Basal Cell Skin Cancer: Should I Have Surgery?

Basal cell skin cancer is the abnormal growth of cells in the skin. It's almost always cured when it's found early and treated.

This cancer grows slowly. Over time, it can damage deeper tissues. But it doesn't usually spread, or metastasize, to other parts of the body.

It's usually caused by too much sun. Tanning beds and sunlamps can also cause it.

Surgery is usually the recommended treatment for basal cell skin cancer.

If the cancer is the low-risk type, you may have a choice between surgery and other treatments.

• Low-risk basal cell skin cancer is small and is only on the top part of the skin. It has a clear border. It is located only in certain areas of the body, such as the back, chest, arms, or legs.
• High-risk basal cell skin cancer is usually larger in size or located on an area of the body such as the face or hands. A skin cancer is also high risk if it has come back again after treatment.

Basal cell skin cancer sometimes comes back, no matter which treatment is used. If it comes back, it can be treated again.

The type of surgery you have may depend on where the cancer is and how big it is. Some surgeries cause more scarring than others. The surgeries include:

• Standard surgery. The area is numbed and the doctor cuts out the cancer. A small amount of tissue around the cancer is also removed. This helps to make sure all the cancer is cut out. The wound is closed with stitches.
• Curettage and electrodessication. The area is numbed. Then the cancer is scraped out using a sharp instrument called a curette. Electrodessication controls the bleeding. It also destroys any cancer cells that may still be there.

Surgery and nonsurgical treatments work well to get rid of low-risk basal cell skin cancer. Surgery works better to keep the cancer from coming back.^{footnote 1}

The other treatment options you have may depend on where the cancer is and how big it is. Treatment options may include:

• Medicated creams. Strong medicine is applied to the skin. It causes redness and irritation in the treated area. The skin gets inflamed and crusts over as it heals. You apply the cream at home for 3 to 6 weeks.
• Cryosurgery. This destroys the cancer by freezing it. It is also called cryotherapy.
• Radiation therapy. This destroys cancer cells with high energy rays, such as X-rays. It often requires several visits.
• Photodynamic therapy. Medicine is put on the skin. Then a special light is used to activate the medicine.

These treatments work well to get rid of low-risk basal cell skin cancer. But surgery works better to keep the cancer from coming back.^{footnote 1}

Both surgery and other, nonsurgical, treatments carry the risks of infection, bleeding, and pain or discomfort.

Surgery usually leaves a scar. Other treatments usually don't leave scars. But in some cases, they can leave the skin lighter or darker in the treated area.

The risks of nonsurgical treatments depend on the type of treatment. For example, medicated cream can cause pain and burning when you put it on. You will likely have redness, irritation, and crusting of your skin during the weeks of treatment. Radiation therapy usually requires repeated visits to the doctor's office. It may cause fatigue. You may have redness, swelling, scaling, and hair loss in the area that is treated.

No matter which treatment you choose, there's always a risk that the cancer could come back.