THE SURGERY CENTERPLANO DERMATOLOGY

Basal Cell Carcinoma

Basal cell carcinoma is the most common type of skin cancer. It typically develops on sun-exposed skin, grows slowly, and rarely spreads to other parts of the body — but left untreated it can be locally destructive, especially on the face.

Under the microscope, basal cell carcinomas grow in several patterns, and your biopsy report usually names yours. Nodular and superficial are two of them. Others, such as the infiltrative and morpheaform types, tend to reach beyond the edge that can be seen on the skin. In a prospective study of 1,686 basal cell carcinomas treated with Mohs surgery at 16 U.S. practices, morpheaform and infiltrative tumors needed the most stages to clear — and superficial tumors spread wider than their appearance suggested, too. The growth pattern is one of the things that guides the choice of treatment.

For most basal cell carcinomas, Mohs micrographic surgery is the most precise treatment: the cancer is removed layer by layer with 100% of the margin examined on site, sparing as much healthy tissue as possible. Cure rates are up to 99% for previously untreated cancers.

Other ways of removing a basal cell carcinoma that your dermatologist may discuss include standard excision — the most common treatment, and curative for many early tumors — and curettage and electrodesiccation (scraping and cautery) for low-risk tumors. For some early, low-risk tumors, a prescription cream such as imiquimod or 5-fluorouracil, or photodynamic therapy, may be offered, and radiation is an option when surgery is not possible. The American Academy of Dermatology notes that creams, photodynamic therapy, freezing, and radiation all carry lower cure rates than surgery.

Here, Mohs surgery for basal cell carcinoma is an outpatient visit under local anesthesia. Most tumors clear in one to two stages, each stage takes about an hour including the laboratory work, and once the margins are clear the repair typically follows the same morning. You will know the cancer is out before you leave.

A selection of the literature appears below ↓

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Macro detail of a laboratory microscope

When to come in

  • A new bump that looks pearly, shiny, or translucent
  • A sore that does not heal, or heals and returns
  • A scar-like or flat, flesh-colored area that changes over time
  • A biopsy-confirmed basal cell carcinoma referred for surgery
  • A basal cell carcinoma on the nose, eyelid, lip, or ear
  • A basal cell carcinoma that has come back after earlier treatment

How we treat it

Mohs micrographic surgery

Layer-by-layer removal with complete margin examination — the most tissue-sparing option.

Excision with margins

Conventional excision where Mohs is not indicated.

Reconstruction, typically the same day

Once the margins are clear, the wound is repaired — with stitches, a skin flap, a skin graft, or natural healing, whichever suits the site.

Your surgeon will walk you through what to expect — including preparation and aftercare — before anything is scheduled.

See also: Mohs surgery, in detail · Squamous cell carcinoma

Further reading: Is a Base Tan Protective? Does a Tanning Bed Once a Week Matter? · Do I Need Sunscreen in the Car or Indoors by a Window? · Do Silicone Scar Sheets Work? · Should You Put Hydrogen Peroxide or Rubbing Alcohol on a Cut? · Steri-Strips: When Do They Come Off, and Can I Remove Them Myself? · Should You Cover a Wound or Let It Breathe? · How Do I Know If My Stitches Are Infected? · Can Stitches Get Wet? When Can I Shower or Swim? · Can You Put Neosporin on Stitches? · Can Mohs Surgery Be Used for Melanoma? · Should You Put Neosporin on a Wound? · I Just Had a Melanoma. What Are My Odds of Getting Another One? · Is There Such a Thing as a Safe Amount of Sun?

Standard excision vs. Mohs surgery for basal cell carcinoma

CompareStandard excisionMohs micrographic surgery
How the margin is checkedThe tumor is removed with a planned border of normal-looking skin and sent to a pathology laboratory, which examines sections of the specimen's edges.Tissue is removed in thin, mapped layers, and 100% of the margin is examined under the microscope on site.
When you learn the resultUsually several days later. If tumor reaches an edge, another procedure may be needed.The same day, before the wound is repaired.
Healthy skin removedA set border all the way around the tumor.More tissue is taken only where the microscope shows cancer remains.
Typical fitMany basal cell carcinomas, especially small, well-defined tumors on the trunk, arms, and legs. It is the most common treatment for basal cell carcinoma, and many early tumors are cured this way.Tumors on the face, ears, hands, feet, and genital skin; tumors that have come back; aggressive growth patterns.
Recurrence in published studiesAbout 10% at five years for previously untreated tumors, in a widely cited review of the literature.About 1% at five years in the same review.

The five-year figures come from Rowe and colleagues' 1989 review, which pooled studies of different tumors from different eras — a pattern across the literature, not a head-to-head comparison. In a later randomized trial of high-risk facial basal cell carcinomas, ten-year recurrence was 4.4% after Mohs and 12.2% after standard excision for first-time tumors (a difference that did not reach statistical significance), and 3.9% versus 13.5% for tumors being treated after a recurrence (a difference that did). Both are sound operations; the right one depends on the tumor.

Common questions

Answers reflect the typical course — your surgeon will go over the specifics of your own plan.

Mohs surgery for basal cell carcinoma is an outpatient procedure under local anesthesia — you are awake and comfortable throughout. The visible tumor is removed along with a thin layer of surrounding tissue. That tissue is color-coded, mapped, and processed in our on-site laboratory, and your surgeon examines 100% of the margin under the microscope. If any cancer remains, only that spot is removed and the process repeats. Once the margins are clear, the wound is repaired — typically right away.

Sometimes. For early, low-risk tumors — typically on the back or legs rather than the face — options that exist include prescription creams (imiquimod or 5-fluorouracil) and photodynamic therapy, and radiation may be used when someone cannot have surgery. The American Academy of Dermatology is direct about the trade-off: the cure rate with creams, photodynamic therapy, freezing, or radiation is lower than with surgery. For the uncommon basal cell carcinoma that has grown deep or spread, FDA-approved oral medications such as vismodegib and sonidegib exist, usually managed with an oncologist. Whether a nonsurgical route is reasonable for your tumor is a conversation to have with your dermatologist.

Plan on about half a day. It is difficult to predict in advance how many stages a tumor will need; most tumors are clear in one to two stages, and each stage takes about an hour including tissue processing. The area is numbed with local anesthesia, so you should not feel pain during the surgery itself. Some mild soreness after the numbness wears off is normal, and pain medicine is routinely prescribed so you have it if you need it. Bring something to read — there will be waiting between stages while we read your tissue.

Any surgery will leave some scarring. Mohs surgery minimizes it by removing only cancerous tissue, and the repair is planned by the same team that removed the tumor. Scars typically improve significantly over 6 to 18 months. Waiting has a cost here: an untreated basal cell carcinoma keeps growing, and a larger tumor means a larger wound and a more visible scar.

Most patients do not need a driver to get home and are back to normal light activity the next day. Expect stitches for one to two weeks depending on the site, and hold off on strenuous exercise until they are out. The wound itself heals over a few weeks, and the scar continues to fade and soften over the following months. Our surgical team will follow you while your wound heals.

Spread to other parts of the body is rare. Coming back at the same spot is uncommon after Mohs surgery, but it can happen late: in a large review of published studies, only about half of recurrences appeared within the first two years, and 18 percent appeared between the fifth and tenth year. New basal cell carcinomas elsewhere are the more common event — in a pooled analysis of published studies, about 44 percent of people who had one basal cell carcinoma developed another within three years. Both are reasons for regular, long-term skin checks with your dermatologist.

It keeps growing — slowly, but without stopping. Over time it can grow deeper and wider, and in advanced cases reach the muscle and bone beneath; on the face, that means a larger operation and a more visible scar later. There is no need to panic over a new diagnosis, and no reason to wait either: referred patients are typically seen here within days of referral.

Guidelines and studies behind this page

For colleagues — and patients who want the data behind the approach.

  1. Kim JYS, et al; Work Group. Guidelines of care for the management of basal cell carcinoma. Journal of the American Academy of Dermatology. 2018;78(3):540-559.
  2. Rowe DE, Carroll RJ, Day CL Jr. Long-term recurrence rates in previously untreated (primary) basal cell carcinoma: implications for patient follow-up. Journal of Dermatologic Surgery and Oncology. 1989;15(3):315-328.
  3. van Loo E, et al. Surgical excision versus Mohs' micrographic surgery for basal cell carcinoma of the face: a randomised clinical trial with 10 year follow-up. European Journal of Cancer. 2014;50(17):3011-3020.
  4. Lim GF, Perez OA, Zitelli JA, Brodland DG. Correlation of basal cell carcinoma subtype with histologically confirmed subclinical extension during Mohs micrographic surgery: a prospective multicenter study. Journal of the American Academy of Dermatology. 2022;86(6):1309-1317.
  5. Marcil I, Stern RS. Risk of developing a subsequent nonmelanoma skin cancer in patients with a history of nonmelanoma skin cancer: a critical review of the literature and meta-analysis. Archives of Dermatology. 2000;136(12):1524-1530.
  6. American Academy of Dermatology. Basal cell carcinoma: From symptoms to treatments (patient information).
  7. National Cancer Institute. Skin Cancer Treatment (PDQ) — Health Professional Version.

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Squamous Cell Carcinoma

The second most common skin cancer — treated promptly because it can spread. High-risk tumors get immunostained margin control.

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Mohs Surgery for Melanoma

The most serious common skin cancer — treated here with same-day, margin-controlled Mohs surgery for appropriate cases.

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Actinic Keratosis

Treatment of precancerous sun-damage lesions before they can progress to squamous cell carcinoma.

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