Basal Cell Carcinoma

• Highest cure rate (more than 99% for some tumours)
• A minimal amount of healthy tissue is removed
• Optimal cosmetic results

• Time consuming - the procedure will take up least half a day
• More expensive than other options

The site will generally heal well, however risks include bleeding, haematoma formation (blood clot under the surface of the skin which rarely requires drainage), dehiscence (the stitches may come apart requiring a longer period of healing and leaving a larger scar), flap or graft failure requiring a longer period of healing, infection, pain (which rarely may be persistent), unsightly scar - which may be keloid, raised, dipped or different in texture or colour (lighter, darker or redder compared to the adjacent skin), nerve damage, numbness or burning (which rarely can be permanent) and a small risk of recurrence of the tumour.

• Suitable for any body site
• Good cure rate with low risk of recurrence

• Scar may be longer than with Mohs surgery
• Lower cure rate than with Mohs surgery
• Stitches are required and the scar will take time to heal and gain full strength

For a surgical excision the site will generally heal well. The scar will on average be at least three times longer than the length of the lesion. Risks include bleeding, haematoma formation (blood clot under the surface which rarely needs to be drained surgically), dehiscence (the wound may come apart requiring a longer period of healing), infection, pain (which rarely may be persistent), damage to nerves or blood vessels, unsightly scar which may be keloid, raised, dipped or different in texture or colour (lighter, darker or redder compared to the adjacent skin), numbness or burning and the need for further treatment according to the results of pathology.

• Avoids need for surgery
• Minimaly invasive treatment

• Lower cure rate than surgery
• Multiple visits required to the hospital

The treatment is performed by an oncologist and they will discuss risks and benefits with you in detail. In general radiotherapy can cause textural change and scarring which usually comes on slowly over a number of years after the treatment. It can also slightly increase the risk of skin cancers in the treated area.

• Relatively simple procedure
• No stitches needed - scar is a similar size to the tumour

• Lower cure rate and higher risk of recurrance compared with other methods of surgical treatment
• Uncertain cosmetic appearance of the scar
• Can take longer to heal than wide local exicision (using stitches)

For curettage and cautery the lesion is removed by scraping (curettage) under local anaesthetic. This will generally leave a flat scar slightly larger than the lesion. Risks include bleeding, infection, pain (which rarely may be persistent), unsightly scar which may be keloid, raised, dipped or different in texture or colour (lighter, darker or redder compared to the adjacent skin), recurrence of the lesion and the need for further treatment according to the results of pathology.

• Treatment can be applied at home
• Can treat large areas if required
• Less invasive than surgical treatments

• Only suitable for superficial BCCs - not suitable for other subtypes
• Lower cure rate than surgical treatment
• Can be difficult to know whether the area has been fully treated
• Prolonged period of treatment

Imiquimod cream will induce inflammation in the skin. This will consist of redness, soreness, oozing, crusts and scabs. After completing the treatment course this reaction will settle over a few weeks. Rarely you may have a severe reaction or allergic reaction to the cream, this can cause ulceration, altered skin pigmentation and scarring. If you have concerns about the severity of the skin reaction you should contact me. As for any medication it is essential to read the information leaflet that comes within the packaging and contains a full list of all recognised side effects.

• Less invasive than surgical treatments
• Relatively non-invasive
• Good for sites which are at risk of poor healing such as the lower legs

• Only suitable for superficial BCCs - not suitable for other subtypes
• Treatment can be painful
• Not suitable for large areas
• Lower cure rate than surgical treatment
• Can be difficult to know whether the area has been fully treated

There will be some degree of discomfort during this light exposure. Rarely if the discomfort is significant it may be necessary to discontinue the treatment. After the treatment has been completed, a dressing will be applied which is to be kept on, usually for two days to prevent any further exposure to light. Common side effects are inflammation, redness and crusting. Uncommon side effects are blistering, bruising, itching, allergic reaction, increased hair growth or loss of hair and pigmentary change (areas of the skin may be left lighter, darker or redder than previously). There is also a risk that the treatment is ineffective or that the problem recurs. The PDT cream may contain peanut oil and it is very important that you inform the clinic if you are allergic to peanuts.

• Simple and quick treatment
• Less invasive than surgical treatments

• Only suitable for superficial BCCs - not suitable for other subtypes
• Pain / discomfort during the healing process
• Not suitable for large areas
• Lower cure rate than surgical treatment
• Can be difficult to know whether the area has been fully treated

Cryotherapy (freezing with liquid nitrogen) will cause inflammation of the skin which usually will settle within 1-2 weeks. There is a risk that the lesion may not respond to treatment or may recur. There will usually be some degree of colour change (skin may be redder, darker or lighter) in the initial weeks of healing and occasionally this can be permanent or there may be scarring of the skin.