April 2026

Basal Cell Carcinoma

Joseph Corsini, Ph.D. and Julie Alessandra, MTE

Basal cells (also called basal keratinocytes) are normal stem cells in the deeper layers of the skin that through a number of developmental stages form keratinocytes and eventually differentiate into the squamous cells which form the outer layer of the skin. Squamous cells have a limited life span so are constantly dying and sluffing off, needing continual replacement to maintain the integrity of the skin. Melanocytes are cells that are distributed in high density throughout the skin, and are also found in other tissues. In the skin, they synthesize melanin and transfer it into to keratinocytes to protect them from the mutagenic effects of UVB light. Cancers can form from all three of the above-mentioned cell types. When basal cells are transformed into cancer cells, they are called basal cell carcinomas. Basal cell tumors develop slowly, are not highly invasive, and do not commonly metastasize. Generally, there is plenty of time to make decisions about treatment. When squamous cells transform into cancer cells, they are termed squamous cell carcinomas. Squamous cell carcinomas are highly invasive and often times readily metastasize to distant locations in the body. Early diagnosis is critical. Melanomas develop from melanocytes, often in the skin but also commonly in other tissues that are populated by melanocytes.

Basal cell carcinomas are common but rarely fatal, they are generally not included in the cancer rate statistics reported by our public agencies and large cancer foundations. These cancers occur at a high rate in individuals who do not produce eumelanin, most commonly due to recessive inactivating mutations in the melanocortin receptor (gingers!). Many genetic mutations are present in these cancer cells, including disruptions in the hedgehog pathways that cause rapid cell division and inappropriate differentiation. Hedgehog pathway inhibitors are now approved for use in cases of recurrent basal cell carcinoma. There has also been some recent interest and effort directed at treating basal cell carcinomas with checkpoint blockade inhibitors. There are a variety of conventional therapies available, as well-as some up and coming approaches with less-conventional modalities that are showing promise – all are listed below.

Mohs surgery is conducted by removing the basal cell cancer followed by incremental removal of a larger and larger radius until no more cancer cells are visible in the microscope. The incremental microscopic assessment is conducted in the clinic while you are waiting so that you don’t have to return to the clinic over and over again. This technique is estimated to remove all cancer cells 97-99% of the time.

Mistletoe extract from various Viscum species is prepared in a variety of ways. It is employed in two primary ways: 1) an immune stimulating agent thought to help activate the natural killer and T cells to overcome immunosuppressive activities of the cancer cell, 2) Direct cytotoxic effects of the mistletoe lectins that induce cell death through the endoplasmic reticulum death pathways. (See Hong, C. E., & Lyu, S. Y. (2025). Mistletoe in Cancer Cell Biology: Recent Advances. Current Issues in Molecular Biology, 47(8), 672.) for a recent review).

Dramatic results have been published showing regression of basal and squamous cell carcinomas through topical application of mistletoe extracts (See Königsberger, K., Urech, K., Reif, M., Baumgartner, S., Martin, D., & Tröger, W. (2024). Viscum album lipophilic extract in actinic keratosis, cutaneous squamous cell carcinoma, and basal cell carcinoma: A retrospective case series. Complementary Medicine Research, 31(3), 241-252). 

Radiotherapy is an accepted viable alternative to surgery. Reported recurrence rates are in the same range as those of surgery (1-3%), and scarring is minimized. For a discussion of this option see: (Basset-Seguin, N., & Herms, F. (2020). Update on the management of basal cell carcinoma. Acta dermato-venereologica, 100(11), 5750.)

Cryoablation therapy is also effective and yields similar recurrence rates to radiotherapy. Scarring should be minimal with this option.  (Tchanque-Fossuo, C. N., & Eisen, D. B. (2018). A systematic review on the use of cryotherapy versus other treatments for basal cell carcinoma. Dermatology Online Journal, 24(11)).

Photodynamic therapy is a non-invasive therapy that uses chemicals that are non-toxic but are converted to toxins upon exposure to certain wavelengths of light. They are applied directly to the lesion. Recurrence rates have been reported to be higher, though it is difficult to determine for sure because different studies use different time points for recurrence. See Tchanque-Fossuo, C. N., & Eisen, D. B. (2018). A systematic review on the use of cryotherapy versus other treatments for basal cell carcinoma. Dermatology Online Journal, 24(11))

Essential oils have been widely investigated as potential anti-cancer agents, especially in cell culture systems. Because they are easy to apply to the skin, there has been a lot of interest in treating melanomas, squamous cell carcinomas, and basal cell carcinomas. There is one case study describing successful treatment of a basal cell carcinoma with frankincense – the before and after images are dramatic. (Fung, K. M., Suhail, M. M., McClendon, B., Woolley, C. L., Young, D. G., & Lin, H. K. (2013). Management of basal cell carcinoma of the skin using frankincense (Boswellia sacra) essential oil: a case report. OA Altern Med, 1, 14).

Electron beam therapy is another approach that yields good cosmetic results. Though we do not know where a person can go to receive that kind of treatment. (Lee, A. D., Lum, N., Thandi, A., Yee, K. A., Seeburruth, D., Park, M., ... & Liu, C. (2025). The clinical outcomes, safety profiles, and treatment patterns of electron beam therapy for basal cell carcinoma. JAAD Reviews, 4, 126-128.).