can be fatal if not treated promptly.

If you’ve been diagnosed with a small or early BCC, a number of effective treatments can usually be performed on an outpatient basis, using a local anesthetic with minimal pain. Afterwards, most wounds can heal naturally, leaving minimal scarring.

Options include:

  • Curettage and electrodesiccation (electrosurgery)
  • Mohs surgery
  • Excisional surgery
  • Radiation therapy
  • Photodynamic therapy
  • Cryosurgery
  • Laser surgery
  • Topical medications
  • Medications for advanced BCC

Basal Cell Carcinoma Treatment (6)

Mohs surgery

Curettage and electrodesiccation (electrosurgery)

How it works

The dermatologist scrapes or shaves off the BCC using a curette (a sharp instrument with a ring-shaped tip), then uses heat or a chemical agent to destroy remaining cancer cells, stop the bleeding and seal off the wound. The physician may repeat the procedure a few times during the same session until no cancer cells remain. Typically, the procedure leaves a round, whitish scar resembling a cigarette burn at the surgery site.

When it’s used

Curettage and electrodesiccation can be effective for most small BCC lesions. In these instances, the procedure has cure rates close to 95 percent.

Mohs surgery

How it works

Mohs surgery is performed during a single visit, in stages. The surgeon removes the visible tumor and a very small margin of tissue around and beneath the tumor site. The surgeon color-codes the tissue and draws a map correlated to the patient’s surgical site. In an on-site lab, the surgeon examines the tissue under a microscope to see if any cancer cells remain. If so, the surgeon returns to the patient and removes more tissue exactly where the cancer cells are. The doctor repeats this process until there is no evidence of cancer. Then the wound may be closed or, in some cases, allowed to heal on its own.

When it’s used

Mohs surgery is the gold standard, the most effective technique for removing BCCs, harming minimal healthy tissue while achieving the highest possible cure rate — up to 99 percent on tumors treated for the first time. It is often recommended for BCCs located in areas around the eyes, nose, lips, ears, scalp, fingers, toes or genitals. Mohs is also used for BCCs that are large, aggressive or growing rapidly and on tumors that have returned, as well as ones with indistinct edges.Get more details about Mohs surgery here.

(Video) Mohs Surgery: The Most Effective Treatment for Skin Cancer

Excisional surgery

How it works

Using a scalpel, the surgeon removes the entire tumor along with a “safety margin” of surrounding tissue and sends it to an off-site lab for analysis. The margin of skin removed depends on the thickness and location of the tumor. If the lab finds cancer cells beyond the margins, more surgery may be performed at a later date until margins are cancer-free.

When it’s used

For small, early BCCs that have not spread, excisional surgery is frequently the only treatment required. Cure rates are above 95 percent in most body areas, similar to those of curettage and electrodesiccation.

Radiation therapy

How it works

The physician uses low-energy X-ray beams to destroy the tumor, with no need for cutting or anesthesia. Destruction of the tumor may require several treatments over a few weeks or daily treatments for a specified time.

When it’s used

With radiation therapy, there is no way of knowing that all of the tumor was destroyed. Since the procedure is less precise and produces cure rates of only 90 percent, itis primarily used for BCCs that are hard to treat with surgery, and in elderly patients or people in poor health for whom surgery is not advised. For some cases of advanced BCC, especially those involving surrounding nerves, radiation may be used after surgery or in combination with other treatments.

Cryosurgery

How it works

The dermatologist uses a cotton-tipped applicator or spray device to apply liquid nitrogen to freeze and destroy the tumor. Later, the lesion and surrounding skin may blister or become crusted and fall off, allowing healthy skin to emerge.

When it’s used

Cryosurgery is effective for smaller, superficial BCCs. It is especially useful for patients with bleeding disorders or problems tolerating anesthesia. The cure rate is between 85 and 90 percent. This technique is used less commonly for invasive BCC because it may miss deeper portions of the tumor, and because scar tissue at the site can make a recurrence harder to detect.

Laser surgery

How it works

The dermatologist directs a beam of intense light at the tumor to target superficial BCCs. Some lasers vaporize (ablate) the skin cancer while others (nonablative lasers) convert the beam of light to heat, which destroys the tumor without injuring the surface of the skin.

When it’s used

Laser surgery is not yet FDA-approved for superficial BCCs but is sometimes used as a secondary therapy, especially when other techniques have been unsuccessful.

(Video) Basal and Squamous Cell Skin Cancers: Treatment including Mohs Surgery Video - Brigham and Women’s

Photodynamic therapy (PDT)

How it works

The dermatologist applies a topical agent to make the lesion sensitive to light, or injects the agent into the tumor. After allowing a short period of time for absorption, the dermatologist uses a blue light or pulsed-dye laser (or sometimes controlled natural sunlight), which causes a reaction that destroys the BCC. After the procedure, patients must strictly avoid sunlight for at least 48 hours, as UV exposure will increase activation of the medication and may cause severe sunburns.

When it’s used

PDT can be used for some superficial BCCs on the face and scalp but is not recommended for invasive BCC.

Topical medications

Approved medications

5-fluorouracil (5-FU)(Efudex®, Carac®, Fluoroplex®, Tolak®)
Imiquimod (Aldara®, Zyclara®)

How they work

These are creams or gels applied directly to affected areas of the skin to treat superficial BCCs with minimal risk of scarring. Imiquimod activates the immune system to attack cancerous cells, while 5-FU is a topical chemotherapy that kills cancerous cells.

When they are used

5-FU, a chemotherapy approved to treat certain internal cancers, has also been FDA-approved in topical form for superficial BCCs, with cure rates between 80 and 90 percent. Imiquimod is approved for superficial BCCs, with cure rates between 80 and 90 percent. Oftentimes tumors diagnosed on biopsy to be superficial will have other invasive areas within the same lesion, making appropriate tumor selection for this treatment intrinsically difficult.

When weighing the pros and cons of treatment options, it’s important to consider that radiation, cryosurgery and topical medications all have one significant drawback in common — no tissue is examined under the microscope, so there is no way to determine how completely the tumor was removed.

Treating advanced BCCs

Approved oral medications

Two oral medications are FDA-approved for treating adults with very rare cases of advanced BCC that are large or have penetrated the skin deeply, spread to other parts of the body or resisted multiple treatments and recurred.

Vismodegib (Erivedge®)
Sonidegib (Odomzo®)

How they work

Both medications are targeted drugs taken by mouth. They work by blocking the “hedgehog” signaling pathway, a key factor in the development of BCC. In 2012, vismodegib became the first medicine ever approved by the FDA for treating advanced BCC. A second hedgehog pathway inhibitor (HHI) drug, sonidegib, was approved for advanced BCC in 2015.

When they are used

Vismodegib is used for the extraordinarily rare cases of metastatic BCC or locally advanced BCC (tumors that have penetrated the skin deeply or frequently recurred) that either recur after surgery or radiation, or cannot be treated with surgery or radiation and have become dangerous or life-threatening.

Sonidegib is used in adults with BCC that is locally advanced, penetrating the skin deeply or repeatedly recurring, as well as in cases when other treatments such as surgery or radiation cannot be used.

Due to a risk of birth defects, women who are pregnant or may become pregnant should not use either drug. Couples must use birth control if the woman is capable of becoming pregnant while her partner is taking the medication.

Scientists are also investigating several other targeted hedgehog inhibitors as potential treatments for locally advanced and metastatic BCC.

Approved immunotherapy medications

In February 2021, the U.S. Food and Drug Administration (FDA) approved the intravenous immunotherapy medication,cemiplimab-rwlc(Libtayo®) for treating patients with certain forms of advanced basal cell carcinoma.

Cemiplimab-rwlc(Libtayo®)

How it works

Cemiplimabis a type of immunotherapy known as a checkpoint blockade therapy, which works by harnessing the power of the immune system to battle cancer. Under normal conditions, the immune system uses checkpoints, which are molecules that suppress production of T cells, the white blood cells that help protect the body from infection. These checkpoints keep T cells from overproducing and attacking normal cells in the body. However, cancer cells have the ability to keep those checkpoints active, suppressing the immune system so the cancer can grow and thrive. Cemiplimabblocks a particular checkpoint called PD-1 from working, so the immune system can releasemassive amounts of T cells to attack and kill cancer cells.

Find out more aboutcemiplimab.

When it’s used

Cemiplimabis used to treat patients with advanced basal cell carcinoma (BCC) previously treated with a hedgehog pathway inhibitor (HHI) or for whom an HHI is not appropriate. Full approval was granted for patients with locally advanced BCC and accelerated approval was granted for patients with metastatic BCC.

(Video) What is Mohs Surgery?

Reviewed by:

Julie K. Karen, MD
Ronald L. Moy, MD

Last updated: April 2021

Note:The information included on this website is medically reviewed and factually accurate. It is intended for educational purposes only. The treatment information on this page is not a recommendation or endorsement of any drug, device or treatment, nor does it suggest that any drug, device or treatment is safe or effective for you. If you have any questions about skin cancer treatments, please talk to your health care provider.

FAQs

What is the best treatment for basal cell carcinoma? ›

Basal cell carcinoma is most often treated with surgery to remove all of the cancer and some of the healthy tissue around it. Options might include: Surgical excision. In this procedure, your doctor cuts out the cancerous lesion and a surrounding margin of healthy skin.

How curable is basal cell cancer? ›

Basal cell skin cancer is almost always cured when it's found early and treated. If the cancer is low-risk, you may have a choice between surgery and a medicated cream. Your doctor can tell you if your cancer is low-risk.

Is Basal cell skin cancer life threatening? ›

Basal cell cancer is the most common form of skin cancer, accounting for nearly 80% of all skin cancers. Basal cell cancers arise from abnormal basal cells in the skin. It is rarely fatal, but it can be locally aggressive.

What happens if you don't remove basal cell carcinoma? ›

Untreated BCCs can become locally invasive, grow wide and deep into the skin and destroy skin, tissue and bone. The longer you wait to get treatment, the more likely it is that the BCC will recur, sometimes repeatedly. There are some highly unusual, aggressive cases when BCC spreads to other parts of the body.

Does basal cell carcinoma grow deep? ›

Basal cell carcinoma spreads very slowly and very rarely will metastasize, Dr. Christensen says. But if it's not treated, basal cell carcinoma can continue to grow deeper under the skin and cause significant destruction to surrounding tissues. It can even become fatal.

How deep do they cut for basal cell carcinoma? ›

A 3-mm surgical margin is sufficient for BCC excision.

Do you need chemo for basal cell carcinoma? ›

Basal cell carcinoma very rarely reaches an advanced stage, so systemic chemotherapy is not typically used to treat these cancers. Advanced basal cell cancers are more likely to be treated with targeted therapy.

Should I worry about basal cell carcinoma? ›

Basal cell carcinoma is a cancer that grows on parts of your skin that get a lot of sun. It's natural to feel worried when your doctor tells you that you have it, but keep in mind that it's the least risky type of skin cancer. As long as you catch it early, you can be cured.

How soon should a basal cell carcinoma be removed? ›

SCC's are removed within 2-4 weeks and melanoma are excised within 1 week. BCC's are slow to move and most of my patients have had them from 2 months to 5 years so waiting 1-3 months should be ok. It also depends on the location and if its near a vital structure like the eye or lips, I would remove it quickly.

What are the warning signs of basal cell carcinoma? ›

Symptoms
  • A shiny, skin-colored bump that's translucent, meaning you can see a bit through the surface. ...
  • A brown, black or blue lesion — or a lesion with dark spots — with a slightly raised, translucent border.
  • A flat, scaly patch with a raised edge. ...
  • A white, waxy, scar-like lesion without a clearly defined border.
1 Oct 2021

How do you know if basal cell carcinoma has spread? ›

Basal and squamous cell cancers don't often spread to other parts of the body. But if your doctor thinks your skin cancer might spread, you might need imaging tests, such as MRI or CT scans.

What is Stage 4 basal cell carcinoma? ›

Stage 4 basal cell carcinoma: In stage 4, the cancer can be any size and has spread (metastasized) to 1 or more lymph nodes which are larger than 3 cm and may have spread to bones or other organs in the body.

Is basal cell carcinoma flat or raised? ›

Basal cell carcinomas

These cancers can appear as: Flat, firm, pale or yellow areas, similar to a scar. Raised reddish patches that might be itchy. Small, pink or red, translucent, shiny, pearly bumps, which might have blue, brown, or black areas.

Can basal cell carcinoma turn into melanoma? ›

Basal cell carcinoma does not progress into melanoma. Each is a separate and distinct type of skin cancer. Basal cell carcinoma is the most common form of skin cancer and one of two major nonmelanoma skin cancer types (the other is squamous cell carcinoma).

How long can you live with basal cell carcinoma? ›

Survival for most non-melanoma skin cancers is excellent. The 5-year relative survival for BCC is 100%. This means that, on average, all of the people diagnosed with BCC are just as likely to live at least 5 years after their diagnosis as people in the general population.

How quickly does basal cell carcinoma spread? ›

BCC usually grows slowly over several months to years, but sometimes it grows quickly over weeks to months. Two common symptoms associated with BCC are itching and having a growth with a recurring cycle of bleeding and healing. The larger the BCC, the more complicated the treatment.

Can biopsy remove basal cell carcinoma? ›

If the doctor thinks that a suspicious area might be skin cancer, the area (or part of it) will be removed and sent to a lab to be looked at under a microscope. This is called a skin biopsy. If the biopsy removes the entire tumor, it's often enough to cure basal and squamous cell skin cancers without further treatment.

What is the most common cause of basal cell carcinoma? ›

The cause of basal cell carcinoma, the most common type of skin cancer, is well known. Most people develop it because their skin has been badly damaged by ultraviolet (UV) light from: The sun. Indoor tanning equipment (such as tanning beds or sunlamps)

Is basal cell carcinoma surgery painful? ›

Your surgeon will use a local anesthetic in the targeted area to prevent you from feeling anything. This means you won't experience any discomfort or pain while you are being treated. After removing layers of tissue, your surgeon will have these examined for evidence of cancer.

How long does it take to recover from basal cell surgery? ›

The wound may take 3 to 6 weeks to heal. How long it takes depends on the size of the area treated. Good wound care may help the scar fade with time. The tissue that was removed will be sent to a lab to be looked at under a microscope.

What is the average size of a basal cell carcinoma? ›

The earliest lesions of basal cell carcinoma are generally seen as a small pink papule sometimes only 1 to 3 mm across.

Do basal cell carcinoma have roots? ›

A BCC can recur even when it has been carefully removed the first time, because some cancer cells may remain undetectable after surgery and others can form roots that extend beyond what's visible. BCCs on the nose, ears and lips are more likely to recur, usually within the first two years after surgery.

Is basal cell carcinoma malignant or benign? ›

Basal cell carcinoma a common cutaneous malignancy that occurs mostly on sun-damaged skin of the head, neck, and trunk.

How do you get basal cell carcinoma? ›

Basal cell carcinoma (BCC) is caused by damage and subsequent DNA changes to the basal cells in the outermost layer of skin. Exposure to ultraviolet (UV) radiation from the sun and indoor tanning is the major cause of BCCs and most skin cancers.

How does basal cell carcinoma make you feel? ›

However, basal cell carcinomas typically don't hurt, and patients rarely feel anything out of the ordinary. Instead, the warning signs are primarily visual.

Does basal cell carcinoma appear suddenly? ›

Basal cell carcinoma can appear suddenly. Unfortunately, when it shows up, it is often not recognized. Ignoring the early warning signs and symptoms of any skin cancer could lead to disfiguring scars or worsening conditions. If you see a sudden change in your skin, it is important that you have it checked immediately.

What else looks like basal cell carcinoma? ›

Sebaceous glands are small glands that grow near hair follicles, and function as a source of the oily, waxy matter that lubricates and waterproofs the skin and hair. When this gland becomes enlarged they can form into a small yellow or flesh coloured papules which can resemble basal cell carcinomas.

What happens if you leave a BCC? ›

However, left untreated, BCCs can grow deeper into the skin and damage surrounding skin, tissue, and bone. Occasionally, a BCC can become aggressive, spreading to other parts of the body and even becoming life threatening.

What stage is basal cell carcinoma? ›

Although most cancers are assigned stages, basal cell carcinoma is seldom staged. That's because it's highly unlikely for basal cell carcinoma to spread, and the extent of a cancer's spread is the primary consideration in most traditional staging models.

Does basal cell carcinoma make you tired? ›

Common side effects are fatigue, nausea, hair loss and potential for infection, among others.

Can you pop basal cell carcinoma? ›

Basal cell carcinoma is the type of skin cancer that most commonly may look like a pimple. The visible parts of basal cell carcinoma lesions are often small, red bumps that may bleed or ooze if picked at. This may look similar to a pimple. However, after it's “popped,” a skin cancer will return in the same spot.

What do cancerous sun spots look like? ›

The edges are irregular, ragged, notched, or blurred. The color is not the same all over and may include shades of brown or black, sometimes with patches of pink, red, white, or blue. The spot is larger than ¼ inch across – about the size of a pencil eraser – although melanomas can sometimes be smaller than this.

Can basal cell carcinoma be misdiagnosed? ›

Skin cancer is increasingly misdiagnosed by physicians. In many cases, skin cancer is incorrectly diagnosed as eczema or another less serious disease.

Why do they remove basal cell carcinoma? ›

When detected early, most basal cell carcinomas (BCCs) can be treated and cured. Prompt treatment is vital, because as the tumor grows, it becomes more dangerous and potentially disfiguring, requiring more extensive treatment. Certain rare, aggressive forms can be fatal if not treated promptly.

What is worse squamous or basal? ›

Though not as common as basal cell (about one million new cases a year), squamous cell is more serious because it is likely to spread (metastasize). Treated early, the cure rate is over 90%, but metastases occur in 1%–5% of cases.

What age do people get basal cell carcinoma? ›

Basal cell carcinoma most often appears in older adults

While people 20 years and younger can certainly get basal cell cancer, it's far more likely in adults who are over 50. To break it down further, people who are aged 50 to 80 are affected most often, and the average age at diagnosis is 67 years old.

How do you shrink basal cell carcinoma? ›

Cryotherapy is used most often for pre-cancerous conditions such as actinic keratosis and for small basal cell and squamous cell carcinomas. For this treatment, the doctor applies liquid nitrogen to the tumor to freeze and kill the cells. This is often repeated a couple of times in the same office visit.

How soon should a basal cell carcinoma be removed? ›

SCC's are removed within 2-4 weeks and melanoma are excised within 1 week. BCC's are slow to move and most of my patients have had them from 2 months to 5 years so waiting 1-3 months should be ok. It also depends on the location and if its near a vital structure like the eye or lips, I would remove it quickly.

How long can you wait to treat basal cell carcinoma? ›

Waiting 1-2 months is ok unless it is a very large tumor or there is something particularly aggressive about the basal cell cancer (ie aggressive pathology, rapid growth, etc). If you have a concern ask your Mohs surgeon if they can fit you in if someone cancels or if a sooner opening comes up.

How long can you live with basal cell carcinoma? ›

Survival for most non-melanoma skin cancers is excellent. The 5-year relative survival for BCC is 100%. This means that, on average, all of the people diagnosed with BCC are just as likely to live at least 5 years after their diagnosis as people in the general population.

Should I worry about basal cell carcinoma? ›

Basal cell carcinoma is a cancer that grows on parts of your skin that get a lot of sun. It's natural to feel worried when your doctor tells you that you have it, but keep in mind that it's the least risky type of skin cancer. As long as you catch it early, you can be cured.

Do you need chemo for basal cell carcinoma? ›

Basal cell carcinoma very rarely reaches an advanced stage, so systemic chemotherapy is not typically used to treat these cancers. Advanced basal cell cancers are more likely to be treated with targeted therapy.

Is basal cell carcinoma flat or raised? ›

Basal cell carcinomas

These cancers can appear as: Flat, firm, pale or yellow areas, similar to a scar. Raised reddish patches that might be itchy. Small, pink or red, translucent, shiny, pearly bumps, which might have blue, brown, or black areas.

How do you know if basal cell carcinoma has spread? ›

Basal and squamous cell cancers don't often spread to other parts of the body. But if your doctor thinks your skin cancer might spread, you might need imaging tests, such as MRI or CT scans.

How quickly does basal cell carcinoma spread? ›

BCC usually grows slowly over several months to years, but sometimes it grows quickly over weeks to months. Two common symptoms associated with BCC are itching and having a growth with a recurring cycle of bleeding and healing. The larger the BCC, the more complicated the treatment.

Can a basal cell turn into melanoma? ›

Basal cell carcinoma does not progress into melanoma. Each is a separate and distinct type of skin cancer. Basal cell carcinoma is the most common form of skin cancer and one of two major nonmelanoma skin cancer types (the other is squamous cell carcinoma).

What is the most common cause of basal cell carcinoma? ›

The cause of basal cell carcinoma, the most common type of skin cancer, is well known. Most people develop it because their skin has been badly damaged by ultraviolet (UV) light from: The sun. Indoor tanning equipment (such as tanning beds or sunlamps)

Should you remove basal cell carcinoma? ›

When detected early, most basal cell carcinomas (BCCs) can be treated and cured. Prompt treatment is vital, because as the tumor grows, it becomes more dangerous and potentially disfiguring, requiring more extensive treatment. Certain rare, aggressive forms can be fatal if not treated promptly.

What is stage 2 basal cell carcinoma? ›

Stage 2 basal cell carcinoma: In stage 2, the cancer is larger than 2 centimeters across, and has not spread to nearby organs or lymph nodes, or a tumor of any size with 2 or more high-risk features.

What age do people get basal cell carcinoma? ›

Basal cell carcinoma most often appears in older adults

While people 20 years and younger can certainly get basal cell cancer, it's far more likely in adults who are over 50. To break it down further, people who are aged 50 to 80 are affected most often, and the average age at diagnosis is 67 years old.

Can biopsy remove basal cell carcinoma? ›

If the doctor thinks that a suspicious area might be skin cancer, the area (or part of it) will be removed and sent to a lab to be looked at under a microscope. This is called a skin biopsy. If the biopsy removes the entire tumor, it's often enough to cure basal and squamous cell skin cancers without further treatment.

Is basal cell carcinoma malignant or benign? ›

Basal cell carcinoma a common cutaneous malignancy that occurs mostly on sun-damaged skin of the head, neck, and trunk.

What is considered a large basal cell carcinoma? ›

Stage 2 basal cell carcinoma – These cancers are larger than 2 centimeters, and while they have not spread to other organs or lymph nodes, they have two or more factors that make them likely to return or spread.

Videos

1. Basal cell carcinoma educational video
(Veterans Health Administration)
2. What Is Mohs Surgery?
(Cleveland Clinic)
3. Basal Cell Carcinoma - Mayo Clinic
(Mayo Clinic)
4. New Advanced Basal Cell Carcinoma Drug
(Mayo Clinic)
5. How Dangerous are Basal Cell Carcinoma and Squamous Cell Carcinoma
(Intermountain Healthcare)
6. Treatment of Basal Cell Carcinoma (BCC)
(CancerQuest-EmoryUniversity)
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