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Basal Cell Skin Cancer: Should I Have Surgery or Use Medicated Cream?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Non-Interactive Decision Point

Basal Cell Skin Cancer: Should I Have Surgery or Use Medicated Cream?

Get the facts

Your options

  • Have surgery to remove basal cell skin cancer.
  • Use medicated creams to kill cancer cells.

Key points to remember

  • Basal cell skin cancer is almost always cured when it's found early and treated.
  • If the cancer is low-risk, you may have a choice between surgery and a medicated cream. Your doctor can tell you if your cancer is low-risk.
  • Surgery and medicated creams both have high cure rates for low-risk basal cell skin cancer, although surgery's cure rate is a little higher.
  • Possible side effects of both treatments include pain or discomfort and infection. Surgery leaves a scar, but the size of the scar varies from case to case. It can range from very visible to nearly invisible.
  • There are other treatments for this cancer. If you don't want to have surgery or use medicated cream, talk to your doctor about what else you might try, such as radiation, photodynamic therapy, or laser treatment.
FAQs

What is basal cell skin cancer?

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, such as muscles and bones. 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 the most common treatment for basal cell skin cancer.

If the cancer is the low-risk type, you may have a choice between surgery and a medicated cream. The cancer is usually low-risk if it's small, not deep, and has well defined borders. Your doctor will tell you if using a cream is a good option for you.

There are other treatments for this cancer, such as radiation and photodynamic therapy (applying a medicine and then shining a special light on it), and laser treatments. If you don't want to have surgery or use medicated cream, talk to your doctor about what else you might try.

Basal cell skin cancer sometimes comes back, no matter which treatment is used.

What surgeries are used for treatment?

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. The wound is closed with stitches. For larger areas, a skin graft or flap might be needed.
  • Mohs surgery. The doctor removes one layer of the skin cancer at a time. Each layer is examined under a microscope before the next layer is removed. When the doctor no longer finds cancer cells, the surgery is over.
  • Curettage and electrosurgery. The cancer is scraped out using a sharp instrument called a curette. Then the area is burned with an electric current that runs through a small metal tool or needle.
  • Cryosurgery. The cancer is destroyed by freezing it with liquid nitrogen. The nitrogen may be sprayed on or applied with a cotton-tipped stick.

Surgery for basal cell skin cancer cures 95 to 99 out of 100 cases, depending on the type of surgery.footnote 1, footnote 2 That means that in 1 to 5 cases out of 100, the surgery does not cure the cancer.

What creams are used for treatment?

The creams used to treat basal cell skin cancer are imiquimod and 5-FU (fluorouracil). They contain powerful medicines that cause a painful irritation in the treated area. The skin gets inflamed and crusts over as it heals.

You apply the cream every day or two for several weeks.

5-FU has a cure rate of 90 out of 100 for basal cell cancer that is superficial (only in the top layer of skin).footnote 3 That means that in 10 out of 100 cases, the cream does not cure the cancer.

Imiquimod has a cure rate of more than 75 out of 100 for superficial basal cell cancer.footnote 4 That means that in 25 out of 100 cases, the cream does not cure the cancer.

What are the risks of treatment?

Both surgery and medicated creams carry the risks of infection and pain or discomfort.

Both treatments have high cure rates, but the cure rate for creams is not as good as the cure rate for surgery.

Surgery usually leaves a scar. If a skin graft is used, it can tighten as it heals and make movement more difficult. Medicated creams don't leave scars. But there is a risk that they will leave some permanent patches of darker or lighter skin.

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

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Get surgery Get surgery
  • You have the surgery in a clinic and go home afterward.
  • You are awake for the surgery, but the area is numbed.
  • You treat the wound at home as it heals.
  • Surgery has a higher cure rate than creams.
  • With Mohs surgery, there is less chance of the cancer returning than with other surgeries and other treatments.footnote 1
  • Surgery usually leaves a scar.
  • Side effects may include infection and pain or discomfort.
  • The cancer may come back.
Use medicated cream Use medicated cream
  • You apply the cream at home every day or two for several weeks.
  • You are careful not to get the cream on other parts of your skin.
  • You take care to protect the treated area from the sun.
  • Treatment with a cream does not leave a scar.
  • The creams have high cure rates, although not as high as surgery.
  • The cream causes pain and a burning feeling when applied.
  • Side effects may include infection, flu-like symptoms, and permanent darker or lighter patches or spots in the treated area.
  • The cancer may come back.

Personal stories about considering surgery or medicated cream for basal cell skin cancer

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

Several people in my family have died of cancer. It wasn't skin cancer, but still, the word "cancer" just really scares me. I want the best possible cure rate, so I'm going to have surgery.

Kes, 42

I know this cancer isn't going to kill me. What really scares me is the whole idea of surgery, even minor surgery. If there's a way for me to avoid it, that's what I want.

Chad, 57

I'm not worried about scarring, because my cancer isn't where most people will ever see the scar. And I just want it over with. I'm going with surgery.

Paula, 68

I have a lot of my life still ahead of me, and I don't like the idea of carrying around a scar from surgery. I'm going to try a medicated cream. If that doesn't work, I can always try something else later.

Wesley, 30

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have surgery

Reasons not to have surgery

The idea of having surgery doesn't bother me.

I want to avoid surgery if possible.

More important
Equally important
More important

I'm not worried about having a scar after treatment.

I worry about having scars on my skin.

More important
Equally important
More important

I don't want treatment that takes several weeks.

I don't mind if treatment takes a while.

More important
Equally important
More important

It's important for me to have the treatment with the highest cure rate.

I feel confident that whatever treatment I have will cure the cancer.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having surgery

Using medicated cream

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1, Using a medicated cream instead of having surgery for basal cell skin cancer means that my skin will look as good as new after treatment is done.
2, Treating my basal cell skin cancer with a medicated cream will take longer than treating it with surgery.
3, The cure rate for treating my cancer with a medicated cream isn't as high as the cure rate for surgery, but it's still very good.

Decide what's next

1,Do you understand the options available to you?
2,Are you clear about which benefits and side effects matter most to you?
3,Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure
2, Check what you need to do before you make this decision.

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision 

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts 

Key concepts that you understood

Key concepts that may need review

Getting ready to act 

Patient choices

What matters to you 

Print Summary

Credits and References

Credits
AuthorHealthwise Staff
Primary Medical ReviewerPatrice Burgess, MD - Family Medicine
Primary Medical ReviewerE. Gregory Thompson, MD - Internal Medicine
Primary Medical ReviewerAdam Husney, MD - Family Medicine
Primary Medical ReviewerKathleen Romito, MD - Family Medicine
Primary Medical ReviewerMartin J. Gabica, MD - Family Medicine
Specialist Medical ReviewerRandall D. Burr, MD - Dermatology
References
Citations
  1. Carucci JA, et al. (2012). Basal cell carcinoma. In LA Goldman et al., eds., Fitzpatrick's Dermatology in General Medicine, 8th ed., vol. 1, pp. 1294-1303. New York: McGraw-Hill.
  2. Habif TP (2010). Premalignant and malignant nonmelanoma skin tumors. In Clinical Dermatology: A Color Guide to Diagnosis and Therapy, 5th ed., pp. 801-846. Edinburgh: Mosby Elsevier.
  3. Love WE, et al. (2009). Topical imiquimod or fluorouracil therapy for basal and squamous cell carcinoma: A systematic review. Archives of Dermatology, 145(12): 1431-1438.
  4. National Comprehensive Cancer Network (2010). Basal cell and squamous cell skin cancers. NCCN Clinical Practice Guidelines in Oncology, Version 1. Available online: http://www.nccn.org/professionals/physician_gls/PDF/nmsc.pdf.
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Basal Cell Skin Cancer: Should I Have Surgery or Use Medicated Cream?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the Facts

Your options

  • Have surgery to remove basal cell skin cancer.
  • Use medicated creams to kill cancer cells.

Key points to remember

  • Basal cell skin cancer is almost always cured when it's found early and treated.
  • If the cancer is low-risk, you may have a choice between surgery and a medicated cream. Your doctor can tell you if your cancer is low-risk.
  • Surgery and medicated creams both have high cure rates for low-risk basal cell skin cancer, although surgery's cure rate is a little higher.
  • Possible side effects of both treatments include pain or discomfort and infection. Surgery leaves a scar, but the size of the scar varies from case to case. It can range from very visible to nearly invisible.
  • There are other treatments for this cancer. If you don't want to have surgery or use medicated cream, talk to your doctor about what else you might try, such as radiation, photodynamic therapy, or laser treatment.
FAQs

What is basal cell skin cancer?

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, such as muscles and bones. 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 the most common treatment for basal cell skin cancer.

If the cancer is the low-risk type, you may have a choice between surgery and a medicated cream. The cancer is usually low-risk if it's small, not deep, and has well defined borders. Your doctor will tell you if using a cream is a good option for you.

There are other treatments for this cancer, such as radiation and photodynamic therapy (applying a medicine and then shining a special light on it), and laser treatments. If you don't want to have surgery or use medicated cream, talk to your doctor about what else you might try.

Basal cell skin cancer sometimes comes back, no matter which treatment is used.

What surgeries are used for treatment?

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. The wound is closed with stitches. For larger areas, a skin graft or flap might be needed.
  • Mohs surgery. The doctor removes one layer of the skin cancer at a time. Each layer is examined under a microscope before the next layer is removed. When the doctor no longer finds cancer cells, the surgery is over.
  • Curettage and electrosurgery. The cancer is scraped out using a sharp instrument called a curette. Then the area is burned with an electric current that runs through a small metal tool or needle.
  • Cryosurgery. The cancer is destroyed by freezing it with liquid nitrogen. The nitrogen may be sprayed on or applied with a cotton-tipped stick.

Surgery for basal cell skin cancer cures 95 to 99 out of 100 cases, depending on the type of surgery.1, 2 That means that in 1 to 5 cases out of 100, the surgery does not cure the cancer.

What creams are used for treatment?

The creams used to treat basal cell skin cancer are imiquimod and 5-FU (fluorouracil). They contain powerful medicines that cause a painful irritation in the treated area. The skin gets inflamed and crusts over as it heals.

You apply the cream every day or two for several weeks.

5-FU has a cure rate of 90 out of 100 for basal cell cancer that is superficial (only in the top layer of skin).3 That means that in 10 out of 100 cases, the cream does not cure the cancer.

Imiquimod has a cure rate of more than 75 out of 100 for superficial basal cell cancer.4 That means that in 25 out of 100 cases, the cream does not cure the cancer.

What are the risks of treatment?

Both surgery and medicated creams carry the risks of infection and pain or discomfort.

Both treatments have high cure rates, but the cure rate for creams is not as good as the cure rate for surgery.

Surgery usually leaves a scar. If a skin graft is used, it can tighten as it heals and make movement more difficult. Medicated creams don't leave scars. But there is a risk that they will leave some permanent patches of darker or lighter skin.

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

2. Compare your options

  Get surgery Use medicated cream
What is usually involved?
  • You have the surgery in a clinic and go home afterward.
  • You are awake for the surgery, but the area is numbed.
  • You treat the wound at home as it heals.
  • You apply the cream at home every day or two for several weeks.
  • You are careful not to get the cream on other parts of your skin.
  • You take care to protect the treated area from the sun.
What are the benefits?
  • Surgery has a higher cure rate than creams.
  • With Mohs surgery, there is less chance of the cancer returning than with other surgeries and other treatments.1
  • Treatment with a cream does not leave a scar.
  • The creams have high cure rates, although not as high as surgery.
What are the risks and side effects?
  • Surgery usually leaves a scar.
  • Side effects may include infection and pain or discomfort.
  • The cancer may come back.
  • The cream causes pain and a burning feeling when applied.
  • Side effects may include infection, flu-like symptoms, and permanent darker or lighter patches or spots in the treated area.
  • The cancer may come back.

Personal stories

Personal stories about considering surgery or medicated cream for basal cell skin cancer

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"Several people in my family have died of cancer. It wasn't skin cancer, but still, the word "cancer" just really scares me. I want the best possible cure rate, so I'm going to have surgery."

— Kes, 42

"I know this cancer isn't going to kill me. What really scares me is the whole idea of surgery, even minor surgery. If there's a way for me to avoid it, that's what I want."

— Chad, 57

"I'm not worried about scarring, because my cancer isn't where most people will ever see the scar. And I just want it over with. I'm going with surgery."

— Paula, 68

"I have a lot of my life still ahead of me, and I don't like the idea of carrying around a scar from surgery. I'm going to try a medicated cream. If that doesn't work, I can always try something else later."

— Wesley, 30

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have surgery

Reasons not to have surgery

The idea of having surgery doesn't bother me.

I want to avoid surgery if possible.

       
More important
Equally important
More important

I'm not worried about having a scar after treatment.

I worry about having scars on my skin.

       
More important
Equally important
More important

I don't want treatment that takes several weeks.

I don't mind if treatment takes a while.

       
More important
Equally important
More important

It's important for me to have the treatment with the highest cure rate.

I feel confident that whatever treatment I have will cure the cancer.

       
More important
Equally important
More important

My other important reasons:

My other important reasons:

  
       
More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having surgery

Using medicated cream

       
Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Using a medicated cream instead of having surgery for basal cell skin cancer means that my skin will look as good as new after treatment is done.

  • True
  • False
  • I'm not sure
You're correct. Although treatment with creams doesn't leave scars, it sometimes leaves permanent white or dark patches of skin.

2. Treating my basal cell skin cancer with a medicated cream will take longer than treating it with surgery.

  • True
  • False
  • I'm not sure
That's right. Surgery is done in the doctor's office, and then it's over. The cream is applied by you at home every day or two for several weeks.

3. The cure rate for treating my cancer with a medicated cream isn't as high as the cure rate for surgery, but it's still very good.

  • True
  • False
  • I'm not sure
You're right. Although the cure rates for medicated creams aren't as high as the cure rates for surgery, they're still pretty high.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

     
Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.
 
Credits
ByHealthwise Staff
Primary Medical ReviewerPatrice Burgess, MD - Family Medicine
Primary Medical ReviewerE. Gregory Thompson, MD - Internal Medicine
Primary Medical ReviewerAdam Husney, MD - Family Medicine
Primary Medical ReviewerKathleen Romito, MD - Family Medicine
Primary Medical ReviewerMartin J. Gabica, MD - Family Medicine
Specialist Medical ReviewerRandall D. Burr, MD - Dermatology
References
Citations
  1. Carucci JA, et al. (2012). Basal cell carcinoma. In LA Goldman et al., eds., Fitzpatrick's Dermatology in General Medicine, 8th ed., vol. 1, pp. 1294-1303. New York: McGraw-Hill.
  2. Habif TP (2010). Premalignant and malignant nonmelanoma skin tumors. In Clinical Dermatology: A Color Guide to Diagnosis and Therapy, 5th ed., pp. 801-846. Edinburgh: Mosby Elsevier.
  3. Love WE, et al. (2009). Topical imiquimod or fluorouracil therapy for basal and squamous cell carcinoma: A systematic review. Archives of Dermatology, 145(12): 1431-1438.
  4. National Comprehensive Cancer Network (2010). Basal cell and squamous cell skin cancers. NCCN Clinical Practice Guidelines in Oncology, Version 1. Available online: http://www.nccn.org/professionals/physician_gls/PDF/nmsc.pdf.
Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.

Current as of: May 3, 2017

Author: Healthwise Staff

Medical Review: Patrice Burgess, MD - Family Medicine & E. Gregory Thompson, MD - Internal Medicine & Adam Husney, MD - Family Medicine & Kathleen Romito, MD - Family Medicine & Martin J. Gabica, MD - Family Medicine & Randall D. Burr, MD - Dermatology