A number of treatments are available for basal cell carcinoma. What treatment is best for you depends on the type, location and size of your cancer, as well as your preferences and ability to do follow-up visits. Treatment selection can also depend on whether this is a first-time or recurring basal cell carcinoma.
Surgery and related procedures
Several surgical options are available for treating basal cell carcinoma. Depending on the size and location of the removed lesion, the wound may be allowed to heal on its own, stitched closed (sutured), or covered with a skin graft, a patch of healthy skin from another site on your body.
These procedures include the following:
- Electrodesiccation and curettage (ED&C). ED&C is generally used to remove smaller or superficial basal cell carcinomas. The surgeon removes the surface of the skin cancer with a blade or scraping instrument (curette) and then sears the base of the cancer with an electric needle to control bleeding and kill cancer cells. In a similar procedure, the base is treated by freezing it with liquid nitrogen (cryotherapy) after curettage. ED&C can leave an oozing, crusty scab that usually heals within four to six weeks.
- Surgical excision. In this procedure, your doctor cuts out the cancerous lesion and a surrounding margin of healthy skin. The margin is examined under a microscope to be sure there are no cancer cells. This procedure is used more often with larger lesions.
- Freezing. This involves killing cancerous cells by freezing them with liquid nitrogen (cryosurgery). It's useful for cancers that are very thin and don't extend deep into the skin. This process requires a more prolonged freezing time — longer than cryotherapy with curettage — so it must be done carefully to avoid nerve damage that can result in a loss of feeling at the site.
- Mohs surgery. During the procedure, your doctor removes the cancer cells layer by layer, examining each layer under the microscope until no abnormal cells remain. This allows the entire growth to be removed and only a very small amount of healthy tissue. This is usually an effective treatment for recurring basal cell carcinoma, a lesion on your face, and lesions that are large, deep, fast-growing or morpheaform. For aggressive cancers, this procedure may be followed by radiation therapy.
Drugs used to treat basal cell carcinoma include the following:
- Topical treatments. Basal cell carcinoma that is superficial and doesn't extend very far into the skin may be treated with creams or ointments. The drugs imiquimod (Aldara) and fluorouracil (Efudex, Fluoroplex, others) are used for several weeks to treat such low-risk basal cell carcinomas.
- Medication for advanced cancer. Basal cell carcinoma that spreads to other areas of the body (metastasizes) may be treated with vismodegib (Erivedge) or sonidegib (Odomzo). These medications may also be an option for people whose cancers haven't responded to other treatments. These medications may block molecular signals that enable basal cell carcinomas to continue growing.