Treatment Options
Basal Cell Carcinoma
Basal Cell Carcinoma (BCC) is a non-worrying form of skin cancer that does not have a risk of spreading elsewhere in the body or causing you health problems, however if left untreated it will grow deeper and wider. Treatment options include surgical treatments and radiotherapy. Some low-risk "superficial" BCCs can also be treated with topical treatment or photodynamic therapy.
Mohs Surgery
Mohs Surgery is a method for precisely removing skin cancers. It is most commonly used on the head and neck and is not generally suitable for the body. The tumour is initially removed with a narrow margin and over the course of several hours additional stages are removed using a microscope to check the margins are free of cancer.
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Wide Local Excision
The tumour is removed with a margin of approximately 4mm and the defect is stitched to leave a scar that is usually at least 3 times as long as the tumour. Cure rates can be up to 95% for certain tumours. It is a good option for most body sites, but for sensitive facial sites, Mohs surgery may be a better option as it allows narrower margins and preservation of healthy skin.
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Radiotherapy
Radiotherapy can be an effective treatment for BCC. It generally involves a number of treatments over several weeks. The cure rate depends upon the site and nature of the tumour but generally will be lower than for surgical excision or Mohs micrographic surgery. The treatment is performed by an oncologist and you should meet with them if you would like further information about this treatment option.
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Curettage and Cautery
The tumour is removed by scraping (curettage) or superficial shaving (saucerisation) under local anaesthetic to leave a scar a little larger than the size of the tumour. It is less invasive than other surgical treatments but the risk of recurrence or incomplete treatment is significantly higher. It is rarely advised for higher risk tumours or sensitive facial sites.
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Topical Treatment
Certain low risk 'superficial' BCCs can be treated with creams - the evidence is strongest for imiquimod, however efudix is also sometimes used. I will most commonly prescribe imiquimod. Typically the cream will need to be applied for a number of weeks and if it is succesful there will be inflammation, blistering and crusting.
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Photodynamic Therapy
Low risk 'superficial' BCCs can be treated with photodynamic therapy. A sensitizing gel is applied and left to sink into the skin then ultraviolet light is applied from a lamp. Two treatments are required separated by a week. Each treatment can take up to two hours or longer.
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Cryotherapy
Low risk 'superficial' BCCs can be treated with cryotherapy - freezing with liquid nitrogen. The treatment is relatively quick and easy but there will often be significant inflammation and/or blistering or crusting after the treatment.
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