Treatment and follow-up of superficial basal cell carcinomas

The choice of treatment for superficial basal cell carcinomas (BCCs) depends on patient and lesion factors (eg site and extent of lesions, patient age, comorbidities [especially immunosuppression], patient preference, and treatment cost; see also Features indicating high and low risk of recurrence of basal cell carcinomas for risk stratification of BCCs).

Well-defined primary superficial BCCs at low-risk sites may be treated with liquid nitrogen cryotherapy. See Cryotherapy for actinic keratoses for more information, including cryotherapy aftercare.

Alternative therapy for a primary superficial BCC is topical therapy with imiquimod. Use:

imiquimod 5% cream topically, at night 5 times a week (on consecutive nights) for 6 weeks. For detailed information on correct application, see the product information. imiquimod imiquimod imiquimod

Curettage and cautery can also be used for patients with well-demarcated superficial BCCs on the trunk and proximal limbs.

Photodynamic therapy is an option for selected superficial BCCs in low-risk sites. Photodynamic therapy involves application of a photosensitiser to the affected skin, followed by activation with light. Various photosensitisers and light delivery techniques are available. Good technique and patient selection are important for optimal response.

Cryotherapy, topical field therapy (including photodynamic therapy), curettage and cautery are not suitable for BCCs with aggressive histological patterns, recurrent superficial BCCs, or BCCs at high-risk sites (eg head and neck; see also Features indicating high and low risk of recurrence of basal cell carcinomas). These potentially high risk BCCs should be excised.
After treatment of a BCC, follow-up is recommended to identify new and recurrent lesions. The recommended follow-up depends on patient and tumour risk factors; see Features indicating high and low risk of recurrence of basal cell carcinomas. Annual follow-up is reasonable.