Common Treatments for Basal and Squamous Cell Carcinomas

An introduction to skin cancer surgery, creams, and other treatments

Nonmelanoma skin cancers, such as basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), are the most common types of cancer around the world. Fortunately, they are also the most curable, especially when the tumors are relatively small and thin. The type of treatment chosen depends on how large the cancer is and where it is found on the body. Here is an overview of some of the most common options (an introduction to more rarely used treatments is also available):

Dermatologist examining patient for signs of skin cancer
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Simple surgical excision (removal) is used to treat both primary and recurrent tumors. The procedure involves surgically removing the tumor and a certain amount of normal-appearing skin surrounding it (the "margin"): for basal cell and squamous cell carcinomas, margins are often 2 to 4 mm. The cure rates following excision are 95% and 92% for primary BCC and SCC, respectively, and are dependent on the site, size, and pattern of the tumor. Excision may be performed in the outpatient or inpatient setting depending on the extent of cancer.

Topical Creams

Since its approval in 2004, the immune system activator imiquimod (also known by the brand name Aldara) has been a commonly prescribed topical (skin only) cream for small superficial and nodular basal cell carcinomas, as well as a pre-cancerous condition called actinic keratosis. It is spread on the lesion five times per week, usually for six weeks, and completely clears the skin in about 88% of patients or more, depending on the exact type of cancer. Another cream for superficial BCC is 5-fluorouracil (Carac or Efudex), a chemotherapy drug that is also used intravenously. These treatments usually don't leave any scars, but they can cause considerable pain and swelling as they work. Several other creams are being tested now, including ingenol mebutate (PEP005), which is derived from a plant called the "petty spurge."

Curettage and Electrodesiccation

Curettage is also used for keratoacanthomas, which are considered pre-squamous cell carcinoma. After scraping away the growth with a long spoon-like instrument called a curette, the physician uses a mild electric current to destroy any remaining abnormal cells. This scraping and the cauterizing process is typically repeated three times, and the wound tends to heal without stitches. It is best for primary, not recurrent, lesions.

The cure rates depend on the site: high-risk locations (nose, ear, chin, mouth) have a recurrence rate of 4% to 18%, depending on the tumor size. Recurrence rates decrease to 3% for tumors at low-risk sites of the trunk and extremities. Overall, the 5-year cure rates for primary BCC and SCC treated with C and E are 92% and 96%, respectively.

Mohs Surgery

The Mohs procedure (also known as Mohs micrographic surgery or margin controlled excision) is an advanced technique developed in the 1940s by Dr. Frederic E. Mohs for removing lesions due to basal or squamous cell carcinoma. It involves removing thin sections of the skin growth, layer by layer. Each layer is then examined under the microscope, and removal of layers continues until no cancerous cells remain.

It has the highest cure rate of any skin cancer treatment and doesn't cause as much scarring as other methods. It is especially useful for treating recurring skin cancer, larger tumors, tumors on the ear, eyelid, nose, lip, or hand, tumors in sites prone to recurrence, and the sclerotic subtype of basal cell carcinoma. It is the "gold standard" treatment: The 5-year recurrence rate is 1% for BCC and 3% for SCC. However, it is more costly, time-consuming, and labor-intensive than other methods.

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