What kills basal cell carcinoma?
Treatment — Skin cancer (non-melanoma)
Non-surgical treatments, such as freezing (cryotherapy), anti-cancer creams, photodynamic therapy (PDT), radiotherapy and electrochemotherapy, are also used in certain circumstances.
Overall, treatment is successful for at least 9 out of 10 people with non-melanoma skin cancer.
If you have skin cancer, your specialist care team may include a dermatologist, a plastic surgeon, a radiotherapy and chemotherapy specialist (an oncologist), a pathologist (a specialist in diseased tissue) and a specialist nurse.
If you have non-melanoma skin cancer, you may see several (or all) of these specialists as part of your treatment.
When deciding which treatment is best for you, doctors will consider:
- the type of cancer you have
- the stage of the cancer (its size and how far it’s spread)
- your general health
Your cancer team will recommend what they think is the best treatment option, but the final decision will be yours.
Before visiting hospital to discuss your treatment options, you may find it useful to write a list of questions you’d like to ask.
For example, you may want to find out what the advantages and disadvantages are of particular treatments.
Surgical excision is an operation to cut out the cancer along with surrounding healthy tissue to ensure the cancer is completely removed.
Surgical excision may be done in combination with a skin graft, which involves removing a patch of healthy skin, usually from a part of the body where any scarring cannot be seen, such as your neck, abdomen or upper thigh. It’s then connected (grafted) to the affected area.
In most cases, surgery is enough to cure non-melanoma skin cancer.
Mohs micrographic surgery
Mohs micrographic surgery (MMS) is a specialist form of surgery used to treat non-melanoma skin cancers when:
- it’s felt there’s a high risk of the cancer spreading or returning
- the cancer is in an area where it would be important to remove as little skin as possible, such as the nose or close to the eyes
MMS involves surgical excision of the tumour and a small area of surrounding skin.
The edges are immediately checked under a microscope to make sure all the tumour has been completely removed.
If it has not, further surgery is done, usually on the same day. This minimises the removal of healthy tissue and reduces scarring while ensuring that the tumour has been completely removed.
Curettage and electrocautery
Curettage and electrocautery is a similar technique to surgical excision, but it’s only suitable in cases where the cancer is quite small.
The surgeon will use a small spoon-shaped or circular blade to scrape off the cancer before burning (cauterising) the skin to remove any remaining cancer cells and seal the wound.
The procedure may need to be repeated 2 or 3 times to ensure the cancer is completely removed.
Cryotherapy uses cold treatment to destroy the cancer. It’s sometimes used for non-melanoma skin cancers that are at an early stage.
Liquid nitrogen is used to freeze the cancer, and this causes the area to form a scab.
After about a month, the scab containing the cancer will fall off your skin. Cryotherapy may leave a small white scar on your skin.
Anti-cancer creams are also used for certain types of non-melanoma skin cancers, but are only recommended when the tumour is contained within the top layer of the skin, such as early basal cell carcinoma and Bowen’s disease.
There are 2 main types of anti-cancer creams:
- chemotherapy creams – these contain a medicine called 5-fluorouracil
- immune stimulating creams – these contain a medicine called imiquimod
For non-melanoma skin cancer, chemotherapy creams containing 5-fluorouracil are used.
The cream is applied to the affected area for several weeks.
As only the surface of the skin is affected, you will not experience the side effects associated with other forms of chemotherapy, such as being sick or hair loss. However, your skin may feel sore for several weeks afterwards.
Immune stimulating creams containing imiquimod is used to treat basal cell carcinomas with a diameter of less than 2cm. It’s also used to treat actinic keratoses and Bowen’s disease.
Imiquimod encourages your immune system to attack the cancer in the skin and is used over several weeks.
Common side effects of 5-fluorouracil cream and imiquimod include redness, flaking or peeling skin and itchiness. Less common and more serious side effects include blistering or skin ulceration.
Photodynamic therapy (PDT)
Photodynamic therapy (PDT) is used to treat basal cell carcinoma, Bowen’s disease and actinic keratoses. It involves using a cream that makes the skin highly sensitive to light.
After the cream has been applied, a strong light source is shone on to the affected area of your skin, which kills the cancer.
PDT may cause a burning sensation and may leave scarring, although there is usually less scarring than with surgery.
Radiotherapy involves using low doses of radiation to destroy the cancer. The level of radiation involved is safe. However, your skin may feel sore for a few weeks after radiotherapy.
Radiotherapy is sometimes used to treat basal cell and squamous cell carcinomas if:
- surgery would not be suitable
- the cancer covers a large area
- the area is difficult to operate on
Radiotherapy is sometimes used after surgical excision to try to prevent the cancer coming back. This is called adjuvant radiotherapy.
Electrochemotherapy is a possible treatment for non-melanoma skin cancer.
It may be considered if:
- surgery is not suitable or has not worked
- radiotherapy and chemotherapy have not worked
The procedure involves giving chemotherapy into the tumour or sometimes directly into a vein (intravenously). Short, powerful pulses of electricity are then directed to the tumour using electrodes.
The electrical pulses allow the medicine to enter the tumour cells more effectively and cause more damage to the tumour.
The procedure is usually done using general anaesthetic, where you’re unconscious, but some people may be able to have local anaesthetic, where you’re conscious but the area being treated is numbed.
Depending on how many tumours need to be treated, the procedure can take up to an hour to complete.
The main side effect is pain where the electrode was used, which can last for a few days and may require painkillers.
It takes around 6 weeks for results to appear and the procedure usually needs to be repeated.
Your specialist can give you more detailed information about electrochemotherapy.
Page last reviewed: 06 January 2020
Next review due: 06 January 2023
Basal Cell Carcinoma
Basal cell carcinoma is a cancer that grows on parts of your skin that get a lot of sun. It’s natural to feel worried when your doctor tells you that you have it, but keep in mind that it’s the least risky type of skin cancer. As long as you catch it early, you can be cured.
This cancer is unlikely to spread from your skin to other parts of your body, but it can move nearby into bone or other tissue under your skin. Several treatments can keep that from happening and get rid of the cancer.
The tumors start off as small shiny bumps, usually on your nose or other parts of your face. But you can get them on any part of your body, including your trunk, legs, and arms. If you’ve got fair skin, you’re more likely to get this skin cancer.
Basal cell carcinoma usually grows very slowly and often doesn’t show up for many years after intense or long-term exposure to the sun. You can get it at a younger age if you’re exposed to a lot of sun or use tanning beds.
Basal cell carcinoma can look different. You may notice a skin growth in a dome shape that has blood vessels in it. It can be pink, brown, or black.
At first, a basal cell carcinoma comes up like a small «pearly» bump that looks like a flesh-colored mole or a pimple that doesn’t go away. Sometimes these growths can look dark. Or you may also see shiny pink or red patches that are slightly scaly.
Another symptom to watch out for is a waxy, hard skin growth.
Basal cell carcinomas are also fragile and can bleed easily.
Ultraviolet (UV) rays from the sun or from a tanning bed are the main cause of basal cell carcinoma.
When UV rays hit your skin, over time, they can damage the DNA in your skin cells. The DNA holds the code for the way these cells grow. Over time, damage to the DNA can cause cancer to form. The process takes many years.
Getting a Diagnosis
Your doctor will look at your skin for growths. They may also ask you questions such as:
- Did you spend a lot of time in the sun while you were growing up?
- Have you had blistering sunburns?
- Do you use sunscreen?
- Have you ever used tanning beds?
- Have you had unusual bleeding spots on your skin that don’t heal?
Your doctor will take a sample, or biopsy, of the growth. They will numb the area and remove some of the skin. Then they send it to a lab, where it will be tested for cancer cells.
Questions for Your Doctor
- What kind of treatments do you suggest?
- Can drugs help treat my condition?
- Will I need surgery?
- How can I keep from getting skin cancer again?
The goal is to get rid of the cancer while leaving as small a scar as possible. To choose the best treatment, your doctor will consider the size and place of the cancer, and how long you’ve had it. They’ll also take into account the chance of scarring, as well as your overall health.
These are some of the treatment options your doctor may suggest:
Cutting out the tumor. Your doctor may call this an «excision.» First they’ll numb the tumor and the skin around it. Then they’ll scrape the tumor with a spoon-shaped device. Next they’ll cut out the tumor and a small surrounding area of normal-appearing skin and send it to a lab.
If the lab results show there are cancer cells in the area around your tumor, your doctor may need to remove more of your skin.
Scraping the tumor away and using electricity to kill cancer cells. You may hear your doctor call this «curettage and desiccation.»First your doctor numbs your skin. Then they use a curette, a tool that has a spoon-like shape to scrape off the tumor. Your doctor controls your bleeding and kills any other cancer cells with an electric needle.
Freezing your cancer cells. This is known as «cryosurgery.» Your doctor kills your cancer cells by freezing them with liquid nitrogen.
Radiation therapy . This treatment uses X-rays to destroy your cancer cells. It’s done over several weeks.
Mohs surgery. This is a technique that’s named after the doctor who invented it. Your surgeon removes your tumor layer by layer. They take out some tissue, then look at it under a microscope to see if it has cancer cells, before moving on to the next layer.
Your doctor may recommend this surgery if your tumor is:
- In a sensitive area of your body
- Has been there for a long time
- Came back after you had other treatments
Creams and pills. Your doctor may suggest some medicine that can treat your basal cell carcinoma. Two creams that you put on your skin are:
You may need to apply these creams for several weeks. Your doctor will check you regularly to see how well they are working.
There is also a pill that your doctor might prescribe called sonidegib (Odomzo) or vismodegib (Erivedge). You’re most likely to get one of these drugs if your basal cell carcinoma has spread to other parts of your body. Other treatments include laser surgery or photodynamic therapy.
Taking Care of Yourself
After you’ve been treated for basal cell carcinoma, you’ll need to take some steps to lower your chance of getting cancer again.
Check your skin. Keep an eye out for new growths. Some signs of cancer include areas of skin that are growing, changing, or bleeding. Check your skin regularly with a hand-held mirror and a full-length mirror so that you can get a good view of all parts of your body.
Avoid too much sun. Stay out of sunlight between 10 a.m. and 2 p.m., when the sun’s UVB burning rays are strongest.
Use sunscreen. The sun’s UVA rays are present all day long — that’s why you need daily sunscreen. Make sure you apply sunscreen with at least a 6% zinc oxide and a sun protection factor of 30 to all parts of the skin that aren’t covered up with clothes every day. You also need to reapply it every 60 to 80 minutes when outside.
Dress right. Wear a broad-brimmed hat and cover up as much as possible, such as long-sleeved shirts and long pants.
Basal cell carcinoma rarely spreads to other parts of the body, and the treatment is almost always successful, especially if it’s caught early.
Sometimes new carcinomas can grow, so it’s important to check your skin for any unusual-looking growths and get them checked by your doctor.
Learn more about basal cell carcinoma, including pictures of skin tumors, on the web site of the American Cancer Society.
WebMD Medical Reference Reviewed by Stephanie S. Gardner, MD on April 26, 2022
Photo Credit (inset, nose): Richard Usatine, MD
Photo Credit (inset, close-up): jax10289 / Getty Images
American Cancer Society: «Skin Cancer: Basal and Squamous Cell.»
National Cancer Institute: »Treatment Options for Nonmelanoma Skin Cancer.»
Medscape: «Basal Cell Carcinoma.»
Memorial Sloan-Kettering Cancer Center: «Basal Cell Carcinoma.»
Cancer Research UK: «How does UV cause skin cancer.»
Harvard Health Letter: «Recognizing and treating basal cell carcinoma.»
Skin Cancer Foundation: «Step by Step Self-Examination.»
Skin Cancer Foundation – Photo Caption
American Academy of Dermatology Association – Photo Caption
Skin Cancer Foundation – Photo Caption
American Academy of Dermatology Association – Photo Caption
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