Treatments for superficial basal cell carcinoma and squamous cell carcinoma in situ

Most skin cancers start by affecting just the top part of the skin. These early skin cancers are usually called superficial or in situ and because they are thin, they can be treated from the surface by cryotherapy (freezing) or applying an ointment, as well as by excision (cutting out). The best treatment depends on a combination of factors:

  • how well the treatment works
  • side effects (including scarring and discomfort)
  • cost
  • convenience

The following table summarises these factors for the most common treatments for basal cell carcinoma and squamous cell carcinoma.

  Excision (surgical removal) Cryotherapy (freezing) Topical treatment (fluorouracil or imiquimod cream)
How well does it work? 98.6% cure rate1 97% cure rate2

Imiquimod: up to 82% cure rate for superficial basal cell carcinoma3

Fluorouracil: up to 92% cure rate for Bowen's disease (superficial squamous cell carcinoma) 4

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.

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. Pensioners and Health Care Card holders are normally bulk-billed (i.e. no out-of-pocket expense).

Approximately $40. In most cases, the cost is completely covered by Medicare.

In biopsy-proven cases of superficial basal cell carcinoma, the Pharmaceutical Benefits Scheme subsidises the cost of imiquimod. The out-of-pocket expense is about $85 (less for pensioners and Health Care Card holders).

The Pharmaceutial Benefits Scheme subsidises the cost of fluorouracil only for Department of Veterans' Affairs cardholders. For others, the out-of-pocket expense is about $80.

 

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.

Fluorouracil cream must be applied twice daily to the affected area and surrounding region for four weeks.

During treatment, the area usually becomes red, irritated and painful. Direct sunlight must be avoided during the treatment period.

 

  • 1. Leibovitch I, Huilgol SC, Selva D, Richards S, Paver R. Basal cell carcinoma treated with Mohs surgery in Australia II. Outcome at 5-year follow-up. J Am Acad Dermatol 2005 Sep;53(3):452-7 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16112352
  • 2. Holt PJA. Cryotherapy for skin cancer: results over a 5‐year period using liquid nitrogen spray cryosurgery. British Journal of Dermatology 1988. https://doi.org/10.1111/j.1365-2133.1988.tb03205.x
  • 3. Imiquimod 5% cream for the treatment of superficial basal cell carcinoma: results from two phase III, randomized, vehicle-controlled studies Geisse, John et al. Journal of the American Academy of Dermatology , Volume 50 , Issue 5 , 722 - 733 DOI: https://doi.org/10.1016/j.jaad.2003.11.066
  • 4. Moreno G, Chia AL, Li mA,Shumack S. Therapeutic options for Bowen's disease. Australas J Dermatol 2007; 48(1):1-8

Further Information: Conditions

Further Information: Treatments