Treatment Options for Advanced Basal Cell Carcinoma

Medically Reviewed by Brunilda Nazario, MD on January 25, 2021
3 min read

Surgery, radiation, and medications you put on your skin are the most common treatments for basal cell carcinoma (BCC). But sometimes they don’t work as well on advanced BCC.

The best treatment for you will depend on several factors, including:

  • Where your tumor is
  • How big your tumor is
  • How deep the tumor goes
  • How far the cancer has spread
  • Your overall health
  • Your medical history
  • Whether you’ve had treatment for the tumor before

Your doctor may recommend more surgeries, medications you take by mouth, or other options. They should also ask what you’d like to do and go over treatment cost. Here’s what you need to know.

This is when your doctor numbs your skin where the cancer is, then cuts the tumor out with a surgical knife. They’ll also cut off some of the nearby skin that’s normal. Your doctor will stitch the opening up. You’ll have a scar where the tumor used to be.

This is a good treatment choice when your tumor is small, has very clear borders, and is caught early. Your doctor will likely send the normal tissue to a lab to see if it has any cancer cells. If it doesn’t, this tells your doctor the surgery got rid of all of the tumor.

In this special type of surgery, a doctor takes out cancer tissue layer by layer, freezing each one as they go. They look at each layer under a microscope to search for cancer cells before moving on to the next one. This helps them make sure they get the whole tumor while easing scarring on your skin.

Doctors often use this surgery for advanced BCC that:

  • Is large in size
  • Is aggressive, or growing quickly
  • Doesn’t have clear borders
  • Has a high risk of coming back

Usually this procedure is best for skin on or surrounding your:

  • Eyes
  • Nose
  • Lips
  • Ears
  • Scalp
  • Fingers
  • Toes
  • Genitals, or private parts

Your doctor may use stitches to close up your surgical site or leave it to heal on its own.

Radiation uses low-energy X-ray beams to kill your tumor’s cancer cells. There’s no cutting involved, so you don’t need anesthesia to numb the area. You’ll likely need several sessions of radiation for it to work.

Radiation isn’t as clear-cut as other forms of treatment. Your doctor may choose it if:

  • Your tumor is hard to treat with surgery
  • You can’t have surgery because of your age or other health issues

You may get radiation along with other treatments. For example, if your tumor is touching nerves, your doctor may use radiation after surgery to try and make sure they get all of the cancer.

Radiation side effects can include:

  • Skin irritation, redness, blistering, or peeling
  • Changes in skin color
  • Hair loss in the area getting radiation
  • Damage to salivary (spit) glands or teeth when radiation is done nearby

You may be able to treat advanced BCC with topical chemotherapy if your advanced BCC hasn’t spread to other parts of your body. Two options are:

  • 5-fluorouracil
  • Imiquimod

These are lotions you apply that kill cancerous cells. You use them for 3 to 6 weeks. They only treat cancers near the surface of your skin. If your cancer is deep, topical chemotherapy won’t get rid of all of it.

You may need chemotherapy drugs through an IV if your advanced BCC is metastatic, or has spread to other parts of your body. These powerful drugs kill rapidly growing cells. They can cause many side effects, including:

  • Nausea and vomiting
  • Diarrhea
  • Hair loss
  • Loss of appetite
  • Fatigue
  • Fever
  • Mouth sores

Chemotherapy is rarely used for advanced BCC. Instead, doctors typically choose targeted drug therapies.

Targeted drug therapy

Advanced BCC that has spread deep into your skin or keeps coming back may respond best to targeted therapy. You take this medication by mouth. It finds the proteins, or abnormal genes or cells, that mark skin cancer cells. The drug then blocks signals for these cells to grow.

There are two approved targeted therapy drugs for treating advanced BCC:

  • Vismodegib (Erivedge)
  • Sonidegib (Odomzo)

These drugs are best for rare cases of metastatic basal cell carcinoma and skin cancer that’s deep or has come back a lot. Doctors usually suggest these drugs if surgery and radiation aren’t an option.

They may cause some side effects, including:

  • Muscle cramps
  • Hair loss
  • Weight loss
  • Fatigue
  • Loss of sense of taste

Show Sources


Cancer Support Community: “Advanced Basal Cell Carcinoma.”

Memorial Sloan Kettering Cancer Center: “Basal Cell Carcinoma Treatment.”

American Cancer Society: “Surgery for Basal and Squamous Cell Skin Cancers,” “Radiation Therapy for Basal and Squamous Cell Skin Cancers,” “Systemic Chemotherapy for Basal and Squamous Cell Skin Cancers.”

Skin Cancer Foundation: “Basal Cell Carcinoma Treatment.”

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