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Non-melanoma skin cancer

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Treatment of basal cell carcinoma

The following are treatment options for basal cell carcinoma (BCC). Treatment plans are designed to meet the unique needs of each person with cancer. Treatment decisions for BCC are based on:

  • person’s age
  • person’s overall health
  • desired cosmetic result
  • number of lesions or tumours
  • size of the tumour
  • definition of tumour border
  • whether it is primary or recurrent BCC
  • location of tumour
  • histological subtype of BCC
  • history of radiation therapy
  • whether the tumour is low or high risk


Surgery is the primary treatment for basal cell carcinoma. The types of surgery that may be offered for BCC include:

  • surgical excision
    • It is used for most well-defined, non-morpheaform tumours less than 2 cm in diameter.
    • It is commonly used to treat tumours on the trunk, arms and legs.
    • It is not used to treat morpheaform and micronodular types of BCC because of their aggressive growth pattern.
  • Mohs surgery
    • This surgery is used as treatment of primary BCC, particularly tumours:
      • that occur at sites known to have high treatment failure rates (periorbital area, nasolabial fold, nose-cheek angle, posterior cheek sulcus, pinna, ear canal, forehead, scalp or tumours that start in a scar)
      • with poorly defined borders
      • larger than 2 cm in diameter
      • of morpheaform or sclerotic type
      • in areas where the maximum preservation of tissue is desired (tumours on the eyelid, nose, finger or genitalia)
  • curettage and electrodesiccation
    • This treatment is used for low-risk BCC (small tumours, generally less than 1 cm in diameter, with well-defined borders).


Cryosurgery may be used to treat low-risk BCC (small tumours with well-defined borders). It is not used for larger tumours or for tumours involving the nose, ears, eyelids, scalp or legs.

Radiation therapy

Radiation therapy may be the primary treatment for some BCC and is the main treatment used as an alternative to surgery. External beam radiation therapy is used as a primary treatment for:

  • very large tumours or tumours whose location makes surgery difficult, such as those on the nose, ear and eyelids
    • Radiation therapy spares tissue so reconstructive surgery is not needed.
  • elderly people who cannot tolerate surgery
  • relief of pain or to control symptoms of very large tumours (palliation)

Radiation therapy may be used after surgery (adjuvant therapy):

  • when cancer cells are found in the margin of tissue removed with the tumour
  • for tumours that grow around nerves (perineural invasion) or involve several nerves


Topical chemotherapy may be used to treat low-risk, superficial BCC. The most common topical chemotherapy drug is 5-fluorouracil (5-FU, Efudex). Close follow-up is needed because this treatment does not destroy any cancer cells that are deep under the surface of the skin.

It is very rare for BCC to spread to other parts of the body, so systemic chemotherapy is rarely used to treat BCC. Systemic chemotherapy may be used to treat uncontrolled local disease or metastatic BCC. Although chemotherapy will not cure the cancer, it may slow the growth of the cancer and relieve symptoms.

Photodynamic therapy

Photodynamic therapy may be used to treat superficial BCC. Close follow-up is needed because this treatment does not destroy any cancer cells that are deep under the surface of the skin.

Biological therapy

Biological therapy is not commonly used to treat BCC, but it may be used to treat superficial BCC. Imiquimod (Aldara or Zyclara) is a cream that is applied directly to the tumour. Close follow-up is needed because this treatment does not destroy any cancer cells that are deep under the surface of the skin.

Targeted therapy

Targeted therapy may be used to treat BCC. Vismodegib (Erivedge) is a drug that targets molecules on cancer cells that help send signals that tell the cells to grow or divide. Vismodegib is sometimes used to treat advanced or metastatic BCC when someone can’t or doesn’t want to have surgery or radiation therapy.

Clinical trials

People with BCC may be offered the opportunity to participate in clinical trials. For more information, go to clinical trials.


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