Superficial basal cell carcinoma

Superficial basal cell carcinoma is a common minor form of skin cancer. It can be treated surgically or by freezing or applying a cream.

Also known as

sBCC

Symptoms and signs

  • Pink or red rough or dry patch, usually present for several months or years
  • Persistent bleeding or crusted/scabbed sore which does not heal after several months

Risk factors

  • Ultraviolet exposure, particularly long term exposure to sunlight (e.g. occupational exposure, working outside). Cumulative sun exposure increases the risk and BCC is therefore more common with increasing age.
  • Previous history of basal cell carcinoma or other skin cancers
  • Occupational or other exposure to arc welding or arsenic
  • Radiotherapy

Prognosis / outcome

Superficial basal cell carcinoma rarely causes significant medical problems. If untreated, it tends to persist as a sore, ulcerated or crusted patch that does not heal or improve.

Progression

Superficial basal cell carcinoma grows slowly and remains confined to its initial site without spreading to other organs. It may form an ulcer (sore) which bleeds or forms a scab or crust.

Procedures for

 

Superficial basal cell carcinoma

Medications for

 

Superficial basal cell carcinoma

Prevention of

 

Superficial basal cell carcinoma

  • Avoid excessive ultraviolet exposure. Use sunscreen, hats, sunglasses, protective clothing and shade at times when the ultraviolet index is greater than 3.
  • Nicotinamide (vitamin B3): 500 mg twice daily reduces the risk of future basal cell carcinoma
  • Avoid excessive ultraviolet exposure

More information

Recommended web links

Clinical images of
Superficial basal cell carcinoma
Click on an image to view it in greater detail.

Treatment options for superficial basal cell carcinoma

Surgical removal of basal cell carcinoma is considered the “gold standard” treatment for superficial basal cell carcinoma because:

  • it has the highest success rate
  • it allows a skin pathologist to examine the removed skin and conform that the basal cell carcinoma has been completely removed.

However, since superficial basal cell carcinoma is relatively minor, for some people there are other considerations:

  • Cosmetic appearance (i.e. minimal scarring after treatment)
  • Cost
  • Convenience and duration of treatment
  • Wish to avoid side effects such as pain, bleeding, bruising and infection

The table below summarises treatment options for superficial basal cell carcinoma and may be helpful in reaching a decision on the most appropriate form of treatment.

  Excision (surgical removal) Cryotherapy (freezing) Topical treatment (imiquimod cream) Photodynamic therapy

How well does it work?

98.6% cure rate (Liebovitch 2005)

97-98% cure rate (Holt 1988, Kuflik 1991)

Imiquimod: up to 82% cure rate for superficial basal cell carcinoma (Geisse 2004)

Studies have demonstrated higher cure rates for photodynamic therapy when compared with topical treatments or cryotherapy. (Morton 2006, Basset-Seguin 2008).

Note that in these studies, success rates for cryotherapy treatment were generally less than in trials where cryotherapy was not compared with PDT.

What are the side effects?

Short term: bleeding, bruising, swelling, pain, infection

Long term: scarring in almost all cases, wound breakdown, nerve damage

Short term: pain, blistering (including blood-filled blisters), swelling

Long term: changes in skin pigmentation. The treated area is commonly lighter or darker than the surrounding skin.

 

Short term: irritation of the treated area: redness, pain, blistering, crusts and pustules

Long-term: side effects are uncommon. Scarring sometimes occurs after severe reactions during treatment.

Short term: pain during and soon after treatment. irritation , redness, blistering and crusts of the the treated area.

Long term: side effects are uncommon. Sacrring sometimes occurs after severe skin reactions.

Side effects are less common and the long term cosmetic outcome is superior to treatment with either cryotherapy or topical treatments. (Morton 2006) 


How much does it cost?

The cost of excision varies, according to the size and the anatomical location of the skin cancer.

Spot Check Clinic generally charges at least $200 for surgical removal. The fee varies according to the size of the skin cancer and the location on the body. This fee is usually discounted for pensioners and Health Care Card holders so that there is minimal or no out of-pocket expense.

If the procedure is performed by a plastic surgeon and/or more complicated techniques such as Moh's surgery or skin flaps or grafts are used, the cost can be thousands of dollars.

Approximately $40.

In most cases, the cost is completely covered by Medicare, but only if the diagnosis has previously been confirmed by a biopsy.

In biopsy-proven cases of superficial basal cell carcinoma, the Pharmaceutical Benefits Scheme subsidises the cost of imiquimod. In these cases, the out-of-pocket expense is about $40 (less for pensioners and Health Care Card holders).

In cases where the PBS does not subsidise imiquimod, the typical cost is $120 or more.

Treatment costs are variable and are influenced by:

  • whether skin preparation treatment (e.g. microneedling) is performed on the day of treatment
  • amount of ALA cream used
  • type of light used to activate the ALA (i.e. LED red light phototherapy vs intense pulsed light)
  • whether post-treatment LED phototherapy sessions are used to speed wound healin

Costs generally vary between $500 to $1000 for treatment of a single skin cancer.

How convenient is it?

Surgical removal must be performed by a doctor. it usually takes 30-60 minutes.

After the procedure, there is a period of aftercare lasting several weeks. Activities and exercise may be restricted during this period.

 

Cryotherapy is performed by a doctor and takes a few minutes.

Cryotherapy aftercare is relatively simple and the wound is usually healed in about three weeks.

Imiquimod cream must be applied daily to the affected area and surrounding region daily, 5 days a week for six weeks.

Treatment can usually be completed in a single visit to the skin cancer clinic, lasting several hours.

Due to inflammation and pain after treatment, it may be necessary to limit work and other activities for several days after treatment.   

References

Leibovitch I, Huilgol S, Selva D et al
Basal cell carcinoma treated with Mohs surgery in Australia II. Outcome at 5-year follow-up.
Journal of the American Academy of Dermatology, 2005 Sep; 53(3): 452-7
2005
https://doi.org/10.1016/j.jaad.2005.04.087
Date accessed:
July 24, 2021
Holt P.
Cryotherapy for skin cancer: results over a 5-year period using liquid nitrogen spray cryosurgery
British Journal of Dermatology, volume 119, issue 2, August 1988, pages 231-240
1988
https://doi.org/10.1111/j.1365-2133.1988.tb03205.x
Date accessed:
July 24, 2021
Geisse J, Caro I, Lindholm J et al
Imiquimod 5% cream for the treatment of superficial basal cell carcinoma: results from two phase III, randomized, vehicle-controlled studies
Journal of the American Academy of Dermatology
2004
https://doi.org/10.1016/j.jaad.2003.11.066
Date accessed:
July 24, 2021
Morton C, Horn M, Leman J et al
Comparison of topical methyl aminolevulinate photodynamic therapy with cryotherapy or Fluorouracil for treatment of squamous cell carcinoma in situ: Results of a multicenter randomized trial
Arch Dermatol 2006 Jun; 142(6): 729-35.
2006
https://doi.org/10.1001/archderm.142.6.729
Date accessed:
July 24, 2021
Basset-Seguin N, Ibbotson S, Emtestam L et al
Topical methyl aminolaevulinate photodynamic therapy versus cryotherapy for superficial basal cell carcinoma: a 5 year randomized trial
Eur J Dermatol Sep-Oct 2008; 18(5): 547-53.
2008
https://doi.org/10.1684/ejd.2008.0472
Date accessed:
July 24, 2021