Treating Basal Cell Carcinoma

Several types of treatment can be used to remove or destroy basal cell skin cancers (BCCs). The options depend on factors such as the tumor size and location, and a person’s age, general health, and preferences. These cancers very rarely spread to other parts of the body, although they can still grow into nearby tissues and cause serious problems if not treated.

All of the treatments listed here can be effective when used in appropriate situations. The chance of the cancer coming back (recurring) ranges from less than 5% after Mohs surgery to up to 15% or higher after some of the others, but this depends on the size of the tumor. Small tumors are less likely to recur than larger ones. Even if a tumor does come back, it can often still be treated effectively.

Surgery

Different types of surgery can be used to treat basal cell cancers.

Curettage and electrodesiccation: This is a common treatment for small BCCs that are at low risk for coming back after treatment. It might need to be repeated to help make sure all of the cancer has been removed.

Shave excision: Shaving off the top layers of the skin (including the tumor) with a small surgical blade might be another option for small BCCs that are at low risk for coming back after treatment.

Standard excision: This type of surgery, in which the tumor and a margin of normal skin around it are removed, is a common treatment for low-risk BCCs. It might also be an option for some BCCs at higher risk for coming back, especially if they’re on the trunk (chest or back), arms, or legs.

Mohs surgery: Mohs surgery is especially useful for treating BCCs that are at higher risk for coming back, such as large tumors, tumors where the edges are not well-defined, tumors in certain locations (such as on or near the nose, eyes, ears, forehead, scalp, fingers, and genital area), and those that have come back after other treatments. However, this approach is also usually more complex and time-consuming than other methods. Other surgical techniques similar to Mohs might also be an option in these situations.

Radiation therapy

Radiation therapy is often a good option for treating people who aren’t able (or don’t want) to have surgery, as well as for treating tumors on the eyelids, nose, or ears, which can be hard to treat surgically.

Radiation might also be a good option for some older people if curing the cancer may not be as important as controlling it over the long term (and limiting side effects).

Radiation is also sometimes used after surgery if it’s not clear that all of the cancer has been removed, or if there’s a higher risk that the cancer might come back.

Other local and topical treatments

Other local treatments are sometimes options for treating superficial BCCs (tumors that haven’t grown too deeply into the skin). These include:

• Cryotherapy
• Photodynamic therapy (PDT)
• Topical chemotherapy
• Immune response modifiers

Close follow-up is needed after these treatments because these they don’t destroy any cancer cells that have grown deep below the surface. Therefore, the risk of the cancer returning is a bit higher than it is after surgery.

Treating cancers that aren’t removed completely or that come back after treatment

Treatment options for BCC that remains after treatment or that comes back later depend on where the tumor is, what the first treatment was, and other factors.

If possible, surgery (such as a re-excision or Mohs surgery) is often recommended to try to remove any remaining cancer. Radiation therapy might be another option, especially if surgery can’t be done for some reason. Radiation usually can’t be repeated in the same area if it was the first treatment, because it’s more likely to cause serious side effects.

If the cancer comes back in nearby lymph nodes or in other parts of the body, systemic treatments such as targeted therapy or immunotherapy drugs might be an option (see below).  

Targeted therapy or immunotherapy for advanced basal cell cancers

In rare cases where basal cell cancer spreads to other parts of the body or can’t be cured with surgery or radiation therapy, a targeted drug such as vismodegib (Erivedge) or sonidegib (Odomzo) can often shrink or slow its growth.

If these drugs are no longer working (or if they can’t be taken for some reason), the immunotherapy drug cemiplimab (Libtayo) can sometimes be helpful.