Basal Cell Carcinoma Treatments and Medications

No one wants to be told they have cancer, but not all cancers are created equal. Admittedly, some cancers are genuinely bad news, however, basal cell carcinoma, the single most common cancer in the world, is a slow-growing cancer. It very rarely spreads to other parts of the body. The good news, then, is that most basal cell carcinomas can be cured. But don’t celebrate too early. Basal cell carcinoma can and does recur—often in the same place—so it pays to stay vigilant.

What is basal cell carcinoma?

Basal cell carcinoma, or BCC, is a cancer of the layer of cells in the lower part of the epidermis, the visible part of the skin. Basal cells continually divide to replenish the top layer of the epidermis, made of squamous cells, which are shed constantly since they areexposed to the outside environment.

Skin cancers are the most common type of cancer worldwide, and basal cell carcinoma is the most common skin cancer. Over 4 million people in the United States are diagnosed with this cancer each year. That number rises every year. Currently, two out of five people can expect to develop BCC in their lifetime.

Fortunately, basal cell carcinoma is a slow-growing cancer that only rarely metastasizes or turns lethal. However, it will invade the healthy skin surrounding it. If not properly treated, it can do extensive local damage and even destroy nerves and other structures in the skin.

There are several different types of basal cell carcinoma, but the most common types are nodular or superficial basal cell carcinoma. Sun exposure and tanning bed use are the single greatest risk factors for basal cell carcinoma. Ultraviolet light damages DNA in certain cells, causing them to grow out of control. However, not all BCC is caused by ultraviolet light exposure. Other risk factors include:

• Fair skin

• Male gender

• Advancing age

• History of skin cancer

• Scars

• Exposure to arsenic

• Radiation treatment

• Some types of inherited disorders

Three out of four basal cell carcinomas appear on the head or neck. Early diagnosis and treatment are critical to minimizing disfigurement.

How is basal cell carcinoma diagnosed?

Basal cell carcinoma is diagnosed with a skin examination, but a biopsy is needed to definitively diagnose the condition and identify its type. Diagnosis may be started by a general practitioner, but the final diagnosis and treatment will usually fall to a dermatologist, a doctor who specializes in skin conditions.

In a physical exam, the doctor will closely examine the lesion. While basal cell carcinoma typically does not have symptoms, the doctor will study the appearance of the lesions to make a diagnosis. A basal cell carcinoma tumor typically looks like a small, shiny pimple or nodule. It is usually pink or flesh-colored, but sometimes could be darker than the surrounding skin. Tiny spider veins may surround the lesion. Some types look more like a scar or develop into a sore. In many cases, basal cell carcinoma can easily be mistaken for eczema, psoriasis, or sun damage (actinic keratosis).

BCC lesions usually appear on the face, but they may also be found on the shoulders, chest, or back. There may be more than one lesion. The doctor will perform a careful examination of your entire skin surface looking for other lesions.

A skin biopsy is required to make a final diagnosis. A small tissue sample of the lesion will be removed and examined by a pathologist.

Basal cell carcinoma treatment options

The goal of basal cell carcinoma treatment is to eradicate the cancer, prevent recurrence, and minimize scarring or disfigurement. Surgery is the primary treatment, but less-invasive surgical procedures, radiation therapy, or medications may be used to supplement or substitute for surgery.

Surgery

Basal cell carcinoma is primarily treated with surgery. Not only does surgery remove the cancer, but it also results in the lowest recurrence rates. While surgeons strive for the best possible cosmetic result, surgery will cause scarring. For larger or more extensive tumors, cosmetic surgery or skin grafts may be required to minimize disfigurement.

Mohs surgery

The gold standard for basal cell cancer treatment is Mohs surgery, which has close to a 100% cure rate, a 1% recurrence rate, and minimizes the size of the wound and scarring. The cancerous cells and surrounding healthy tissue are removed in layers and examined under a microscope. The surgery proceeds layer by layer until there is no cancer visible under microscopic examination. Unfortunately, it is an expensive and time-consuming surgery, so it is usually reserved for larger, deeper, or higher-risk tumors.

Surgical excision

More commonly, basal cell carcinoma is just surgically removed (excised). The tumor and a small margin of surrounding tissues are cut out. The procedure is fast, inexpensive, and has a cure rate of 97% to 98% and a 10% recurrence rate. However, a long healing process and visible scarring are common.

Electrodesiccation and curettage (EDC)

Another common surgery for smaller basal cell carcinoma tumors is to first scrape away the upper layers of the tumor with a curette. An electrical needle is then used to generate an electrical spark that dehydrates and kills the remaining cancer cells (electrodesiccation).

Cryotherapy

Cryosurgery is a less-invasive alternative for low-risk basal cell carcinoma. A dermatologist freezes and kills the tumor and surrounding tissues by applying liquid nitrogen to the skin. The procedure is quick but may leave thick, raised scars or change the color of the skin.

Photodynamic therapy (PDT)

For patients with multiple tumors or bleeding problems, photodynamic therapy may be offered as an alternative to surgery. A photosensitive chemical is injected into the tumor and absorbed only by cancer cells. When the skin is exposed to intense light, the chemical changes into a poison that kills the cancer cells while leaving healthy cells intact. The cure rate is low (72%) and the recurrence rate is high (over 40%). Follow-up treatment is often required.

Radiation therapy

Radiotherapy eradicates basal cell carcinoma cells with targeted X-rays. It may be used after surgery or in cases where surgery is not possible due to underlying medical conditions.

Medications

Medications are normally not prescribed for basal cell carcinoma. Patients with low-risk superficial BCC may be offered topical medications as an alternative to surgery. While these drugs are highly successful at clearing the tumor and don’t leave scars, the recurrence rate is higher than surgery. In rare cases in which the cancer has spread to other parts of the body, systemic medications may be used.

Basal cell carcinoma medications

Medications are not commonly used to treat basal cell carcinoma. Topical drugs may be prescribed in some cases before, after, or in place of surgery. If the cancer is low-risk and caught early, patients may be given the option of using topical medications rather than undergoing surgery. Advanced, inoperable cases will be treated by systemic drugs.

Topical immunomodulators

Some patients may be prescribed topical imiquimod either in place of surgery or before surgery to shrink the tumor’s size. Imiquimod activates immune system cells to attack the cancer. Regimens with application for six weeks may have up to a 100% clearance rate for superficial basal cell carcinoma, but clearance rates are less for other types of BCC and overall long-term recurrence rates are higher than surgical treatment.

Topical chemotherapy

Antimetabolites are chemotherapy drugs that kill cancer cells by interfering with their ability to synthesize and repair their genetic information. For basal cell skin cancer, topical 5-fluorouracil (5-FU) cream applied twice daily for up to twelve can clear as high as 90% of superficial basal cell carcinoma tumors.

Hedgehog pathway inhibitors

Less than one percent of basal cell carcinomas metastasize and cannot be surgically removed. Doctors treat these cases with hedgehog pathway inhibitors. The “hedgehog pathway” is a series of chemical reactions in cells that cause them to differentiate into particular types of cells, like nerve cells or stomach cells. Active in human embryo cells, the hedgehog pathway is inactive in adult cells. In basal cell carcinoma, one type of hedgehog pathway, the Sonic hedgehog pathway, is improperly activated, leading to the production of tumor cells. Taken orally, drugs such as Erivedge (vismodegib) and Odomzo (sonidegib) shut this pathway down, leading to tumor response in 50-60% of patients (dependent upon locally advanced or metastatic designation).

What is the best medication for basal cell carcinoma?

Treatment for basal cell carcinoma will be highly individualized. Surgery is the mainstay, and most cases won’t require drug treatment. Only a limited number of medications are prescribed for basal cell carcinoma, but there is no “best” medication.

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What is the best medication for basal cell carcinoma?