Guidelines of care for the management of basal cell carcinoma

J Am Acad Dermatol. 2018 Mar;78(3):540-559. doi: 10.1016/j.jaad.2017.10.006. Epub 2018 Jan 10.


Basal cell carcinoma (BCC) is the most common form of human cancer, with a continually increasing annual incidence in the United States. When diagnosed early, the majority of BCCs are readily treated with office-based therapy, which is highly curative. In these evidence-based guidelines of care, we provide recommendations for the management of patients with BCC, as well as an in-depth review of the best available literature in support of these recommendations. We discuss biopsy techniques for a clinically suspicious lesion and offer recommendations for the histopathologic interpretation of BCC. In the absence of a formal staging system, the best available stratification based on risk for recurrence is reviewed. With regard to treatment, we provide recommendations on treatment modalities along a broad therapeutic spectrum, ranging from topical agents and superficially destructive modalities to surgical techniques and systemic therapy. Finally, we review the available literature and provide recommendations on prevention and the most appropriate follow-up for patients in whom BCC has been diagnosed.

Keywords: basal cell carcinoma; biopsy; curettage; metastasis; phototherapy; radiotherapy; staging; surgery; surveillance; topical therapy.

Publication types

  • Practice Guideline

MeSH terms

  • Administration, Cutaneous
  • Aminoquinolines / therapeutic use
  • Anilides / therapeutic use
  • Antineoplastic Agents / therapeutic use
  • Carcinoma, Basal Cell / diagnosis
  • Carcinoma, Basal Cell / secondary*
  • Carcinoma, Basal Cell / therapy*
  • Dermatologic Surgical Procedures*
  • Early Detection of Cancer
  • Humans
  • Imiquimod
  • Neoplasm Grading
  • Neoplasm Staging
  • Neoplasms, Second Primary / diagnosis
  • Neoplasms, Second Primary / prevention & control*
  • Photochemotherapy*
  • Photosensitizing Agents / therapeutic use
  • Pyridines / therapeutic use
  • Radiotherapy
  • Skin Neoplasms / diagnosis
  • Skin Neoplasms / pathology*
  • Skin Neoplasms / therapy*
  • United States


  • Aminoquinolines
  • Anilides
  • Antineoplastic Agents
  • HhAntag691
  • Photosensitizing Agents
  • Pyridines
  • Imiquimod