For general education, not medical advice. This guide can’t diagnose you or replace care from your own clinician. If you’re worried about a spot or symptom, see a board-certified dermatologist.
BCC (BCC) is the most common skin cancer. It starts in the basal cells at the base of the outer skin layer, usually on sun-exposed areas like the face, ears, neck, and hands. It grows slowly and rarely spreads to other parts of the body. But left alone, it can grow into nearby skin, cartilage, and bone. The good news: caught early, it is highly curable.
Key points
- BCC is the most common skin cancer; it grows slowly and rarely spreads, but it can damage nearby tissue if untreated.1
- It is highly curable. Surgery is the usual first choice. Other treatments fit selected tumors or people who cannot have surgery.2
- A biopsy confirms the diagnosis, and because new spots and recurrences can appear years later, ongoing skin checks matter.3
What is basal cell carcinoma?
BCC is a cancer of the basal cells in the outer layer of skin. The main cause is years of ultraviolet light, from the sun or tanning beds. It is very common. One study estimated more than 5 million BCCs and SCCs treated across the United States in 2012. It found similar rates of the two cancers among Medicare patients. That split should not be applied to everyone in the country.1
How BCC behaves is what makes it both serious and very treatable. It grows slowly, and it rarely spreads to other organs. The harm comes from local growth. On the face, a tumor left alone can damage the skin, cartilage, and tissue near the eyes, nose, and ears. So it is treated even though it rarely spreads.4
Signs and what to look for
BCC can look like several things, so any spot that is new, changing, or not healing is worth checking. Common signs include:
- A pearly or shiny bump, sometimes with tiny visible blood vessels
- A flat, scaly, reddish patch
- A sore that bleeds, scabs, heals, and comes back in the same place
- A waxy, scar-like area with poorly defined edges
These can appear skin-colored, pink, brown, or black. A spot that keeps bleeding or will not heal is a classic clue.
How it is diagnosed
Diagnosis starts with a skin exam, often using a handheld magnifier (dermoscopy). The diagnosis is confirmed with a biopsy, where a small sample is taken and checked under the microscope. The biopsy also tells the type, or subtype, of BCC, which guides treatment.3
Tumors are then sorted into lower-risk and higher-risk groups. That group drives the choice of treatment. A BCC is higher-risk if it has an aggressive type under the microscope, sits on the central face, is large, has fuzzy borders, has come back before, or grows in someone with a weak immune system.4
How it is treated
Most BCCs are cured with treatment done in the office. The right option depends on the tumor's risk group, size, location, and your preferences. The grid covers care for tumors that can be treated at the skin site. The rows apply to different risk groups. They are not a head-to-head ranking for every BCC.
Read all source findings
Surgical excision
Review of 52 randomized trials, mostly low-risk BCC: surgical treatments had the lowest recurrence rates. Evidence for differences between surgical methods in high-risk facial BCC was low certainty.
van Loo E, Mosterd K, Krekels GAM, et al. Eur J Cancer. 2014;50(17):3011–3020.
RCT, high-risk facial BCC, 10-year follow-up: recurrence after standard excision 12.2% (new) and 13.5% (returning); 56% of recurrences in new tumors appeared after 5 years.
Nagore E, Grau C, Molinero J, Fortea JM. J Eur Acad Dermatol Venereol. 2003;17(2):167–170.
Retrospective series of 273 BCCs in 248 people, with follow-up available for 151 cases: five-year recurrence was 26% with involved margins versus 14% with clear margins. The authors recommended individualized management based on site and histology.
Kim JYS, Kozlow JH, Mittal B, et al. J Am Acad Dermatol. 2018;78(3):540–559.
AAD guideline: surgery is the mainstay; office-based therapy cures most BCC caught early.
Mohs surgery (margin-controlled; high-risk / recurrent sites)
Mosterd K, Krekels GAM, Nieman FH, et al. Lancet Oncol. 2008;9(12):1149–1156.
RCT, facial BCC, 5-year: recurrent tumors recurred 2.4% (margin-controlled) vs 12.1% (standard excision), p=0.015; for new tumors the difference (2.5% vs 4.1%) was not significant (p=0.397).
van Loo E, Mosterd K, Krekels GAM, et al. Eur J Cancer. 2014;50(17):3011–3020.
10-year follow-up: new tumors 4.4% vs 12.2% (p=0.100, not significant); returning tumors 3.9% vs 13.5% (p=0.023).
Cochrane: for high-risk facial primary BCC there may be slightly fewer recurrences with margin-controlled surgery, but the evidence is low-certainty.
Topical imiquimod (low-risk superficial/nodular)
Bath-Hextall F, Ozolins M, Armstrong SJ, et al. Lancet Oncol. 2014;15(1):96–105.
SINS RCT (n=501): 3-year success 84% (imiquimod) vs 98% (surgery), RR 0.84.
Williams HC, Bath-Hextall F, Ozolins M, et al. J Invest Dermatol. 2017;137(3):614–619.
5-year success 82.5% (imiquimod) vs 97.7% (surgery); most cream failures in year 1.
Cochrane: imiquimod had more recurrence than excision (16.4% versus 1.6% at three years). Patient-rated cosmetic differences were unclear. Observer ratings favored cream, but the certainty of that cosmetic evidence was low.
Photodynamic therapy (superficial / thin BCC)
Basset-Séguin N, Ibbotson SH, Emtestam L, et al. Eur J Dermatol. 2008;18(5):547–553.
Randomized superficial-BCC comparison: five-year recurrence was 22% after MAL-PDT versus 20% after freezing. Good or excellent cosmetic outcomes were 60% versus 16%. Recurrence difference was not statistically clear.
Peris K, Fargnoli MC, Garbe C, et al. Eur J Cancer. 2019;118:10–34.
European guideline: PDT is an option for superficial and thin nodular low-risk BCC, with regimen and tumor selection important. It is not a substitute for surgery in thick or high-risk disease.
Cryotherapy or curettage & electrodesiccation (low-risk)
Peris K, Fargnoli MC, Garbe C, et al. Eur J Cancer. 2019;118:10–34.
European guideline: curettage, cautery, and cryotherapy are options for low-risk superficial BCC.
Kim JYS, Kozlow JH, Mittal B, et al. J Am Acad Dermatol. 2018;78(3):540–559.
AAD guideline: destructive options are reserved for low-risk tumors; surgery is preferred for higher-risk lesions.
Radiotherapy (non-surgical candidates)
Cochrane: one older trial found more four-year recurrence after radiotherapy than surgery (6.4% versus 0.6%) and worse cosmetic outcomes. This does not establish the result for every current radiation technique.
Peris K, Fargnoli MC, Garbe C, et al. Eur J Cancer. 2019;118:10–34.
European guideline: radiotherapy is a valid alternative to surgery on the face, especially in the elderly.
Surgery is the usual first choice. It removes the tumor and allows the tissue edges to be checked. In the trials reviewed by Cochrane, surgery had the lowest risk of the cancer coming back.2 For some high-risk, returning, or central-face tumors, Mohs surgery checks the edges during the visit.4 In one trial of high-risk facial BCC, 10-year return rates after standard surgery were about 12% for new tumors and 14% for returning ones. After Mohs, the rates were about 4% for both groups. The difference was statistically clear for returning tumors, but not for new ones. These results do not apply to all BCCs.56
Some low-risk tumors have other choices. Prescription creams, freezing, scraping with cautery, and light treatment may suit selected tumors. The type and depth matter. These options do not all suit the same tumors. Most have less lasting clearance than surgery.2 A trial of imiquimod cream found fewer tumors stayed clear than with surgery, but patients did not report a clear cosmetic difference.7 In the Cochrane review, an observer rating favored the cream. The cosmetic evidence was low certainty.2 Radiation can be used when surgery is a poor fit. In the trial evidence, more tumors came back after radiation than after surgery.2
When BCC cannot be treated with surgery or radiation
A medical oncologist may offer pills or infusions if BCC grows too far into nearby tissue or spreads. This is a different setting from the office treatments above. Tumor shrinkage in these trials is not the same outcome as cure after surgery.
Hedgehog-blocking pills. Vismodegib and sonidegib block a signal that helps BCC grow. In one vismodegib study, tumors shrank in 43% of people with disease that had grown too far nearby and 30% of those with spread to distant sites. There was no control group.8 In the BOLT study, sonidegib 200 mg had response rates of 56% for disease grown far nearby and 8% for disease at distant sites. That trial compared two doses, not sonidegib with surgery or another drug. The distant-spread group was small.9 The pills can cause muscle cramps, hair loss, changes in taste, and weight loss. In the United States, sonidegib is approved for disease grown far nearby, not disease at distant sites. The cancer team checks which drug fits the diagnosis and its approved use.10
Immunotherapy after a hedgehog drug. Cemiplimab is an infusion that helps immune cells attack cancer. In a single-group trial after hedgehog drugs stopped helping or could not be used, 31% of people with BCC grown far into nearby tissue had a response. This was not a comparison with either pill. Grade 3 or worse adverse events occurred in 48% of patients.11 Immune treatment can harm healthy organs, so an oncology team must weigh the risks.
Other options patients ask about
Black salve or Cansema. Do not use these products to remove a skin cancer. Reports show damage to healthy skin and cancer left behind. A scab or a healed surface does not prove that the cancer is gone. The evidence shows harm; it does not establish a safe cure.1213
Home removal. Do not cut, burn, freeze, or use acids on a spot that may be BCC. This can scar the skin and leave cancer beneath the surface. A clinician needs a tissue sample to confirm what the spot is and choose treatment.314
Eggplant creams, BEC5, or solasodine glycosides. One small trial of a specific cream called Zycure found biopsy clearance at eight weeks in 41 of 62 people, versus 8 of 32 given the cream base alone. Of 37 treated responders checked for a year, 29 had no return. This was not a 78% cure rate for everyone who started treatment. Evidence remains limited. The study did not compare the cream with surgery or establish that other products work the same way. Do not replace a proven treatment with an online cream.15
Diets, herbs, supplements, or essential oils. None has been shown to cure BCC. A product described as natural can still cause harm or interact with medicines. Tell your care team what you use. Supportive care can help you feel better during treatment; it does not replace cancer care.16
Waiting instead of treatment. BCC can damage nearby tissue even when it grows slowly. In some frail people with a short life expectancy and a small, symptom-free, low-risk BCC, planned observation may be reasonable. The evidence is from a cohort, not a trial proving it is as safe as treatment. It requires regular checks and a plan to act if the tumor grows or causes problems. Discuss this with your clinician rather than leaving a spot unchecked.17
Lowering your risk and catching new ones early
Most BCC is caused by ultraviolet light from the sun and tanning beds, so reducing UV exposure over a lifetime lowers the risk.418 For people who have already had two or more skin cancers, a daily vitamin (nicotinamide) modestly lowered the rate of new non-melanoma skin cancers in a trial.
Sunlight and tanning beds raise BCC risk. Use shade, protective clothes, and sunscreen, and avoid tanning beds. In the Nambour trial, daily sunscreen did not clearly reduce new BCCs. Its benefit for SCC does not prove a BCC-specific benefit.
In high-risk adults with normal immune systems, a trial found fewer new non-melanoma skin cancers overall during one year of nicotinamide. For BCC alone, its 20% reduction was not statistically significant. Pooled reviews disagree about BCC benefit. The BCC-specific result is mixed, and benefits did not persist after treatment stopped. Digestive side effects may occur.
Whole-body prevention, separate from the spot treatments above. “No effect” means good trials found no benefit. Every source is PubMed-verified; not medical advice.
Having one BCC raises the chance of getting another, and some recurrences appear more than five years later, so regular skin checks are an important part of care after a diagnosis.5
When to see a doctor
See a clinician for any spot that is new, changing, bleeding, or not healing, especially a sore that heals and comes back in the same place. If you have already had a BCC, keep up with regular skin checks, since new spots and late recurrences can appear years later.
Worried about a spot?
SpotDoc offers full-body skin cancer screening in Brownwood Square, The Villages. No referral needed for most plans.
Frequently asked questions
Is BCC dangerous? It is rarely life-threatening because it almost never spreads to other organs. The concern is local growth: left untreated, it can damage nearby skin, cartilage, and tissue, especially on the face. Caught early, it is highly curable.4
Will it come back after treatment? Most tumors are cured, and surgery has the lowest recurrence rates.2 Some recurrences appear more than five years later, and having one BCC raises the chance of getting another, so ongoing skin checks matter.5
Can I treat it with a cream instead of surgery? For small, low-risk surface tumors, a prescription cream is an option, but it cures fewer tumors than surgery. In a head-to-head trial, 3-year success was 84% with imiquimod cream vs 98% with surgery.7 Creams are not a standard choice for high-risk BCC. The depth and type must be checked first.
What is Mohs surgery, and do I need it? It is a margin-controlled technique that checks the whole edge of the removed tissue under the microscope during the procedure. Guidelines reserve it for high-risk, recurrent, or critical-site tumors rather than every BCC.4 Your clinician can tell you whether your tumor falls into that group.
Does BCC spread? Very rarely. Spread to lymph nodes or other organs happens in a small fraction of cases. The usual concern is the tumor growing into nearby tissue, not spreading through the body.4
Questions to ask your clinician
- What risk group is my tumor, and how does that change my options?
- Which treatment fits this spot, and what will the scar or healed area look like?
- Will the removed tissue be checked for clear edges?
- How often should I have skin checks now that I have had a BCC?
- What can I do to lower my risk of new skin cancers?
BCC is one of several skin cancers and precancers. Related guides cover SCC, actinic keratosis, and the treatments above, including surgical excision. A thorough skin cancer screening is the place to start.
Reviewed by Tyler Long, DO. Last reviewed November 3, 2026.
Update log
How this guide has changed since it was first published.
- November 3, 2026Clarified study outcomes, separated advanced-treatment evidence, and added patient safety information. Reviewed and accepted for publication November 3, 2026.
- June 30, 2026Guide published.
References
Sources supporting this guide are listed below, with links to the publications or issuing organizations. Numbers match the citations in the text and the grids above.
- Rogers HW, Weinstock MA, Feldman SR, Coldiron BM. Incidence estimate of nonmelanoma skin cancer (keratinocyte carcinomas) in the U.S. population, 2012. JAMA Dermatol. 2015;151(10):1081–1086.View source
- Thomson J, Hogan S, Leonardi-Bee J, Williams HC, Bath-Hextall FJ. Interventions for basal cell carcinoma of the skin. Cochrane Database Syst Rev. 2020;11(11):CD003412.View source
- Kim JYS, Kozlow JH, Mittal B, et al. Guidelines of care for the management of basal cell carcinoma. J Am Acad Dermatol. 2018;78(3):540–559.View source
- Peris K, Fargnoli MC, Garbe C, et al. Diagnosis and treatment of basal cell carcinoma: European consensus-based interdisciplinary guidelines. Eur J Cancer. 2019;118:10–34.View source
- van Loo E, Mosterd K, Krekels GAM, et al. Surgical excision versus Mohs’ micrographic surgery for basal cell carcinoma of the face: a randomised clinical trial with 10 year follow-up. Eur J Cancer. 2014;50(17):3011–3020.View source
- Mosterd K, Krekels GAM, Nieman FH, et al. Surgical excision versus Mohs’ micrographic surgery for primary and recurrent basal-cell carcinoma of the face: a prospective randomised controlled trial with 5-years’ follow-up. Lancet Oncol. 2008;9(12):1149–1156.View source
- Bath-Hextall F, Ozolins M, Armstrong SJ, et al. Surgical excision versus imiquimod 5% cream for nodular and superficial basal-cell carcinoma (SINS): a multicentre, non-inferiority, randomised controlled trial. Lancet Oncol. 2014;15(1):96–105.View source
- Sekulic A, Migden MR, Oro AE, et al. Efficacy and safety of vismodegib in advanced basal-cell carcinoma. N Engl J Med. 2012;366(23):2171–2179.View source
- Dummer R, Guminski A, Gutzmer R, et al. Long-term efficacy and safety of sonidegib in patients with advanced basal cell carcinoma: 42-month analysis of the randomized phase 2 BOLT study. Br J Dermatol. 2020;182(6):1369–1378.View source
- National Cancer Institute. Sonidegib. National Cancer Institute. Accessed November 3, 2026.View source
- Stratigos AJ, Sekulic A, Peris K, et al. Cemiplimab in locally advanced basal cell carcinoma after hedgehog inhibitor therapy: an open-label, multicentre, single-arm, phase 2 trial. Lancet Oncol. 2021;22(6):848–857.View source
- Croaker A, Liu L, Myers SP. Persisting cancer in black salve treated skin lesions: results of a large 5-year retrospective analysis of Australian histopathology specimens. Integr Cancer Ther. 2023;22:15347354221151145.View source
- Leecy TN, Beer TW, Harvey NT, et al. Histopathological features associated with application of black salve to cutaneous lesions: a series of 16 cases and review of the literature. Pathology. 2013;45(7):670–674.View source
- Feldstein S, Afshar M, Krakowski AC. Chemical burn from vinegar following an internet-based protocol for self-removal of nevi. J Clin Aesthet Dermatol. 2015;8(6):50.View source
- Punjabi S, Cook LJ, Kersey P, Marks R, Cerio R. Solasodine glycoalkaloids: a novel topical therapy for basal cell carcinoma. A double-blind, randomized, placebo-controlled, parallel group, multicenter study. Int J Dermatol. 2008;47(1):78–82.View source
- National Center for Complementary and Integrative Health. Cancer and Complementary Health Approaches: What You Need To Know. National Institutes of Health. Accessed November 3, 2026.View source
- van Winden MEC, Hetterschijt CRM, Bronkhorst EM, et al. Evaluation of Watchful Waiting and Tumor Behavior in Patients With Basal Cell Carcinoma: An Observational Cohort Study of 280 Basal Cell Carcinomas in 89 Patients. JAMA Dermatol. 2021;157(10):1174–1181.View source
- Leiter U, Garbe C. Epidemiology of melanoma and nonmelanoma skin cancer: the role of sunlight. Adv Exp Med Biol. 2008;624:89–103.View source
- Nagore E, Grau C, Molinero J, Fortea JM. Positive margins in basal cell carcinoma: relationship to clinical features and recurrence risk. A retrospective study of 248 patients. J Eur Acad Dermatol Venereol. 2003;17(2):167–170.View source
- Williams HC, Bath-Hextall F, Ozolins M, et al. Surgery versus 5% imiquimod for nodular and superficial basal cell carcinoma: 5-year results of the SINS randomized controlled trial. J Invest Dermatol. 2017;137(3):614–619.View source
- Basset-Séguin N, Ibbotson SH, Emtestam L, et al. Topical methyl aminolaevulinate photodynamic therapy versus cryotherapy for superficial basal cell carcinoma: a 5-year randomized trial. Eur J Dermatol. 2008;18(5):547–553.View source
- English DR, Armstrong BK, Kricker A, Fleming C. Sunlight and cancer. Cancer Causes Control. 1997;8(3):271–283.View source
- Green A, Williams G, Neale R, et al. Daily sunscreen application and betacarotene supplementation in prevention of basal-cell and squamous-cell carcinomas of the skin: a randomised controlled trial. Lancet. 1999;354(9180):723–729.View source
- Chen AC, Martin AJ, Choy B, et al. A Phase 3 Randomized Trial of Nicotinamide for Skin-Cancer Chemoprevention. N Engl J Med. 2015;373(17):1618–1626.View source
- Mainville L, Smilga AS, Fortin PR. Effect of Nicotinamide in Skin Cancer and Actinic Keratoses Chemoprophylaxis, and Adverse Effects Related to Nicotinamide: A Systematic Review and Meta-Analysis. J Cutan Med Surg. 2022;26(3):297–308.View source
- Tosti G, Pepe F, Gnagnarella P, et al. The Role of Nicotinamide as Chemo-Preventive Agent in NMSCs: A Systematic Review and Meta-Analysis. Nutrients. 2023;16(1):100.View source