Version May 2024
| Treatment modality | |
| Surgical excision | Advantages |
| Margin controlled. Usually performed under local anesthesia. Area of tissue removed (including important structures) can be more precisely controlled than with cryosurgery, radiation therapy, or electrosurgery, therefore limiting unnecessary damage to critical structures. Resultant scar can be optimized both cosmetically and functionally. | |
| Disadvantages | |
| Occasionally performed under conscious sedation or general anesthesia with their inherent risks. Random margin results in both a poorer cure rate compared with Mohs and the unnecessary sacrifice of normal tissues, which in critical or cosmetically sensitive areas results in potentially unnecessary disfigurement. | |
| Mohs surgery | Advantages |
| 100% margin control. Offers highest cure rate for both primary and recurrent BCCs while maximizing preservation of normal tissue. No sedation or general anesthesia required. | |
| Disadvantages | |
| More costly than simple excision, cryosurgery, or electrosurgery (not radiation). Invasive. Longer procedure compared with simple excision, cryosurgery, or electrosurgery (not radiation). Requires special training in the technique. | |
| Cryosurgery | Advantages |
| Cost effective, relatively quick, requires a single visit, potential excellent cosmesis and cure rate in appropriately selected tumors, no sedation or general anesthesia required. | |
| Disadvantages | |
| Not margin controlled. Requires considerable experience on the part of the clinician, wound care, pigmentary changes, possible permanent damage to underlying nerves or other critical structures. | |
| Curettage and electrodessication | Advantages |
| Cost effective, relatively quick, requires a single visit, relatively easy wound care, well suited for multiple lesions, usually affords good to excellent cosmetic results, no sedation or general anesthesia required, and offers low recurrence rates in small, primary BCCs that lack "high-risk" features. | |
| Disadvantages | |
| Not margin controlled. Recurrence rate unacceptably high with larger (>5 mm) lesions located in high-risk sites, requires special equipment, requires experience in its use to achieve higher cure rates. Poor choice in most BCCs of the head. Must be cautious in patients with pacemakers. | |
| Radiation therapy | Advantages |
| Noninvasive. High cure rate for selected lesions. Relative sparing of critical structures. Good for patients who are not otherwise candidates for surgery. Relatively painless. | |
| Disadvantages | |
| Not margin controlled. Requires repeat office visits. Poorer long-term cosmetic results. Generally avoid in younger patients, in lesions located on the trunk or extremities, in deeply invasive lesions, or previously irradiated sites. More expensive than simple excision, Mohs surgery, cryotherapy, and electrosurgery. | |
| Topical fluorouracil and imiquimod | Advantages |
| Noninvasive. Rarely causes scarring. Avoids operative risks. Able to use in patients who are otherwise not candidates for surgery. | |
| Disadvantages | |
| Limited role for superficial BCCs located in low-risk areas. Brisk, inflammatory reaction that can be poorly tolerated. Requires prolonged application. |
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