Surgical and non-surgical treatments for basal cell carcinoma (BCC): a literature review

Abstract

Basal cell carcinoma (BCC) is the most common type of skin cancer worldwide, accounting for the majority of cutaneous malignancies. It is characterized by slow growth, low metastatic potential, and significant local tissue destruction. Treatment options include surgical approaches—such as standard excision and Mohs micrographic surgery—and nonsurgical modalities, including topical therapies, photodynamic therapy, and systemic agents for advanced disease. Considering the wide range of therapeutic choices, it is essential to compare their effectiveness, safety, and clinical applicability. This study aims to analyze recent evidence on surgical and nonsurgical treatments for BCC, highlighting their benefits, limitations, and success rates. This literature review was conducted through a bibliographic search performed between September and November 2025, using the descriptors basal cell carcinoma, surgical treatment, nonsurgical treatment, excision, Mohs surgery, and photodynamic therapy. Articles published in the last five years, in Portuguese or English, and addressing therapeutic outcomes in BCC were included. After screening, six studies met the inclusion criteria and were selected for analysis. The reviewed studies showed that surgical procedures—particularly conventional excision with adequate margins and Mohs micrographic surgery—provide the highest cure rates and lowest recurrence levels, especially for high-risk lesions or tumors located in cosmetically sensitive areas. Nonsurgical treatments, such as imiquimod, 5-fluorouracil, and photodynamic therapy, demonstrated effectiveness mainly for superficial lesions, offering superior cosmetic results and lower morbidity. Treatment choice depends on tumor subtype, location, size, and patient characteristics. Overall, complication rates were low across both therapeutic groups. Both surgical and nonsurgical approaches play a significant role in the management of basal cell carcinoma. Surgery remains the gold standard, particularly for nodular and high-risk lesions, whereas nonsurgical modalities serve as valid alternatives for selected cases, especially superficial tumors or when better cosmetic outcomes are desired. Individualizing treatment is essential to optimize clinical results.