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No one wants to be told they have cancer, but not all cancers are created equal. Admittedly, some cancers are genuinely bad news, however, basal cell carcinoma, the single most common cancer in the world, is a slow-growing cancer. It very rarely spreads to other parts of the body. The good news, then, is that most basal cell carcinomas can be cured. But don’t celebrate too early. Basal cell carcinoma can and does recur—often in the same place—so it pays to stay vigilant.
What is basal cell carcinoma?
Basal cell carcinoma, or BCC, is a cancer of the layer of cells in the lower part of the epidermis, the visible part of the skin. Basal cells continually divide to replenish the top layer of the epidermis, made of squamous cells, which are shed constantly since they areexposed to the outside environment.
Skin cancers are the most common type of cancer worldwide, and basal cell carcinoma is the most common skin cancer. Over 4 million people in the United States are diagnosed with this cancer each year. That number rises every year. Currently, two out of five people can expect to develop BCC in their lifetime.
Fortunately, basal cell carcinoma is a slow-growing cancer that only rarely metastasizes or turns lethal. However, it will invade the healthy skin surrounding it. If not properly treated, it can do extensive local damage and even destroy nerves and other structures in the skin.
There are several different types of basal cell carcinoma, but the most common types are nodular or superficial basal cell carcinoma. Sun exposure and tanning bed use are the single greatest risk factors for basal cell carcinoma. Ultraviolet light damages DNA in certain cells, causing them to grow out of control. However, not all BCC is caused by ultraviolet light exposure. Other risk factors include:
- Fair skin
- Male gender
- Advancing age
- History of skin cancer
- Scars
- Exposure to arsenic
- Radiation treatment
- Some types of inherited disorders
Three out of four basal cell carcinomas appear on the head or neck. Early diagnosis and treatment are critical to minimizing disfigurement.
How is basal cell carcinoma diagnosed?
Basal cell carcinoma is diagnosed with a skin examination, but a biopsy is needed to definitively diagnose the condition and identify its type. Diagnosis may be started by a general practitioner, but the final diagnosis and treatment will usually fall to a dermatologist, a doctor who specializes in skin conditions.
In a physical exam, the doctor will closely examine the lesion. While basal cell carcinoma typically does not have symptoms, the doctor will study the appearance of the lesions to make a diagnosis. A basal cell carcinoma tumor typically looks like a small, shiny pimple or nodule. It is usually pink or flesh-colored, but sometimes could be darker than the surrounding skin. Tiny spider veins may surround the lesion. Some types look more like a scar or develop into a sore. In many cases, basal cell carcinoma can easily be mistaken for eczema, psoriasis, or sun damage (actinic keratosis).
BCC lesions usually appear on the face, but they may also be found on the shoulders, chest, or back. There may be more than one lesion. The doctor will perform a careful examination of your entire skin surface looking for other lesions.
A skin biopsy is required to make a final diagnosis. A small tissue sample of the lesion will be removed and examined by a pathologist.
Basal cell carcinoma treatment options
The goal of basal cell carcinoma treatment is to eradicate the cancer, prevent recurrence, and minimize scarring or disfigurement. Surgery is the primary treatment, but less-invasive surgical procedures, radiation therapy, or medications may be used to supplement or substitute for surgery.
Surgery
Basal cell carcinoma is primarily treated with surgery. Not only does surgery remove the cancer, but it also results in the lowest recurrence rates. While surgeons strive for the best possible cosmetic result, surgery will cause scarring. For larger or more extensive tumors, cosmetic surgery or skin grafts may be required to minimize disfigurement.
Mohs surgery
The gold standard for basal cell cancer treatment is Mohs surgery, which has close to a 100% cure rate, a 1% recurrence rate, and minimizes the size of the wound and scarring. The cancerous cells and surrounding healthy tissue are removed in layers and examined under a microscope. The surgery proceeds layer by layer until there is no cancer visible under microscopic examination. Unfortunately, it is an expensive and time-consuming surgery, so it is usually reserved for larger, deeper, or higher-risk tumors.
Surgical excision
More commonly, basal cell carcinoma is just surgically removed (excised). The tumor and a small margin of surrounding tissues are cut out. The procedure is fast, inexpensive, and has a cure rate of 97% to 98% and a 10% recurrence rate. However, a long healing process and visible scarring are common.
Electrodesiccation and curettage (EDC)
Another common surgery for smaller basal cell carcinoma tumors is to first scrape away the upper layers of the tumor with a curette. An electrical needle is then used to generate an electrical spark that dehydrates and kills the remaining cancer cells (electrodesiccation).
Cryotherapy
Cryosurgery is a less-invasive alternative for low-risk basal cell carcinoma. A dermatologist freezes and kills the tumor and surrounding tissues by applying liquid nitrogen to the skin. The procedure is quick but may leave thick, raised scars or change the color of the skin.
Photodynamic therapy (PDT)
For patients with multiple tumors or bleeding problems, photodynamic therapy may be offered as an alternative to surgery. A photosensitive chemical is injected into the tumor and absorbed only by cancer cells. When the skin is exposed to intense light, the chemical changes into a poison that kills the cancer cells while leaving healthy cells intact. The cure rate is low (72%) and the recurrence rate is high (over 40%). Follow-up treatment is often required.
Radiation therapy
Radiotherapy eradicates basal cell carcinoma cells with targeted X-rays. It may be used after surgery or in cases where surgery is not possible due to underlying medical conditions.
Medications
Medications are normally not prescribed for basal cell carcinoma. Patients with low-risk superficial BCC may be offered topical medications as an alternative to surgery. While these drugs are highly successful at clearing the tumor and don’t leave scars, the recurrence rate is higher than surgery. In rare cases in which the cancer has spread to other parts of the body, systemic medications may be used.
Basal cell carcinoma medications
Medications are not commonly used to treat basal cell carcinoma. Topical drugs may be prescribed in some cases before, after, or in place of surgery. If the cancer is low-risk and caught early, patients may be given the option of using topical medications rather than undergoing surgery. Advanced, inoperable cases will be treated by systemic drugs.
Topical immunomodulators
Some patients may be prescribed topical imiquimod either in place of surgery or before surgery to shrink the tumor’s size. Imiquimod activates immune system cells to attack the cancer. Regimens with application for six weeks may have up to a 100% clearance rate for superficial basal cell carcinoma, but clearance rates are less for other types of BCC and overall long-term recurrence rates are higher than surgical treatment.
Topical chemotherapy
Antimetabolites are chemotherapy drugs that kill cancer cells by interfering with their ability to synthesize and repair their genetic information. For basal cell skin cancer, topical 5-fluorouracil (5-FU) cream applied twice daily for up to twelve can clear as high as 90% of superficial basal cell carcinoma tumors.
Hedgehog pathway inhibitors
Less than one percent of basal cell carcinomas metastasize and cannot be surgically removed. Doctors treat these cases with hedgehog pathway inhibitors. The “hedgehog pathway” is a series of chemical reactions in cells that cause them to differentiate into particular types of cells, like nerve cells or stomach cells. Active in human embryo cells, the hedgehog pathway is inactive in adult cells. In basal cell carcinoma, one type of hedgehog pathway, the Sonic hedgehog pathway, is improperly activated, leading to the production of tumor cells. Taken orally, drugs such as Erivedge (vismodegib) and Odomzo (sonidegib) shut this pathway down, leading to tumor response in 50-60% of patients (dependent upon locally advanced or metastatic designation).
What is the best medication for basal cell carcinoma?
Treatment for basal cell carcinoma will be highly individualized. Surgery is the mainstay, and most cases won’t require drug treatment. Only a limited number of medications are prescribed for basal cell carcinoma, but there is no “best” medication.
| Best medications for basal cell carcinoma | ||||
|---|---|---|---|---|
| Drug Name | Drug Class | Administration Route | Standard Dosage | Common Side Effects |
| Aldara (imiquimod) | Immunomodulatory agent | Oral, topical, injection, etc. | Apply 5% cream to the lesions five times per week for six weeks | Itching, burning, redness |
| Efudex (fluorouracil) | Antimetabolite | Topical | Apply 5% cream or solution using a nonmetal applicator or glove to the lesion twice daily for three to six weeks (may be extended to ten to twelve weeks) | Redness, itching, blistering |
| Erivedge (vismodegib) | Hedgehog pathway inhibitor | Oral | One 150 mg capsule daily | Muscle spasms, alopecia, changes in taste |
| Odomzo (sonidegib) | Hedgehog pathway inhibitor | Oral | One 200 mg capsule daily at least one hour before or two hours after a meal | Muscle spasms, alopecia, changes in taste |
Many of the standard dosages above are from the U.S. Food and Drug Administration (FDA). Dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.
What are the common side effects of basal cell carcinoma medication?
All drugs have side effects, but these side effects will vary depending on the type of drug. The following is not a complete list of possible side effects. A healthcare professional can address any concerns you may have about possible side effects or drug interactions.Imiquimod cream produces skin side effects such as redness, itching, burning, swelling, scabbing, and sores. More serious side effects include severe swelling and flu-like symptoms. Avoid sunlight and sunlamps when using imiquimod.
The most frequent side effects of topical fluorouracil are skin reactions such as redness, burning, crusting, itching, rash, and sores. Topical fluorouracil should not be applied to mucous membranes.
More than three in 10 patients will experience side effects from hedgehog pathway inhibitors such as muscle spasms, alopecia (random hair loss), taste disturbances, fatigue, involuntary weight loss, and muscle pain. Side effects and the drugs’ ineffectiveness are bad enough that many patients discontinue these medications.
What is the best home remedy for basal cell carcinoma?
Basal cell carcinoma cannot be eradicated with home or natural remedies. The only effective way to get rid of the tumors is surgical removal or, in low-risk cases, topical medications. Home treatment, however, can help the recovery process, minimize scarring, and prevent future recurrence.
Keep the surgical wound clean and dressed
Keep the wound moist and covered with a pressure bandage for 48 hours. To avoid scarring, try to avoid moving the body part with the wound for about two weeks while it heals.
Use silicone on the scar
After stitches have been removed, place over-the-counter silicone gels or sheets over the scar for two to six months to minimize scarring.
Avoid sunlight
Dermatologists recommend not exposing the wound to sunlight for up to a year. Not only does sunlight cause scars to darken, but it also increases the risk of recurrence. When you’re out in the sun, cover all exposed skin every two hours with at least an SPF 30 sunscreen.
Check your skin regularly
Treatment for basal cell carcinoma is highly successful, but you need to keep your guard up. Patients who have had basal cell carcinoma not only have a high risk of recurrence, they are also more likely to develop other types of skin cancer. Check your skin at least once a month. If you see a problem, don’t hesitate to visit your dermatologist.
Frequently asked questions about basal cell carcinoma
What is the best treatment for basal cell carcinoma?
The standard treatment for basal cell skin cancer is surgical removal. The gold standard is Mohs micrographic surgery. It has the highest cure rate and the lowest rate of recurrence because it allows all of the surrounding tissues to be examined for cancer cells.
Is basal cell carcinoma life-threatening? / How serious is basal cell carcinoma?
Basal cell carcinoma is a slow-growing cancer that only rarely spreads to the lymph nodes or other parts of the body. Metastatic basal cell carcinoma occurs in less than one percent of cases.. With treatment, the five-year survival rate of typical basal cell skin cancer is nearly 100%.
How do they remove basal cell carcinoma?
Basal cell carcinoma is removed by cutting it out (excision), slicing it out in layers (Mohs surgery), scraping it out followed by killing remaining tissues with an electrical current (curettage and electrodesiccation, respectively), or freezing it to death with liquid nitrogen (cryotherapy).
Can basal cell carcinoma go away on its own?
Basal cell carcinoma is both slow-growing and immunologically “hot.” That means the body’s immune system actively fights and kills the cancer cells. In very rare cases, then, a basal cell carcinoma tumor can shrink and disappear on its own without treatment. Unfortunately, that doesn’t mean the cancer has gone away. There is an increased risk the cancer will return or reactivate. Most tumors, however, will grow larger over time and can cause significant damage.
How do you get rid of basal cell carcinoma without surgery?
For low-risk basal cell skin cancer, patients may be offered treatment with a topical anticancer drug such as imiquimod or 5-fluorouracil. Both drugs can successfully clear the cancer without scar formation, but recurrence rates are higher than surgical treatments.
Related resources for basal cell carcinoma
- Bad report card: herbal remedies for skin cancer. MedpageToday
- Basal and Squamous Cell Carcinoma. American Cancer Society
- Basal cell carcinoma—review of treatment modalities. Journal of Dermatology and Clinical Research
- Basal Cell Skin Cancer: Should I Have Surgery or Use Topical Creams? The University of Michigan Medicine
- Keeping up appearances: minimizing scarring after skin cancer surgery. Cure
- Natural treatments for skin cancer are not as safe as you think. American Academy of Dermatology