Treatments for basal cell carcinoma

The following are treatment options for basal cell carcinoma (BCC) of the skin. Your healthcare team will suggest treatments based on the risk group. They will work with you to develop a treatment plan.

BCC is most often treated with local therapy. This means that only the cancer on the skin and the area around it are treated.

But if BCC has spread to other parts of the body, systemic therapy may be used. Systemic therapy travels through the bloodstream to reach and destroy cancer cells all over the body.

Surgery is usually offered for BCC. The type of surgery done depends on the risk group, where the cancer is located and the size of the cancer.

Surgical excision removes the cancer along with some normal tissue around it (called the surgical margin). It is a standard treatment for BCC in all risk groups.

Mohs surgery removes the cancer in layers, little by little, until no cancer remains. It is mainly done for high-risk BCC, especially on the face, or when high-risk BCC could not be completely removed by surgical excision. It may also be used to treat recurrent BCC.

Curettage and electrodesiccation uses a sharp tool (called a curette) to scrape the cancer. Then the area is treated with an electrical current to destroy any remaining cancer cells. It is commonly used for low-risk BCC. It is often used for small cancers on the neck, trunk of the body, arms or legs.

Cryosurgery uses extreme cold to freeze and destroy tissue. It is mainly used to treat low-risk BCC on the trunk of the body, arms or legs.

Reconstructive surgery repairs the skin and nearby area after BCC is removed. It may be done if a large area of skin is removed to make sure the cancer is completely gone. The doctor takes a piece of skin from another part of the body, called a skin graft or skin flap, to rebuild the area.

You may be offered photodynamic therapy (PDT) for superficial BCC. It uses a light-sensitive drug (photosensitizer) and a special type of light to destroy cancer cells. PDT may be used for a small tumour if it is in a very visible place on your body.

You may be offered external beam radiation therapy for BCC. It uses high-energy rays or particles to destroy cancer cells. It is used instead of surgery when the cancer is in an area that is hard to treat, such as an eyelid or ear. It may also be used to treat BCC that was not completely removed by surgery (called incomplete excision).

You may be offered drug therapy for BCC. The type of drug therapy used depends on where the cancer is located.

Topical therapy uses a cream or gel to put drugs directly on the skin. It may be used to treat small, superficial BCC on the neck, trunk of the body, arms or legs. The topical therapy drug used for BCC is imiquimod (Aldara, Zyclara). It is usually put on the growth or abnormal area once a day for several weeks.

Targeted therapy uses drugs to target specific molecules (such as proteins) on or inside cancer cells to stop the growth and spread of cancer cells. It may be used for BCC that has spread (metastatic BCC). It is also used for BCC that has grown into nearby areas (locally advanced BCC) when surgery or radiation can’t be used. The targeted therapy drugs used for BCC is vismodegib (Erivedge) and sonidegib (Odomzo). They are given daily as a pill.

Immunotherapy helps to strengthen or restore the immune system's ability to fight cancer. It may be used for locally advanced BCC that was already treated with a hedgehog pathway inhibitor, such as vismodegib. The immunotherapy drug used for BCC is cemiplimab (Libtayo). It is given by a needle into a vein every 2 or 3 weeks.

Systemic chemotherapy is not usually offered for BCC. But it may be used for BCC that has grown into nearby areas or BCC that has spread. The most common chemotherapy drug used is cisplatin (Platinol AQ). It is given with a needle into a vein (intravenously). It may be used alone or combined with paclitaxel (Taxol). There is no standard chemotherapy treatment plan for BCC.

You may be asked if you want to join a clinical trial for skin cancer. Find out more about clinical trials.