By Dr Ananya Mandal, MD
Basal cell carcinoma is highly localized and very rarely spreads, meaning that treatment can achieve a cure rate of almost a 100%. Some of the methods for treatment include surgical and nonsurgical approaches.
Surgery is the most common approach to treating basal cell carcinoma and surgery can be divided into two types, destructive and excisional surgery.
This type of surgery attempts to destroy and kill the cancer cells.
One of the most common methods used is curettage and eletrodessication. An instrument called a curette is used to scrape off any cancer until the dermis is reached. An electrical device is then used to denature a layer of the dermis and the currette used again to remove denatured dermis until the surgeon is happy that reasonable margins have been achieved.
Curettage and cautery is best suited for low-risk lesions that are small, well defined and non-aggressive. With this therapy, the 5 year cure rates are around 97%.
Another example of destructive surgery is cryosurgery. This is used to treat both solitary and multiple lesions. This method employs the extremely cold tips of instruments to freeze and kill cancer cells. The lesion then forms a crust and falls off. Use of the curette before cryosurgery may improve the results.
Another destructive surgery technique is carbon dioxide (CO2) laser surgery. This is not a widely used form of treatment and is recommended for low-risk lesions.
Excisional surgery is used for cases where the tumor is completely removed, as well as some of the surrounding healthy flesh in order to provide a safety margin. Excisional surgery is a highly effective treatment for primary lesions.
After removal, the lesion is examined under a microscope. Curettage may be combined with excision. For recurrent or previously treated lesions, the success rates are lower than for primary or untreated lesions.
Mohs' micrographic surgery is one of the most accurate surgical methods for the excision of basal cell carcinoma. The technique allows accurate microscopic control which allows healthy tissue to be preserved while cancerous tissue is removed. High cure rates are achieved with this approach, even with lesions that are particularly difficult to treat.
Non surgical therapies
There are several nonsurgical approaches to treating basal cell carcinoma.
Radiotherapy describes the use of high energy beams which are directed at the lesion to destroy cancerous cells.
Skin therapy refers to the use of medications such as fluorouracil for treating lesions. Skin therapy is useful for low-risk, superficial lesions such as those found on the legs or trunk.
Photodynamic therapy is a treatment approach that involves priming the lesion with medication and then using laser beams to kill the cancer cells.
Chemotherapy with anticancer drugs is not usually necessary in the treatment of basal cell cancer. If the cancer is recurrent, multiple, aggressive and has spread to other organs, chemotherapy may be needed.
Reviewed by Sally Robertson, BSc