This handout is for basal cell carcinoma. Your care team identified this based on: pearly papule with arborising telangiectasia ± rolled border ± central ulceration on chronically uv-exposed skin (nccn bcc 2025; aad 2019).
Other reasons your team may use this plan: non-healing, recurrently bleeding or crusting skin lesion ("the lesion that will not heal") — classic bcc story (nccn bcc 2025); atrophic, scar-like, ill-defined plaque on the face/forehead — morphoeic/sclerosing/infiltrative bcc (high-risk histologic pattern, nccn bcc 2025); pigmented lesion with dermoscopic arborising telangiectasia, blue-grey ovoid nests or leaf-like areas — pigmented bcc vs melanoma pivot (route melanoma if uncertain).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| standard_surgical_excision_4mm_margin | — | — | — | NCCN BCC 2025 — 4-mm clinical margin standard excision achieves ~95% cure in low-risk primary BCC. |
| electrodesiccation_and_curettage | — | — | — | NCCN BCC 2025 — ED&C for low-risk superficial/nodular BCC on non-terminal-hair-bearing skin; avoid on scalp / beard area (deeper follicular extension). |
| cryosurgery | — | — | — | NCCN BCC 2025 — cryosurgery is an option for selected superficial low-risk BCC when surgery is declined / unfeasible. |
| imiquimod | 5% cream | topical | 5x/week x 6 weeks | NCCN BCC 2025 — topical imiquimod 5% for superficial BCC only (NOT nodular / infiltrative); clearance ~75-80% at 12 wk; brisk inflammation expected. |
| fluorouracil | 5% cream | topical | BID x 3-6 weeks | NCCN BCC 2025 — topical 5-FU 5% for superficial BCC only; lower clearance than imiquimod and surgery; expect erosion / inflammation. |
| definitive_radiotherapy | — | — | — | NCCN BCC 2025 — definitive RT for non-surgical candidates or selected cosmetic sites; AVOID in Gorlin (radiosensitive — risk of new BCC and secondary malignancy) and in young patients. |
Plan: BCC — risk-directed treatment ladder (NCCN BCC 2025; ERIVANCE / BOLT / Stratigos)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Lifelong derm continuity: photoprotection (broad-spectrum SPF ≥30, sun-protective clothing, behavioural avoidance), skin self-examination education, family / Gorlin counselling, chemoprevention discussion (nicotinamide 500 mg BID — ONTRAC trial NEJM PMID 26488693 reduced new NMSC ~23% in high-risk patients; consider for those with multiple BCC / SCC / dense field). Organ-transplant recipients receive intensified surveillance and individualised immunosuppression review with transplant team. Recurrence at the prior site → re-biopsy + escalate to Mohs / margin-assessed excision; new advanced / metastatic disease → re-enter systemic ladder.
Guideline: NCCN Basal Cell Skin Cancer v.1.2025 (NCCN.org) + AAD/ACMS/ASDSA/ASMS appropriate-use criteria for Mohs micrographic surgery + ERIVANCE (Sekulic NEJM 2012; PMID 22670903, DOI 10.1056/NEJMoa1113713) + BOLT primary (Migden Lancet Oncol 2015; PMID 25981810, DOI 10.1016/S1470-2045(15)70100-2) + BOLT 42-month final (Dummer JAAD 2020; PMID 33358380, DOI 10.1016/j.jaad.2020.08.042) + Cemiplimab post-HHI laBCC (Stratigos Lancet Oncol 2021; PMID 34000246, DOI 10.1016/S1470-2045(21)00126-1) + Nicotinamide chemoprevention ONTRAC (Chen NEJM 2015; PMID 26488693, DOI 10.1056/NEJMoa1506197) + AAD 2019 cutaneous melanoma for the pigmented-BCC-vs-melanoma pivot (Swetter JAAD 2019; PMID 30392755)