Basal cell carcinoma is the most common type of skin cancer, affecting millions of people every year. While rarely life-threatening, this condition requires prompt attention to prevent local tissue damage and disfigurement. Understanding treatment options—from standard surgical approaches to innovative therapies being tested in clinical studies—can help patients and their families navigate the journey toward recovery and improved quality of life.

How Treatment Approaches Aim to Help Patients

The primary goal when treating basal cell carcinoma is to completely remove the cancerous tissue while preserving as much healthy skin as possible. This approach helps maintain both function and appearance, particularly when the cancer appears on visible areas like the face or neck. Because basal cell carcinoma typically grows slowly and rarely spreads to other parts of the body, early treatment offers an excellent chance of cure with minimal complications.^[1]

Treatment decisions depend on several factors that make each person’s situation unique. The location and size of the tumor matter greatly—a small growth on the arm might be treated differently than one near the eye. The specific subtype of basal cell carcinoma also influences the approach. Some forms, like nodular basal cell carcinoma (which appears as a round, pimple-like bump), may respond well to simpler treatments, while morpheaform types (which look like scars) often require more aggressive removal because they tend to spread deeper into surrounding tissue.^[3]

Patient characteristics also shape treatment planning. A person’s overall health status, their ability to undergo certain procedures, and whether they’ve had skin cancer before all factor into the decision-making process. Additionally, medical societies and expert panels have developed guidelines that help doctors choose the most appropriate treatment based on whether a tumor is considered low-risk or high-risk for coming back after treatment.

Beyond the established treatments that have been used for many years, researchers continue to explore new approaches through clinical trials. These studies test innovative therapies that might offer benefits for patients whose cancer cannot be treated with standard methods, or for those seeking alternatives to surgery. This ongoing research represents hope for people facing more challenging forms of the disease.

Established Treatment Methods for Basal Cell Carcinoma

Surgery remains the cornerstone of basal cell carcinoma treatment, with several proven techniques available depending on the tumor’s characteristics. Surgical excision is one of the most common approaches. During this procedure, a doctor cuts out the cancerous growth along with a margin of healthy tissue surrounding it. This margin acts as a safety buffer, helping ensure that all cancer cells have been removed. The tissue is then examined under a microscope to confirm complete removal. For many patients with low-risk tumors, surgical excision offers cure rates exceeding 95 percent.^[10]

Another surgical option is Mohs micrographic surgery, which is particularly valuable for high-risk tumors or cancers located in cosmetically sensitive areas. This specialized technique removes the cancer layer by layer. After each layer is removed, the surgeon immediately examines the tissue under a microscope while the patient waits. If cancer cells remain at the edges, another thin layer is removed from only that specific area. This process continues until no cancer cells can be detected. Mohs surgery preserves the maximum amount of healthy tissue while achieving very high cure rates, often above 99 percent for certain tumor types.^[10]

Curettage and electrodesiccation represents a simpler approach suitable for small, low-risk tumors. The doctor uses a sharp, spoon-shaped instrument called a curette to scrape away the cancer. Then, an electrical current is applied to destroy any remaining cancer cells and stop bleeding. This procedure may be repeated several times during the same session. While effective for appropriate cases, it typically leaves a round, whitish scar at the treatment site.^[10]

Cryosurgery uses extreme cold to freeze and destroy cancerous tissue. Liquid nitrogen is applied directly to the tumor, causing the cancer cells to die. This method works best for low-risk tumors on the trunk, arms, or legs. It’s a relatively quick procedure that doesn’t require cutting, but it may not be appropriate for tumors that extend deep into the skin or have unclear borders.^[11]

For patients who cannot undergo surgery—perhaps due to other health conditions, tumor location, or personal circumstances—radiation therapy offers an alternative. This treatment uses high-energy rays to destroy cancer cells. Radiation may require multiple sessions over several weeks, with each session lasting just a few minutes. It can be particularly useful for tumors in areas that are difficult to operate on, such as eyelids or ears. Radiation therapy may also be recommended after surgery if the cancer wasn’t completely removed, or for advanced cases where the tumor has grown extensively into nearby tissues.^[11]

For very small, superficial basal cell carcinomas, topical medications applied directly to the skin may be sufficient. Imiquimod is a cream that works by stimulating the body’s immune system to attack cancer cells. Patients typically apply it to the affected area several times per week for several weeks. Another topical option is fluorouracil (also called 5-FU), a chemotherapy drug that kills rapidly dividing cancer cells when applied to the skin. These medications are generally reserved for low-risk, superficial tumors on the trunk or limbs, where surgical scarring might be more noticeable or problematic.^[16]

Photodynamic therapy combines a light-sensitive medication with specific wavelengths of light to destroy cancer cells. First, a photosensitizing agent is applied to the tumor. After a waiting period that allows the medication to be absorbed by cancer cells, the area is exposed to a special light source that activates the drug, causing it to produce substances that kill the cancer. This approach may be used for superficial tumors in certain situations.^[10]

The duration of treatment varies considerably depending on the method chosen. A single surgical procedure might take anywhere from 30 minutes to several hours, particularly for Mohs surgery. Radiation therapy typically requires multiple visits over several weeks—often 15 to 30 sessions. Topical medications need to be applied daily or several times weekly for periods ranging from four to twelve weeks. Follow-up appointments after treatment are essential to monitor healing and watch for any signs that the cancer might return.

Side effects differ based on the treatment type. Surgical procedures can cause pain, bleeding, infection, and scarring. The extent of scarring depends on the tumor’s size and location, as well as the surgical technique used. Radiation therapy may cause skin redness, irritation, and fatigue that accumulates over the treatment course. Topical medications often cause local skin reactions including redness, swelling, crusting, and discomfort at the application site—these reactions actually indicate that the medication is working, but they can be bothersome for patients. Most side effects from these treatments are temporary and resolve after treatment ends.

Innovative Therapies Under Investigation

While standard treatments successfully cure the vast majority of basal cell carcinomas, researchers have developed new therapeutic approaches for situations where conventional options fall short. These innovations primarily target what doctors call locally advanced basal cell carcinoma—tumors that have grown too large or are located in areas where surgery or radiation would cause unacceptable damage. They also help patients with the extremely rare occurrence of metastatic basal cell carcinoma, where cancer has spread to other parts of the body.^[15]

The most significant breakthrough in treating advanced basal cell carcinoma involves drugs that block the Hedgehog signaling pathway. This biological pathway normally helps control cell growth and development, but mutations in genes related to this pathway drive the development of most basal cell carcinomas. When this pathway becomes abnormally active, cells multiply uncontrollably, forming tumors. By inhibiting this pathway, researchers can potentially slow or stop tumor growth.^[15]

Vismodegib was the first Hedgehog pathway inhibitor to receive approval from both the United States Food and Drug Administration (FDA) and the European Medicines Agency (EMA). This medication works by blocking a protein called Smoothened, which is a crucial component of the Hedgehog pathway. When Smoothened is blocked, the cancer-causing signals cannot reach the cell’s nucleus, and tumor growth slows. Vismodegib is taken as a pill once daily and represents a systemic therapy—meaning it travels through the bloodstream to reach cancer cells throughout the body.^[15]

Clinical trials testing vismodegib in patients with locally advanced basal cell carcinoma have shown that a significant number of patients experience tumor shrinkage. Some patients saw their tumors disappear completely, while others had substantial size reduction. These results offered hope to people who previously had very limited options. The trials evaluated patients who could not undergo surgery or radiation due to the tumor’s size, location, or because such treatments would cause too much damage to surrounding tissues.

However, Hedgehog pathway inhibitors come with their own set of side effects that patients and doctors must carefully consider. Common problems include muscle spasms or cramps, which can be quite uncomfortable. Many patients experience taste disturbances—food may taste different or have no taste at all, which can affect appetite and nutrition. Hair loss occurs in some patients, as the Hedgehog pathway plays a role in hair follicle function. Weight loss is also relatively common, sometimes resulting from taste changes and reduced appetite. Other side effects may include fatigue, nausea, and diarrhea. Because of these effects, some patients stop taking the medication before completing their full course of treatment.^[15]

Clinical trials involving these medications typically enroll patients whose disease meets specific criteria. To be eligible, patients usually must have locally advanced basal cell carcinoma that has recurred after surgery, or where surgery is inappropriate. Alternatively, they might have metastatic disease. Trials also evaluate whether patients are healthy enough to tolerate the treatment and don’t have other conditions that might interfere with the study. These studies have been conducted in multiple countries, including the United States and various European nations, giving patients in many regions access to these investigational treatments.

Researchers continue to study these and newer Hedgehog inhibitors to better understand how to use them most effectively. Questions being explored include: How long should patients take these medications? Can they be combined with other treatments? What can be done to reduce side effects? Can these drugs help prevent new basal cell carcinomas in high-risk patients? Ongoing clinical trials in Phase II (which focus on determining whether a treatment works and at what dose) and Phase III (which compare new treatments against standard treatments or placebo) continue to provide answers to these questions.

Beyond Hedgehog inhibitors, researchers are investigating other innovative approaches, though these remain in earlier stages of development. Some studies explore whether immunotherapy—treatments that harness the body’s immune system to fight cancer—might be effective for certain basal cell carcinomas. While immunotherapy has shown remarkable success in treating melanoma and other cancers, its role in basal cell carcinoma is still being defined through clinical research.

Scientists are also working to identify biomarkers that might predict which tumors are more likely to respond to specific treatments. This type of research could eventually allow doctors to personalize treatment plans based on the molecular characteristics of each patient’s cancer, potentially improving outcomes while minimizing unnecessary side effects.

Most common treatment methods

• Surgical treatments
  • Surgical excision removes the cancer along with a margin of healthy tissue, with cure rates often exceeding 95 percent for low-risk tumors
  • Mohs micrographic surgery removes cancer layer by layer with immediate microscopic examination, preserving maximum healthy tissue and achieving cure rates above 99 percent for many tumor types
  • Curettage and electrodesiccation scrapes away cancer using a curette, then applies electrical current to destroy remaining cells—suitable for small, low-risk tumors
  • Cryosurgery uses liquid nitrogen to freeze and destroy cancerous tissue, typically for low-risk tumors on the trunk, arms, or legs
• Radiation therapy
  • Uses high-energy rays to destroy cancer cells over multiple sessions spanning several weeks
  • Particularly useful for tumors in difficult surgical locations like eyelids or ears
  • May be used after incomplete surgical removal or for patients unable to undergo surgery
• Topical medications
  • Imiquimod cream stimulates the immune system to attack cancer cells, applied several times weekly for several weeks
  • Fluorouracil (5-FU) chemotherapy cream kills rapidly dividing cancer cells when applied to the skin
  • Reserved for low-risk, superficial tumors on the trunk or limbs
• Photodynamic therapy
  • Combines light-sensitive medication with specific light wavelengths to destroy cancer cells
  • Used for superficial tumors in selected cases
• Targeted therapy
  • Vismodegib blocks the Hedgehog signaling pathway that drives tumor growth
  • Taken as a daily pill for locally advanced or metastatic basal cell carcinoma
  • Reserved for cases where surgery or radiation is not feasible
  • Approved by FDA and EMA for advanced disease