ENWhen a long-standing pearly bump or “spot” on the face or neck keeps healing and bleeding, and a dermatologist calls it basal cell carcinoma, the usual treatment in Germany is surgery with the edges of the removed tissue checked under a microscope. The word sounds frightening, but how serious is it?
Basal cell carcinoma (BCC) is the most common malignant skin tumour. It very rarely spreads to other organs but grows into deeper tissue and destroys it, so it should not be left alone. Basal cell carcinoma treatment in Germany is provided by dermatologists and, at university hospitals, by dermato-oncologists, who specialise in skin tumours. This page covers BCC; for other skin tumours, see skin cancer treatment in Germany.
What basal cell carcinoma is and why it should not wait
BCC arises from basal cells, the bottom layer of the outer skin. The main cause is ultraviolet light: years of sun and sunburn, especially in childhood. It is commoner in fair-skinned and older people, usually on the face, mostly the nose, or on the ears and scalp. Nodular BCC is a shiny bump with a pearly rim, superficial BCC a flat reddish patch, and morphoeic BCC a flat, whitish, scar-like area with blurred borders.
Waiting is unwise: BCC grows slowly, but the longer it grows near the eye, nose or ear, the more must be removed and the harder the reconstruction. A neglected tumour reaches cartilage and can grow into bone or the eye socket. Melanoma is a different, more aggressive tumour arising from pigment cells.
Diagnosing basal cell carcinoma
BCC is recognised with a dermatoscope and confirmed by a biopsy. A dermatoscope is an illuminated magnifier that helps to tell BCC from melanoma and other tumours. The whole skin, including the scalp, is checked, because one BCC raises the risk of further skin tumours.
A biopsy, a small tissue sample examined under the microscope, shows the tumour type, which determines the method. For large tumours or suspected spread into bone or the eye socket, CT or MRI shows the depth. Bring photos of the lesion over time, the pathology report and any biopsy slides or blocks for review in Germany. See also skin cancer screening.
Surgery with microscopic margin control
The main treatment is surgery, and for tumours on the face and poorly defined forms German clinics use micrographically controlled surgery. All edges of the removed tissue, sides and base, are examined under the microscope. If the tumour reaches an edge, only that spot is re-excised. Only what is needed is removed, sparing as much healthy skin as possible.
Surgery is done under local anaesthesia, sometimes in stages: the tumour is removed and the wound dressed. In German centres the histology result usually comes in one to two days; if the margins are clear, the wound is closed, otherwise the step is repeated. Larger defects are repaired with a flap of neighbouring skin. Plan your stay around these days.
This follows the German guideline, the S2k-Leitlinie Basalzellkarzinom der Haut in the AWMF registry, which calls surgery with histological margin control the most effective, first-choice treatment and recommends the micrographic method for high-risk and recurrent tumours.
When surgery is not the first choice: creams, photodynamic therapy, radiotherapy, tablets
Other methods are chosen for superficial tumours or when surgery is impossible or would disfigure the face. Superficial BCC can be treated with creams, especially if surgery is ruled out: imiquimod makes the skin’s immune system attack the tumour, 5-fluorouracil stops its cells dividing. Photodynamic therapy applies a light-sensitising substance and activates it with a special lamp. Some small superficial tumours on the trunk or limbs are frozen with liquid nitrogen. The honest drawback: the margins cannot be checked, so recurrence is likelier and regular check-ups are needed.
Radiotherapy is offered when surgery is impossible or too disfiguring, for example in frail older people with a tumour near the eye, or if surgery is declined.
Advanced BCC that can no longer be removed or irradiated, and rare metastases, are treated with capsules (vismodegib, sonidegib) that block the Hedgehog signalling pathway, a growth signal constantly active in BCC. In the EU, sonidegib is approved for locally advanced BCC unsuitable for surgery or radiotherapy, vismodegib also for metastases causing symptoms. If they stop working or are not tolerated, the next step is immunotherapy with the antibody cemiplimab; the tumour board decides. The German Cancer Research Center’s Krebsinformationsdienst explains these treatments (in German).
Frequently asked questions
Can a laser remove basal cell carcinoma?
Sometimes, but it is a fallback, not the standard. The German guideline allows lasers for small, low-risk BCC when neither surgery nor creams are suitable. As with creams, the margins cannot be checked, and BCC tends to extend deeper rather than sideways, so regular check-ups matter.
Will there be a scar?
A scar is possible; how visible it is depends on the size and site of the wound and on healing. Margin-controlled surgery takes less healthy skin than a wide excision, and a flap of neighbouring skin helps to keep the shape of an eyelid, nose or lip. Creams and photodynamic therapy usually leave no scar.
Can basal cell carcinoma come back?
Yes, it can recur in the same place, and anyone who has had one is at higher risk of a new tumour elsewhere. Recurrence is less likely after surgery with histological margin control than after other methods. Check-ups, self-examination and sun protection matter; show a new spot or non-healing sore to a dermatologist promptly.
How AlenMed organises basal cell carcinoma treatment
AlenMed finds a university skin clinic, arranges dates and costs and accompanies you. Patients go, for example, to the Department of Dermatology and Venereology at University Hospital Cologne, directed by Prof. Esther von Stebut. The Department of Dermatology, Venereology and Allergology at University Hospital Frankfurt is led by Prof. Bastian Schilling. Another option is the Charité Department of Dermatology in Berlin.
We translate your photos and histology for assessment by the clinic’s dermato-oncologist. Surgery dates allow for two-stage wound closure, and the clinic sends a cost estimate (Kostenvoranschlag). We arrange the visa invitation and an interpreter for appointments. After a single low-risk BCC, check-ups usually follow after six months, then once a year; with a high risk of recurrence, every three months. Follow-up can continue with a dermatologist at home; see also dermatology in Germany. If radiotherapy is needed, see radiotherapy prices. AlenMed’s office is in Munich; partner clinics are all over Germany.
This material is for information only and is not an offer; the doctor decides on the treatment method at an in-person appointment.
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