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11 treatment settings, 6 with more than one named option. Each section lays out the options the standard of care names, what each is for, the trials behind them with their recorded results, the side effects and cautions on record, and questions to ask. Built from the cancer page's standard-of-care rows; nothing here is advice for your case.
Answer a few questions from a report and read the guideline statement that applies, quoted word for word with its source. Educational aids, not advice.
Standard excision with 4 mm margin, curettage and electrodesiccation, or topical imiquimod / 5-FU / photodynamic therapy for superficial lesions.
The 1957 chemotherapy that remains the backbone of treatment for bowel, stomach, pancreatic, anal, head and neck and breast cancers, and as a cream for skin precancers.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
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Mohs micrographic surgery or excision with complete margin assessment; radiotherapy if surgery not feasible.
IMRT and IGRT shape the radiation beam to the tumour's outline from multiple angles and check the patient's position with a scan before every session, so surrounding organs receive less dose. Fewer, larger doses are now standard in breast and prostate cancer, but a low-dose bath still spreads across normal tissue.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
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Vismodegib or sonidegib; cemiplimab after hedgehog-inhibitor failure or intolerance; multidisciplinary review for surgery/radiotherapy after response.
Vismodegib was the first hedgehog-pathway drug, for basal cell carcinomas too advanced for surgery; it shrinks most tumours but muscle cramps, taste loss and hair loss make long-term use hard.
Sonidegib (Odomzo) is the second hedgehog inhibitor for locally advanced basal cell carcinoma, similar in effect and side effects to vismodegib.
A PD-1 blocker that is the standard for advanced skin squamous cell carcinoma, and in 2025 became the first adjuvant immunotherapy for it.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
No side-effect rates or interaction flags are recorded for these options yet. The side-effect lookup and interaction checker cover the products that have them.
Add these to your appointment list, or take the full question set for this cancer.
For a superficial or low-risk nodular basal cell carcinoma this is a real choice and not a formality, so here are the numbers instead of the phrase several options are available. Surgery has the highest cure rate: the Cochrane review of 52 randomised trials and 6,690 participants concluded that surgical interventions have the lowest recurrence rates. In the UK SINS trial, 501 people with primary nodular or superficial disease at low-risk sites were randomised between imiquimod cream (once daily, six weeks for superficial and twelve for nodular) and excision with a 4 mm margin: treatment succeeded in 83.6 percent against 98.4 percent at three years and 82.5 percent against 97.7 percent at five, and most cream failures happened in the first year. Among the non-surgical options, a Dutch trial of 601 people with superficial disease gives the ranking at five years: imiquimod 80.5 percent tumour-free, fluorouracil cream 70.0 percent, photodynamic therapy 62.7 percent. Curettage and cautery, scraping the lesion away and sealing the surface with heat, usually repeated two or three times in one sitting, is a surgical option for low-risk disease; the BAD notes that unlike an excision it leaves no margins for a pathologist to check but is generally considered effective for a low-risk basal cell carcinoma. Cryotherapy is offered for superficial lesions and the BAD says it generates a wound that usually heals with a scar. Now the other side, because cure rate is not the only axis. Creams take weeks of a visibly inflamed, itching, weeping face (in SINS, itching in 211 of the imiquimod group against 129 of the surgery group); photodynamic therapy causes moderate to severe pain and burning during the treatment itself; and the cosmetic result of the non-surgical options is better, not worse. The Cochrane review found observers rated the outcome good or excellent in 60.6 percent after imiquimod against 35.6 percent after excision, and after photodynamic therapy against excision 87.1 percent against 46.6 percent, while patients rated imiquimod and surgery the same. So: surgery is one appointment and the highest cure rate and a scar; a cream is six to twelve weeks of a sore face, a one-in-six chance of failure, and usually a better-looking result. Both are defensible. Not treating at all is a third option the BAD names for a slow-growing lesion on a non-critical site or where someone could not tolerate treatment.
Imiquimod (Aldara) is a cream that provokes the skin's own immune system to clear superficial basal cell carcinomas and the sun-damage patches (actinic keratoses) that can turn into skin cancer.
The 1957 chemotherapy that remains the backbone of treatment for bowel, stomach, pancreatic, anal, head and neck and breast cancers, and as a cream for skin precancers.
Methyl aminolevulinate is a cream applied to sun-damaged skin or a superficial basal cell carcinoma and then activated with red light, clearing precancerous and early skin cancers with better cosmetic results than surgery or freezing.
Aminolevulinic acid is painted on sun-damaged skin and then activated with a lamp, destroying actinic keratoses before they can become skin cancer; in Europe the gel is also approved for superficial basal cell carcinoma.
Red or near-infrared lasers and lamps that switch on a light-sensitive drug sitting in a tumour. Each drug has its own colour, so the machine is matched to the drug: skin lamps for sun damage, fibre-optic lasers for the oesophagus, lung and bladder, and a new near-infrared laser for the head and neck.
Multidisciplinary tumour boards are regular meetings where surgeons, oncologists, radiologists and pathologists review each patient's case with the full dataset and agree a plan before treatment starts. They are mandatory in the UK and for accreditation in the US, Europe and Germany, and change the diagnosis or plan in 10 to 30% of cases, though randomised evidence is lacking.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
Add these to your appointment list, or take the full question set for this cancer.
Two different questions get muddled here and they have different answers. Will this one come back: usually not, and the risk depends on what it was and how it was treated. In the Dutch randomised trial of high-risk facial basal cell carcinoma, ten-year recurrence was 4.4 percent after Mohs and 12.2 percent after standard excision for primary tumours, and 3.9 against 13.5 percent for recurrent ones; the same trial found that 56 percent of the recurrences of primary tumours appeared more than five years after treatment, which is why a clear five years is reassuring but is not the end of the story for a high-risk lesion on the face. Will I get another one: probably, and sooner than you would guess. In a meta-analysis of 17 studies, the three-year cumulative risk of a further basal cell carcinoma after a first was 44 percent, at least ten times the rate of first tumours in a comparable population, while the risk of a squamous cell carcinoma after a basal cell carcinoma was 6 percent. Those are cohort figures rather than a prediction for you, and they are about new cancers on damaged skin rather than this one returning. What follow-up is offered follows from that, and it is lighter than most people expect. The BAD says not everyone needs it, that people are usually discharged if the recurrence risk is low and they are not at high risk of future skin cancers, and that it is considered for advanced disease, a high risk of recurrence, or a high risk of multiple cancers such as people with weakened immune systems or genetic syndromes. Cancer Research UK says an early basal cell carcinoma may mean a single follow-up appointment and then none. Being discharged is not being dropped: it is a transfer of the surveillance to you, and both the BAD and Cancer Research UK are explicit about what you are then meant to do, which is check your own skin monthly, ask someone to look at the places you cannot see, and go to the GP for any mark that is growing, changing, bleeding or not healing, including a change where this one was treated.
Organised follow-up for the 18 million US and 50+ million global cancer survivors: watching for recurrence and second cancers, managing long-term side effects such as heart damage, infertility, neuropathy and fatigue, and helping people return to work and life.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
Add these to your appointment list, or take the full question set for this cancer.
This is a real choice and the numbers for it exist. In 601 Dutch patients with superficial basal cell carcinoma, five-year tumour-free survival was 80.5 per cent with imiquimod cream, 70.0 per cent with fluorouracil cream and 62.7 per cent with methyl aminolevulinate photodynamic therapy; imiquimod beat photodynamic therapy with a hazard ratio for failure of 0.48 and fluorouracil with 0.65. Against surgery all of them lose: SINS randomised 501 people in the United Kingdom and found clinical success at five years of 82.5 per cent with imiquimod against 97.7 per cent with excision, a relative risk of 0.84 whose confidence interval fell below the non-inferiority margin, so imiquimod is inferior rather than unproven. Cryotherapy matched photodynamic therapy on five-year recurrence, 20 against 22 per cent, and lost badly on appearance, 16 against 60 per cent excellent. Failures come early in every one of these trials, so a lesion still clear at a year is likely to stay clear.
Imiquimod (Aldara) is a cream that provokes the skin's own immune system to clear superficial basal cell carcinomas and the sun-damage patches (actinic keratoses) that can turn into skin cancer.
The 1957 chemotherapy that remains the backbone of treatment for bowel, stomach, pancreatic, anal, head and neck and breast cancers, and as a cream for skin precancers.
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
Clinical success at three years 84 per cent with imiquimod against 98 per cent with surgery (relative risk 0.84, 98 per cent confidence interval 0.78 to 0.91, p<0.0001), and at five years 82.5 against 97.7 per cent; imiquimod was inferior, not non-inferior.
Five-year recurrence 20 per cent after cryotherapy against 22 per cent after methyl aminolevulinate photodynamic therapy (p=0.86), with an excellent cosmetic outcome in 16 against 60 per cent (p=0.00078).
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The creams and the light are licensed for the thin superficial form, and stretching them to the thicker nodular form has been tested twice with the same answer. Methyl aminolevulinate photodynamic therapy against excision gave five-year recurrence of 14 against 4 per cent and a sustained complete response of 76 against 96 per cent, with an excellent or good cosmetic outcome in 87 against 54 per cent. Scraping the tumour off first and then applying imiquimod, tested in the SCIN trial, gave freedom from treatment failure at five years of 77.8 against 98.2 per cent, a relative risk of failure of 15.93. Both are defensible for someone who cannot or will not have facial surgery, and neither is equivalent to it.
This setting names no product or technology record yet; the approach above is the standard as written. Ask your team which specific treatments they mean.
Five-year recurrence 14 per cent after methyl aminolevulinate photodynamic therapy against 4 per cent after excision (sustained complete response 76 against 96 per cent, p=0.01), with an excellent or good cosmetic outcome in 87 against 54 per cent.
Freedom from treatment failure at five years 77.8 per cent after curettage with imiquimod against 98.2 per cent after surgical excision; relative risk of failure 15.93 (95 per cent confidence interval 2.10 to 120.64), non-inferiority not concluded.
No side-effect rates or interaction flags are recorded for these options yet. The side-effect lookup and interaction checker cover the products that have them.
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For a large facial basal cell carcinoma where the operation would cost an eyelid or a nostril, a hedgehog inhibitor can be given first. VISMONEO gave vismodegib for a mean of 6.0 months to 55 patients with a mean lesion size of 47.3 mm and downstaged the planned surgery in 44 of them (80 per cent, 67 to 90), with 27 complete responses of which 25 were proved on biopsy. The part usually left out belongs in the conversation: at three years 16 of those 44 patients had a known recurrence, 36 per cent. The drug changes the operation, it does not replace it.
Vismodegib was the first hedgehog-pathway drug, for basal cell carcinomas too advanced for surgery; it shrinks most tumours but muscle cramps, taste loss and hair loss make long-term use hard.
Surgical downstaging in 44 of 55 patients (80 per cent, 95 per cent confidence interval 67 to 90) with 27 complete responses, an objective response rate of 71 per cent, and recurrence in 16 of the 44 downstaged patients (36 per cent) by three years.
No side-effect rates or interaction flags are recorded for these options yet. The side-effect lookup and interaction checker cover the products that have them.
Add these to your appointment list, or take the full question set for this cancer.
Vismodegib and sonidegib work and most people stop taking them. STEVIE gave vismodegib to 1,215 patients in ordinary practice: response was 68.5 per cent in locally advanced disease, 98 per cent had a treatment-emergent adverse event, 23.8 per cent had a serious one, and the median treatment duration was 8.6 months, with only 12 per cent still taking it at the analysis. The characteristic events are muscle spasms, loss of taste, hair loss and weight loss, none dangerous and all wearing. Most of them resolve within a year of stopping. Intermittent dosing, neoadjuvant courses and topical delivery are the three attempts to get round it.
Vismodegib was the first hedgehog-pathway drug, for basal cell carcinomas too advanced for surgery; it shrinks most tumours but muscle cramps, taste loss and hair loss make long-term use hard.
Sonidegib (Odomzo) is the second hedgehog inhibitor for locally advanced basal cell carcinoma, similar in effect and side effects to vismodegib.
Pills that block a developmental signalling pathway hijacked by basal cell skin cancer, shrinking tumours that cannot be operated on; also used in some leukaemia.
Investigator-assessed response 68.5 per cent in locally advanced and 36.9 per cent in metastatic basal cell carcinoma, with treatment-emergent adverse events in 98 per cent, serious events in 23.8 per cent and a median treatment duration of 8.6 months.
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Cemiplimab, a PD-1 antibody. In 84 patients with locally advanced disease who had progressed on, could not tolerate, or had no better than stable disease after nine months of a hedgehog inhibitor, objective response by independent central review was 31 per cent (21 to 42) with five complete responses; grade 3 or 4 treatment-emergent adverse events occurred in 48 per cent and serious events in 35 per cent. It was approved in February 2021 on that single-arm evidence and there is no randomised comparison. That basal cell carcinoma responds to checkpoint blockade at all is not obvious for a tumour that almost never spreads, and is explained by its very high ultraviolet mutational burden.
A PD-1 blocker that is the standard for advanced skin squamous cell carcinoma, and in 2025 became the first adjuvant immunotherapy for it.
Immune checkpoint inhibitors are antibodies against CTLA-4, PD-1 or PD-L1 that release the brakes on T cells so they attack the cancer. They are approved in more than 20 tumour types and produce lasting, sometimes curative responses that chemotherapy rarely does, but most patients do not respond and autoimmune side effects are the cost.
Objective response by independent central review in 26 of 84 patients (31 per cent, 95 per cent confidence interval 21 to 42) with five complete responses; grade 3 or 4 treatment-emergent adverse events in 48 per cent.
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Less than the approvals suggest. NICE technology appraisal TA489 recommendation 1.1 does not recommend vismodegib within its marketing authorisation for metastatic basal cell carcinoma or for locally advanced disease unsuitable for surgery or radiotherapy: the committee found the comparison with best supportive care not good enough for decision-making and the cost per quality-adjusted life year much higher than 30,000 pounds. Recommendation 1.2 allows anyone already on it to continue. There is no NICE appraisal of sonidegib, and none of cemiplimab in basal cell carcinoma. The commonest cancer in human beings has one NICE technology appraisal and it is a refusal.
Vismodegib was the first hedgehog-pathway drug, for basal cell carcinomas too advanced for surgery; it shrinks most tumours but muscle cramps, taste loss and hair loss make long-term use hard.
Sonidegib (Odomzo) is the second hedgehog inhibitor for locally advanced basal cell carcinoma, similar in effect and side effects to vismodegib.
A PD-1 blocker that is the standard for advanced skin squamous cell carcinoma, and in 2025 became the first adjuvant immunotherapy for it.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
No side-effect rates or interaction flags are recorded for these options yet. The side-effect lookup and interaction checker cover the products that have them.
Add these to your appointment list, or take the full question set for this cancer.