Basal Cell Carcinoma: Treatment for Early and Advanced Cases

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Basal cell carcinoma (BCC) is the most common type of skin cancer in the world. Doctors diagnose around 2 million cases of BCC in the United States each year. Most of the time, basal cell carcinoma is curable by removing the cancerous lesion. In very rare cases, this type of skin cancer can grow deep into the tissue and invade the lymph nodes, resulting in a stage 4 basal cell carcinoma. Treatment options vary for basal cell carcinoma, depending on how early the cancer is detected.

Basal Cell Carcinoma Treatment Options for Early Cases

Checking your skin for potential skin cancers should be part of your everyday hygiene. If possible, have a partner check your back and areas of your scalp for lesions that show any signs of being cancerous. A skin cancer may look like a:

  • Brown or black spot or streak under your fingernail or toenail
  • Dome-shaped growth
  • Freckle, mole or spot that changes color
  • Mole or spot that changes in appearance, turns itchy, or bleeds
  • Small patch of scaly skin that doesn’t respond to moisturizer
  • Wound or sore that doesn’t heal

If you notice any skin lesions of this type, see a dermatologist for an examination. The dermatologist may be able to tell by looking if the spot is cancerous, or he or she might remove all or part of it for examination by a pathologist.

BCC is a slow-growing skin cancer, so when you detect it early you stand a good chance of achieving a total cure simply by removing the growth. Your dermatologist or a plastic surgeon may recommend any of these types of surgery to treat basal cell carcinoma:

  • Curettage and electrodessication: This procedure is performed in the office and involves scraping the BCC from the skin, then applying a small burst of electrical energy to the lesion to destroy any remaining cancer cells. Because this procedure can leave an unsightly scar, it usually is performed only on lesions of the trunk that won’t be visible when wearing clothing.
  • Excision: The most common procedure for removing a BCC, excision involves numbing the skin and removing the lesion plus some healthy surrounding skin. The tissue is sent to a pathologist to determine if any cancer cells exist in the healthy skin (“margins”). If the margins are clear, then you should not need further treatment. If cancer cells appear in the margins, then you may require additional treatment or evaluation.
  • Mohs surgery: This procedure is performed in an outpatient setting in which the surgeon uses an instrument to slowly shave away skin layers until all of the cancerous cells have been removed. Dermatologists often recommend Mohs surgery for BCC lesions on the face because the procedure avoids removing healthy skin along with the cancerous cells, which helps minimize scarring.

Depending on your age, the stage of your BCC, and your general health status, your dermatologist may recommend other types of treatment, including:

  • Cryotherapy: Freezing the lesion to destroy the cancerous cells
  • Light therapy: Using light to destroy the BCC
  • Radiation therapy: Destroying cancerous cells by focusing a beam of radiation on them
  • Topical medications: Applying cancer-fighting creams to the BCC site, either as a primary treatment or in conjunction with other skin cancer treatments. Topical 5-fluorouracil (5-FU) is commonly prescribed.

Treatments for Stage 4 Basal Cell Carcinoma

In the rare instances where a BCC has spread deep into the tissue, invaded a nearby lymph node, or even metastasized (spread to other parts of the body), doctors usually follow these steps:

  • Surgery to remove the cancerous tumor and lymph nodes, if necessary
  • Radiation therapy to treat the tissue surrounding the tumor
  • Oral medications for cancer, including sonidegib and vismodegib (targeted therapy)

Fortunately, basal cell carcinoma usually is detected in its earlier stages and does not require such aggressive treatment. Nonetheless, you should check your skin regularly for unusual lesions, apply sunscreen or sunblock whenever you go outdoors, wear sun protection (hats, long sleeves, etc.), and take good care of your skin with routine cleansing and moisturizing. Following these good skin care tips helps build and maintain healthy skin throughout your life.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 May 19
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. Skin Cancer. U.S. National Library of Medicine, MedlinePlus.
  2. Basal Cell Skin Cancer. U.S. National Library of Medicine, MedlinePlus.
  3. Basal Cell Carcinoma: Diagnosis and Treatment. American Academy of Dermatology Association.
  4. Basal and Squamous Cell Skin Cancer Stages. American Cancer Society.