Treatments for basal cell carcinoma

The following are treatment options for basal cell carcinoma (BCC) of the skin. Your healthcare team will suggest treatments based on the risk group. They will work with you to develop a treatment plan.

BCC is most often treated with local therapy. This means that only the cancer on the skin and the area around it are treated. Surgery is the main local therapy used for BCC.

If BCC has spread to other parts of the body, systemic therapy may be used. Systemic therapy travels through the bloodstream to reach and destroy cancer cells all over the body. Targeted therapy and immunotherapy are some systemic therapies that may be used for BCC.

Surgery is usually offered for BCC. The type of surgery done depends on the risk group, where the cancer is located and the size of the cancer.

Surgical excision removes the cancer along with some normal tissue around it (called the surgical margin). It is a standard treatment for BCC in all risk groups.

Mohs surgery removes the cancer in layers, little by little, until no cancer remains. It is mainly done for high-risk BCC, especially on the face, or when high-risk BCC could not be completely removed by surgical excision. It may also be used to treat recurrent BCC.

Curettage and electrodesiccation (C&E) uses a sharp tool (called a curette) to scrape the cancer and remove it from the body. Then the area is treated with an electrical current to destroy any remaining cancer cells. It is commonly used for low-risk BCC. It is often used for small cancers on the neck, the central part of the body (called the trunk), arms or legs.

Cryosurgery uses extreme cold to freeze and destroy tissue. It is mainly used to treat low-risk BCC on the trunk of the body, arms or legs.

A skin graft or a skin flap may be done to repair the skin and nearby area after BCC is removed. Skin from another area of the body is removed and placed over the surgical area to cover the open wound and repair the skin. It may be done if a large area of skin is removed to make sure the cancer is completely gone.

Find out more about surgery for non-melanoma skin cancer.

Radiation therapy uses high-energy rays or particles to destroy cancer cells. It is used instead of surgery when the cancer is in an area that is hard to treat, such as an eyelid or ear.

Radiation therapy may also be used:

• to treat BCC that was not completely removed by surgery (called incomplete excision)
• when BCC has grown into nearby areas (called locally advanced BCC) or has spread to other parts of the body (called metastatic BCC)

Find out more about radiation therapy for non-melanoma skin cancer.

Drug therapy uses drugs to treat BCC. The type of drug therapy used depends on where the cancer is located.

Topical therapy is given as a cream, or ointment that contains a drug and is applied on the skin. It may be used to treat small, superficial or low-risk BCC on the neck, trunk of the body, arms or legs. The topical therapies that may be used for BCC are:

• the chemotherapy drug fluorouracil (also called 5-fluorouracil or 5-FU)
• the immunotherapy drug imiquimod (Aldara, Zyclara)

Topical therapy drugs are usually put on the growth or abnormal area once a day for several weeks.

Targeted therapy uses drugs to target specific molecules (such as proteins) on or inside cancer cells to stop the growth and spread of cancer cells. The targeted therapy drugs that may be used for BCC are:

• vismodegib (Erivedge)
• sonidegib (Odomzo)

They may be used for locally advanced or metastatic BCC when surgery or radiation can’t be used. These drugs are given daily as a pill.

Immunotherapy helps to strengthen or restore the immune system's ability to fight cancer. The immunotherapy drugs that may be used for BCC are:

• cemiplimab (Libtayo)
• pembrolizumab (Keytruda)

These drugs may be used for locally advanced BCC that was already treated with a hedgehog pathway inhibitor, such as vismodegib. They are given by a needle into a vein (intravenously) every 2 or 3 weeks.

Systemic chemotherapy is not usually offered for localized BCC. But it may be used for BCC that has grown into nearby areas or BCC that has spread. The most common chemotherapy drug used is cisplatin. It is given intravenously. It may be used alone or combined with the chemotherapy drug paclitaxel.

Find out more about drug therapy for non-melanoma skin cancer.

You may be offered photodynamic therapy (PDT) for superficial or low-risk BCC. It uses a light-sensitive drug (photosensitizer) and a special type of light to destroy cancer cells. PDT may be used for a small tumour if it is in a very visible place on your body.

Find out more about photodynamic therapy for non-melanoma skin cancer.

Talk to your doctor about clinical trials open to people with non-melanoma skin cancer in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.