What are the surgical options for the treatment of basal cell carcinoma (BCC)?

Updated: Mar 02, 2020
  • Author: Robert S Bader, MD; Chief Editor: William D James, MD  more...
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Answer

The goal of therapy for patients with BCC is removal of the tumor with the best possible cosmetic result. By far, surgical modalities are the most studied, most effective, and most used BCC treatments. The effectiveness of surgical modalities depends heavily on the surgeon's skills; considerable differences in cure rates have been observed among surgeons. Modalities used include electrodesiccation and curettage, excisional surgery, Mohs micrographically controlled surgery, and cryosurgery. [74, 75, 76]

National Comprehensive Cancer Network (NCCN) guidelines recommend that low-risk BCC in non–hair-bearing areas be treated with curettage and electrodessication. If fat is reached, surgical excision should generally be performed. Standard excision is an alternative, if the lesion can be excised with 4-mm clinical margins and second-intention healing, linear repair, or skin graft. Margins should be assessed postoperatively. High-risk patients should undergo excision with postoperative margin assessment or a Mohs resection. [7]

The American Academy of Dermatology, in collaboration with the American College of Mohs Surgery, the American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery, has developed appropriate use criteria for Mohs micrographic surgery. These include criteria for rating the appropriateness of Mohs micrographic surgery in 69 basal cell carcinoma scenarios. [77]

Some studies suggest that dermato-oncological surgery is associated with a high risk of infection. [40] This risk is greater in patients with diabetes and in those having such surgery in the thigh or lower leg and foot.

See Surgical Treatment of Basal Cell Carcinoma for more complete information on this topic.


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