Your treatment will be planned by the hospital multidisciplinary team of doctors and other healthcare professionals. They will tell you about the risks, benefits and side-effects of the treatment you are offered, and how they may affect your life afterwards. Your wishes will be taken into account.

You will then need to agree to the treatment before it can start. This is called giving your consent. Don’t be afraid to ask questions if there is anything you don’t understand.

You will usually have treatment as an outpatient, so it should not disturb your routine too much. But it is a good idea to think about whether your treatment plan will have any practical or financial implications for you and your family. Your keyworker (a member of the multidisciplinary team) will be able to talk to you about these, and tell you about other sources of help and support.

Cryotherapy

Cryotherapy uses a very cold substance (liquid nitrogen) to remove the tumour by freezing it. It is only suitable if the cancer is very small. You will be treated in an outpatient clinic, and you will be able to go home the same day.

When the liquid nitrogen is sprayed on to the affected area you may feel a painful stinging sensation. Afterwards it may feel like a burn. A day or two later the skin may blister. It may be a blood blister. This may need draining, but the top of the blister should not be broken. It will need to be covered with a dressing until a scab has grown. After about a month, the scab will drop off, and you may have a white scar.

You will have a follow-up visit between six weeks and six months later to check that the treatment has been effective. In some cases the treatment may need to be repeated.

Surgery

Curettage and cautery

Curettage and cautery may be used for small or surface BCCs. First the treatment area is numbed with a local anaesthetic. Then a spoon-shaped instrument with a sharp edge (a curette) is used to scrape away the cancer. The wound is then heat-sealed (cauterised). The treatment may leave a flat, white scar.

Surgical excision

A standard treatment for a BCC is surgery to cut it out along with some of the surrounding normal skin. This surgery cures 98% of the patients who receive it. It is a straightforward operation, performed under local anaesthetic. You will be given an injection to numb only the area of operation. On small wounds, stitches will be removed after a few days. For wounds on thicker skin, such as on the back, they may left in for up to two weeks.

Mohs micrographic surgery

In some cases a special type of surgery, called Mohs micrographic surgery, may be used if simple surgery is not suitable. The obvious tumour is first removed by excision, or sometimes curettage. Then, after you have had a local anaesthetic, layers of skin are taken off around the tumour one layer at a time. Each piece removed is then examined in its entirety under a microscope, to see whether there are still cancer cells present at any point. This is done in order to ensure that all of the tumour is removed and to conserve as much healthy tissue as possible, and so minimise the size of the defect. Repair of the area may require a skin graft or skin flap.

Mohs surgery is most often used for a BCC that has recurred, or which may have spread to a surrounding area, particularly when the cosmetic look is important, such as on the face, or some areas of the head and neck.

It is usually done as an outpatient case.

Skin grafts and skin flaps

If surgery leaves a significant wound, or it is in a highly visible place, such as the face, a small skin graft or skin flap (plastic surgery) may be needed to improve the look.

For a graft, a thin layer of healthy skin is taken from another part of the body. To get the best colour match, skin is usually taken from behind the ear for a face graft. For a graft for other areas of the body, skin is taken from somewhere that is usually hidden, such as the inner thigh area. The two areas involved in the graft will look unattractive to begin with. Within a week or two they will have healed and the scars begun to fade.

In some cases, a general anaesthetic is needed.

With most operations you will be able to go home the same day. Very occasionally patients will need to stay in hospital for one or two days while the grafted skin sticks and heals.

For a flap, a slightly thicker layer of skin, including blood vessels, is cut from skin next to the BCC wound, and moved to cover the wound. It is usually all done under local anaesthetic, as part of the same surgical procedure.

Preparing for a general anaesthetic

In the few cases that need a general anaesthetic, your fitness for the anaesthetic will be tested, usually by a nurse specialist at a pre-assessment clinic. An appointment will be arranged with you before the planned date for your surgery. You will be asked about your general health, about any breathing or chest problems you have, about any medicines or supplements you are taking, and allergies. A blood sample may be taken. Your pulse and heart-rate may be monitored. You will not be asked to do exercises.

Additional treatment

Careful examination of the tumour and surrounding tissue removed during surgery will help your doctors to decide whether to recommend any additional treatment.

Radiotherapy

BCC responds well to radiotherapy. Radiotherapy uses radiation to kill cancer cells. It may be used for those unfit for surgery because of another medical condition or for those with a BCC in an awkward place for surgery (for example close to the eyes). Your treatment will be carefully planned with you. You may need one or more visits to the radiotherapy department to complete the preparation work in readiness for treatment. Your treatment may require that a metal shield is made, which allows the X-rays to reach only the BCC, while protecting the surrounding normal skin.

You will have to lie on the couch underneath the X-ray machine. Each treatment dose will only take a few minutes, and it is painless. The radiographer will tell you when it is important to keep very still.

You will be alone in the room while the treatment is given, but the radiographer will monitor you the whole time using closed circuit television.

Side-effects

The radiotherapy treatment can leave the skin feeling sore and red for several weeks. Occasionally a scab develops over the treated area, and for a while the BCC may look worse than before treatment. You will be given advice on how to care for the tender skin. As it heals, the treated area will look pink, but gradually over the next few months this will fade. Sometimes the treated area of skin may be left looking paler than the skin around it.

Hair is likely to be lost in the treated area, but it may grow back over a period of 6-12 months. Sweat glands in the treated area may be affected too.

You will be able to talk about the possible side-effects of your treatment with your doctor.

Photodynamic therapy (PDT)

Photodynamic therapy is a new form of treatment for BCC. Its use is promising for thin or superficial BCC, but it is not yet an established treatment.

A light-sensitive drug in a cream is spread onto the area to be treated four to six hours beforehand. Light from a special light source is then beamed at the treatment area. This triggers the chemical that destroys the cancer cells, while causing very little damage to the skin. Exposure to the light will be for between 20-45 minutes, but it may be less with some machines. Two treatments are usually given.

If needed, you will be given a local anaesthetic before treatment. Afterwards, you may be given a steroid cream for pain-relief at home. The wound is similar to a graze, and its care is the same. The skin will heal within 7-10 days, depending on the size of the wound. Most patients will not scar.

Topical therapy (creams)

A special cream that interferes with the growth of the BCC cells can be applied to the skin (called topical application). You will normally be asked to use the cream for three to four weeks. The most commonly used is 5-Fluorouracil (5-FU). Topical imiquimod looks promising, but its use and effectiveness are still being evaluated. Generally, these are only suitable for thin BCCs and they are not often used on the face (especially near the eyes).

After treatment

Whatever treatment you have had, you should be given clear, written instructions about the care of your wound. If you have had surgery needing stitches, you will be given instructions about when and where to get them removed. You should also be given follow-up information, with a contact telephone number in the specialist department, for your further information or assistance.