Basal cell carcinomas are highly curable with both surgical and nonsurgical therapy. Treatment may be selected based on the tumor's location, size, and depth; the patient's general health, medical history, and cosmetic preferences; and whether the tumor has been treated before.
Managing Low-Risk Basal Cell Carcinoma
Basal cell carcinomas that are small, superficial, have a well-defined edge, and have not been treated before are at low risk of spreading. There are numerous treatment options for low-risk basal cell tumors, depending on where they occur on the body.
Some of the treatment options for low-risk basal cell carcinoma are:
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Surgery
Surgery is recommended to remove basal cell carcinomas that are larger and more likely to spread into surrounding tissue. Standard surgical excision involves removing the tumor from the skin along with a "safety margin" (an extra amount) of normal skin to ensure that all cancer cells have been removed. The wound is then closed with sutures. Surgery is most effective for tumors with well-defined borders and can be performed virtually anywhere on the body. An advantage of surgery is that the tissue can be sent to a laboratory for microscopic evaluation by a pathologist, who will verify whether the entire tumor has been removed along with a sufficient safety margin.
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Curettage and Electrodesiccation
This is the most common treatment for basal cell carcinoma and is most effective for small, superficial tumors found on the trunk and extremities. The surgeon uses a semi-sharp instrument with a spoon-shaped edge (called a curette) to scrape away cancerous tissue. The area is then treated with an electric needle to control bleeding and destroy any cancer cells that may remain around the edge of the wound. The wound usually heals within a few weeks.
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Cryosurgery
This treatment involves applying liquid nitrogen to freeze the abnormal tissue, which then sloughs off as the underlying skin heals.
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Topical chemotherapy treatment with fluorouracil (also called 5-FU)
Topical treatment targets damaged skin without touching surrounding normal tissues. Available in a cream or lotion, 5-FU is applied by the patient at home for about three to six weeks. The patient's skin may become irritated and red during treatment with 5-FU. Because topical chemotherapy may not penetrate all layers of the skin, careful follow-up is essential after treatment.
Imiquimod, a topical lotion applied by the patient at home that causes local immune cells to attack abnormal tissue, may be used to treat small, superficial basal cell carcinomas in low-risk areas.
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Laser surgery
Tumor tissue is vaporized with a highly focused beam of light. Because laser surgery only kills tumor cells on the surface of the skin, close follow-up is essential.
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Mohs Surgery
For tumors with a high risk of recurrence, doctors at Memorial Sloan-Kettering may recommend a highly specialized technique called Mohs surgery. In this procedure, a surgeon removes tumor tissue layer by layer, mapping and freezing each layer, and examining it for tumor cells under a microscope before proceeding to the next layer. A precise, complex, and time-consuming process, Mohs surgery ensures that the entire tumor is removed and minimizes scarring by preserving as much normal skin as possible. Mohs surgery has the highest cure rate of all therapies for advanced basal cell carcinomas and is particularly effective for large tumors, tumors that have recurred after other treatments, and tumors in areas such as the face that require preservation of as much normal skin as possible.
Our doctors are evaluating a new, more efficient technique, called confocal reflectance microscopy, to rapidly image tissue removed during Mohs surgery. This technique may expedite the detection of remaining tumor cells without the need for complex frozen tissue processing.
