Basal Cell Carcinoma medications & treatments

Medically reviewed by  Jamie Winn, PharmD

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Basal cell carcinoma (BCC) is the most common type of skin cancer and it accounts for almost 80% of all skin cancers. BCC affects close to 1 in 5 Americans and it’s estimated that 3.6 million cases of BCC are diagnosed in the United States each year. It affects men at a slightly higher rate than women and is 19 times more common in Caucasians than people of color, although it can affect any race.

What is basal cell carcinoma?

Basal cell carcinoma (BCC) is a type of non-melanoma skin cancer that was once known as basal cell epithelioma. BCC is the most common form of skin cancer in the world. It is a slow-growing tumor that usually starts in basal cells, which are found in the base of the epidermis (top layer of the skin). Basal cells are responsible for making new skin cells to replace the ones that die off. Metastases are rare with BCC.

BCC will typically appear as an abnormal growth on the skin. It can look like a wart, mole, open sore, transparent bump, or red patch. These lesions usually appear on areas of the body that are exposed to the sun, such as your face, head, or neck. Basal cell carcinomas can itch, bleed, crust, and are sometimes painful.

Basal cell carcinoma causes

While the exact cause of basal cell skin cancer is not known, exposure to ultraviolet (UV) rays is thought to be the main cause. Some other risk factors for BCC include:

• Sun exposure or use of a tanning bed (these 2 account for 90% of BCCs)
• Fair skin
• Family history of skin cancer
• Previous skin cancer
• Over 50 years of age
• Severe sunburns
• Weakened immune system from a medical condition or medication
• Certain rare genetic diseases
• Arsenic exposure
• Kidney dialysis

How is basal cell carcinoma diagnosed?

To properly diagnose BCC, your dermatologist or healthcare professional will examine your skin, look at your symptoms, review your medical history, and run some tests.

Basal cell carcinoma symptoms

Approximately 85% of BCCs occur on the face, head, and neck, but they can occur on other parts of the body. They usually appear as an abnormal growth or a sore that won’t heal. Some warning signs and symptoms of BCC include:

• A sore that doesn’t heal or heals and then comes back.
• A pink or reddish patch with an indention in the center.
• A shiny, skin-colored bump that is translucent (you can see through it)
• A scar-like lesion with poorly defined borders that is waxy and white or yellow in color
• A lesion with dark spots (brown, black, or blue) with a raised, translucent border
• A flat, scaly lesion with a raised edge

If your doctor suspects your symptoms may be due to skin cancer, they will take a biopsy. This involves them removing a part or all of the lesion to be examined under a microscope, looking for cancer cells. This is the definitive way of positively diagnosing skin cancer and determining what type it is.

What are some basal cell carcinoma treatment options?

The goal of BCC treatment is to completely get rid of the cancer and prevent it from coming back while minimizing scarring. Surgery is the first-line treatment, but some other therapies and medications may be used. Your treatment will depend on the size and location of the cancer, as well as how long you have had it. Early detection is key, and when caught early, most cases of BCC can be treated and cured.

Surgical excision

This procedure will involve your doctor removing the entire lesion along with a margin of healthy skin surrounding it. The margins are then examined under a microscope for cancerous cells. If they find cancer cells beyond the margins, follow-up surgeries will be performed until the margin cells are free of cancer. If the wound is too big for stitches after the tumor is removed, your doctor may do reconstructive surgery using a skin graft or flap. This will help heal the skin and restore its appearance. This procedure has up to a 98% cure rate but can cause significant scarring.

Mohs surgery

Mohs micrographic surgery is the most effective treatment for BCC with over a 99% success rate. Your doctor will remove the tumor and a small margin of tissue around and under the tumor site. They will examine the tissue under a microscope on-site to see if any cancer cells remain. If so, they will repeat the process until there is no evidence of cancer. This procedure is typically used for BCCs that have a high risk of coming back or for those in areas around the eyes, nose, lips, ears, fingers, toes, or genitals.

Curettage and electrodesiccation

During this procedure, your dermatologist will scrape off the top layer of the BCC using a curette. They will then use an electric needle and heat to kill any remaining cancer cells.

Cryosurgery

Cryotherapy involves freezing cancer cells with liquid nitrogen and can typically be done during an office visit. It is used for low-risk BCC or when surgery is not an option.

Radiation therapy

This non-invasive procedure uses X-ray beams to kill cancer cells. This may require several treatments over a few weeks or daily treatments for a specified time.

Photodynamic therapy (PDT)

PDT is a 2 part procedure that can be useful for superficial BCCs on the face and scalp. Your dermatologist will apply a topical solution to the lesion that will make it sensitive to light before activation by exposure to light (eg, laser).

Medications

Two topical medications you apply to the skin that have been approved by the U.S. Food and Drug Administration (FDA) for BCC are an immune response modifier, Aldara (imiquimod), and Efudex (5-fluorouracil), which is topical chemotherapy. Two oral medications used for BCC that have returned after treatment or spread to other parts of the body (metastatic) are Erivedge (vismodegib) and Odomzo (sonidegib).

In other advanced BCC cases, your doctor may recommend an infusion immunotherapy medication Libtayo (cemplimab), which is given in their office, a hospital, or a cancer treatment center.

What is the best medication for basal cell carcinoma?

The best medication for the treatment of BCC will depend on the individual’s specific medical BCC, medical history, medications that the individual is already taking that may potentially interact with BCC medications, and the individual’s potential response to the treatment. It is advisable to always speak with your healthcare provider about the best medication for you. The table below includes a list of the most prescribed or over-the-counter BCC medications approved by the Food and Drug Administration (FDA).

Your healthcare provider will determine the right dosage based on your response to the treatment, medical basal cell carcinoma, weight, and age. Other possible side effects may exist; this is not a complete list.

What are the most common side effects of basal cell carcinoma medications?

As with all medicines, those used for BCCwill have some side effects, depending on the class you are taking:

Topical treatments such as Aldara (imiquimod) and Efudex (5-fluorouracil) commonly cause application site reactions such as itching, burning, redness, and pain. They may also cause flaking and increased sensitivity to the sun.

Oral medications such as Erivedge (vismodegib) and Odomzo (sonidegib) can cause muscle spasms, hair loss, fatigue, nausea, diarrhea, and change in taste.

Libtayo (cemiplimab) is given via IV infusion and can cause fatigue, rash, nausea, diarrhea, muscle and joint pain, cough, and infusion site reactions.

What are some home remedies for basal cell carcinoma?

If you have BCC, you will need surgery or other medical treatments to get rid of your tumor. There are some preventive measures you can take to help protect your skin and reduce your risk of skin cancer.

Basal cell carcinoma prevention

Try some of these tips to prevent BCC:

• Protect your skin from the sun. Avoid the sun when possible or if you have to be outside wear sunscreen. The American Academy of Dermatology recommends using a sunscreen that has broad-spectrum protection, SPF 30 or higher, and water resistance.
• Avoid tanning beds. Unnecessary exposure to UV lights in tanning beds puts you at a higher risk for BCC.
• Wear protective clothing. Cover your skin with a long-sleeved shirt, pants, a broad-brimmed hat, and sunglasses with UV protection, when possible.
• Check your skin regularly. Perform a self-exam monthly and notify your dermatologist if you notice any new growth or skin changes

Frequently asked questions about basal cell carcinoma

What are some BCC warning signs?

You may have new growth or changes to your skin. Some things to look for include:

• Shiny, lump or nodule that has blood vessels visible in it.
• Crusty patches of skin that may bleed.
• A pink or reddish patch with an indention in the center.
• A scar-like lesion with poorly defined borders that is waxy and white or yellow in color
• A lesion with dark spots (brown, black, or blue) with a raised, translucent border
• A flat, scaly lesion with a raised edge

Is BCC a fatal disease?

BCC is a slow-growing tumor that with treatment has over a 99% cure rate. It typically does not affect other parts of the body. Metastatic BCC occurs in less than 1% of cases.

Is surgery the only treatment option for BCC?

No, there are other non-invasive treatments such as photodynamic therapy, radiation therapy, and 2 topical medications, Aldara (imiquimod), and Efudex (5-fluorouracil).

What parts of the body does BCC affect?

Although it can affect any part of the body, BCC lesions usually appear on areas that are exposed to the sun, such as your face, head, or neck.

What are some complications of BCC?

Complications of basal cell carcinoma include a risk of the BCC coming back, even after it’s been successfully treated. You will also have an increased risk of developing other forms of skin cancer such as squamous cell carcinoma. And although it’s very rare, BCC can metastasize to lymph nodes nearby or other areas of the body (bones, lungs).

Related resources for basal cell carcinoma

• Basal cell carcinoma overview. SkinCancer.org
• Basal cell carcinoma overview. MayoClinic
• Skin cancer types: Basal cell carcinoma. American Academy of Dermatology Association
• What is Basal cell carcinoma? WebMD
• Basal cell carcinoma symptoms and causes. Cleveland Clinic
• Basal cell carcinoma study. National Library of Medicine