Basal cell carcinoma surgery (Surgical excision of basal cell carcinoma)
Surgery to remove a basal cell carcinoma (the most common skin cancer) with a margin of healthy skin so the whole tumour is taken away.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Surgery removes the basal cell carcinoma with a margin of normal skin, and the tissue is checked under a microscope to see if the edges are clear.
- If the edges are not clear, more surgery may be needed — so 'it's been removed' is not final until the laboratory report confirms it.
- Most people heal within a couple of weeks, but a graft or flap to close the gap means a longer recovery.
- Surgery does not prevent new skin cancers; ongoing sun protection and skin checks are part of looking after yourself.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your surgeon will give you advice for your situation.
Gives the best chance of removing the whole BCC in one treatment
Surgery may not be the first choice for very superficial BCCs, where creams, photodynamic therapy or freezing may be options.
Keep the dressing dry and the wound protected. Some oozing or bruising is normal. Take simple pain relief such as paracetamol if needed.
Clear wound-care instructions and a named contact for problems.
Keep the dressing dry and the wound protected. Some oozing or bruising is normal. Take simple pain relief such as...
Non-dissolvable stitches are usually removed around 5–14 days, depending on the site. Avoid stretching or knocking...
The laboratory report usually comes back within 1–2 weeks and tells you whether the edges are clear. If they are...
The scar gradually softens, flattens and fades. Redness can take several months to settle. Protect the area from...
What is basal cell carcinoma surgery?
Basal cell carcinoma (BCC) is the most common type of skin cancer. It is usually slow-growing and very rarely spreads to other parts of the body, but it does need treating because, left alone, it keeps growing into nearby skin and tissue. Surgery is the main treatment and aims to remove the whole tumour.
The surgeon cuts out the BCC along with a small border (margin) of normal-looking skin around and beneath it, to give the best chance that no cancer is left behind. The piece of skin is then sent to a laboratory, where a pathologist checks under a microscope whether the edges are clear of cancer cells.
For more difficult BCCs — for example on the nose, eyelid or ear, large ones, or ones that have come back — a specialist technique called Mohs micrographic surgery may be used. The skin is removed and checked under the microscope straight away, layer by layer, until the edges are clear, which spares as much healthy skin as possible.
Surgery treats the BCC you can see. It does not stop new skin cancers forming elsewhere, so sun protection and skin checks still matter afterwards.
Types & techniques
There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.
Standard excision vs Mohs surgery
| Standard excision | Mohs surgery | |
|---|---|---|
| Margin check | Laboratory report after surgery (1–2 weeks) | Checked during surgery, same day |
| Best for | Most BCCs on the body and limbs | Difficult, recurrent or facial BCCs |
| Healthy skin spared | Standard margin removed | Designed to spare as much as possible |
| Availability | Widely available | Specialist centres |
Your skin cancer team will recommend the method that best fits the type, size and site of your BCC.
Preparing for your surgery
- Make sure you understand the diagnosis and which method is planned (excision, Mohs, or curettage), and ask what closing the wound may involve.
- Tell the team about blood-thinning medicines (such as warfarin, apixaban, clopidogrel or aspirin) and any supplements, as some increase bleeding.
- Mention any heart devices (pacemaker or defibrillator), as this can affect the use of heat sealing.
- Tell them if you have diabetes, take steroids, or have a condition that affects wound healing.
- Stop smoking if you can, especially if a graft or flap is planned, as smoking reduces blood supply and healing.
- Arrange a lift home and time off if a graft, flap or larger procedure is planned.
- Ask how and when you will get your results, and who to contact if you have questions.
What happens
Most BCC surgery is done while you are awake, using a local anaesthetic injection to numb the skin so you should not feel pain, only some pushing or pressure. For a standard excision, the surgeon marks a margin around the visible BCC, cuts out the tumour with that border of normal skin, and closes the wound with stitches. The removed skin goes to the laboratory.
For Mohs surgery, the visible cancer is removed and you wait while it is examined under the microscope. If cancer remains at an edge, only that area is removed again, and the process repeats until the edges are clear. The wound is then closed, sometimes with a graft or flap.
Larger or more complex cases may be done under general anaesthetic, or the removal and the reconstruction may be staged. Your team will explain the plan for your situation.
Is this operation right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Surgery may not be the first choice for very superficial BCCs, where creams, photodynamic therapy or freezing may be options.
- People too frail for surgery, or on a difficult-to-manage anatomical site, may be better suited to radiotherapy or non-surgical treatment.
- Curettage and cautery is not suitable for high-risk, recurrent or aggressive BCCs, or for ill-defined lesions where a checked margin matters.
- Where the diagnosis is uncertain, a biopsy should come before any destructive treatment that leaves nothing to examine.
Delay surgery if…
- There is an active skin or wound infection at or near the site.
- Blood-thinning medicines need adjusting and this has not yet been arranged with the prescriber.
- Blood sugar in diabetes is poorly controlled, which can impair healing.
- You are unwell, or you cannot arrange the aftercare a graft or flap would need.
Alternatives to discuss
- Radiotherapy, particularly for older patients or sites that are hard to operate on.
- Topical creams (such as imiquimod or 5-fluorouracil) or photodynamic therapy for selected superficial BCCs.
- Cryotherapy (freezing) for small, low-risk lesions.
- Active monitoring in selected frail patients where treatment risk outweighs benefit.
- A skin-cancer multidisciplinary team (MDT) discussion to choose the best option.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Anaesthetic choices
The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.
Benefits
- Gives the best chance of removing the whole BCC in one treatment
- The tissue is examined under a microscope, so you find out whether the edges are clear
- High cure rates, particularly with Mohs surgery for difficult or facial BCCs
- Removes a lesion that would otherwise keep growing into nearby skin
- Provides a clear diagnosis and a plan for follow-up
Risks & complications
- Bruising, swelling and tenderness around the wound
- A scar — its size depends on the tumour and how the wound is closed
- Bleeding or oozing in the first day or two
- Temporary numbness around the wound
- Wound infection needing antibiotics
- The laboratory finding cancer at the edges, meaning more surgery is needed
- A graft or flap that partly fails to heal
- Stitches coming apart or delayed healing
- Noticeable or raised scarring
- Damage to a nearby nerve causing lasting numbness or weakness (more of a concern on the face)
- The BCC coming back at the same site (recurrence), sometimes years later
- A new skin cancer developing elsewhere over time
The most important point is that removing the visible BCC does not always mean the edges are clear — that is confirmed by the laboratory report. If the margins are involved, you may be advised to have further surgery. For BCCs on the face (especially the nose, eyelids and ears), choose a surgeon experienced in skin cancer and facial reconstruction, and ask how the wound will be closed and what scar to expect.
Published figures to discuss
Cure and recurrence rates vary with the type, size and site of the BCC, whether it has been treated before, and the surgical method. Figures from studies are averages and cannot predict an individual outcome, but they help set expectations. Incomplete excision (cancer at the edges) is a recognised reason for further surgery.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Recurrence after Mohs surgery (previously untreated BCC) | About 1–2% over follow-up | Mohs gives one of the highest cure rates, even for high-risk facial BCCs. NHS patient information cites a 98–99% cure rate. | NHS — Treatment for non-melanoma skin cancernhs.ukPublished figure |
| Recurrence when the excision edge is involved (positive margin) | Substantially higher — around a quarter of cases in one large series | Why the laboratory report matters: an involved margin usually prompts further surgery. | Guide sourcesClinical context |
| Recommended excision margin for low-risk, well-defined BCC | Around 3 mm, with wider margins (about 4–6 mm) for high-risk or larger lesions | Margins are a clinical decision; wider margins improve clearance but remove more skin. | Non-melanoma skin cancer: UK National Multidisciplinary Guidelines (PMC)ncbi.nlm.nih.govSource-linked context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
Recovery — what to expect, and when
Recovery from a simple excision is usually quick — a few days of mild soreness around a healing wound. If a skin graft or flap was needed, healing takes longer and needs more wound care.
- A tender, slightly raised, pink scar that fades over months
- Mild numbness or odd sensation around the wound
- Tightness near the wound that eases as skin stretches
- Itching as the wound heals
- Waiting a week or two for the laboratory result
Aftercare
- Follow the wound-care instructions you are given, and keep the dressing dry until advised otherwise.
- Take simple pain relief such as paracetamol if the area is sore.
- Avoid heavy lifting, stretching or activity that pulls on the wound in the early days.
- If you have a graft or flap, follow the specific care advice closely, as it needs a good blood supply to heal.
- Protect the healing scar from the sun with clothing or sunscreen.
- Attend your appointment to get the results and remove stitches.
- Keep an eye on the wound for signs of infection and know who to contact.
- Wound-care and dressing instructions understood
- Date booked for stitch removal and results
- Simple pain relief at home
- Time off arranged if a graft or flap was done
- Sun protection for the scar
- Clinic contact number saved for problems
Scars and how they heal
Every excision leaves a scar. A simple closure usually heals as a thin line that fades over months. Larger removals, grafts or flaps leave more noticeable scars, and a graft also leaves a smaller wound where the skin was taken from (the donor site). Scars on the face are planned to follow natural lines where possible. Sun protection helps them settle. Ask your surgeon what scar to expect before agreeing to surgery.
⚠ Get urgent help if…
- Increasing redness, heat, swelling or pus around the wound (signs of infection)
- Spreading redness with fever or feeling unwell
- Bleeding that does not stop with gentle pressure
- A graft or flap turning dark, dusky or very pale
- Wound edges coming apart
- Worsening pain rather than gradually improving pain
- A new lump or change at the scar in the months or years afterwards
Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your surgeon gives you.
Results & realistic expectations
A good result means the whole BCC has been removed with clear edges on the laboratory report, the wound heals well, and the scar settles acceptably. Surgery for BCC has high cure rates, and Mohs surgery offers a particularly high chance of clearance for difficult lesions. However, no operation can promise that the cancer will never come back, or that a new skin cancer will not develop elsewhere.
If the report shows cancer at the edges, this does not mean anything has gone wrong — it means the margin was not clear and a further procedure is usually recommended to complete the treatment.
Most BCCs that are fully removed do not come back, but recurrence is possible, particularly with incompletely excised, large, recurrent or aggressive types, and sometimes years later. Because anyone who has had one BCC is more likely to develop others, ongoing skin self-checks and sun protection remain important for life. Your team will advise whether you need scheduled skin-cancer follow-up.
Combining with other procedures
BCC surgery is often combined with reconstruction in the same sitting — a flap or graft to close the gap — particularly on the face. If a lesion is at a difficult site, Mohs surgery and the reconstruction may be planned together so the wound is closed only once the edges are confirmed clear.
Follow-up & long-term care
You will usually be given your laboratory results within a week or two, either at a wound-check appointment or by letter or phone. Follow-up after that depends on the type of BCC and your overall skin-cancer risk: some people are discharged with self-check advice, others are reviewed in clinic. Anyone treated for skin cancer should be shown how to check their own skin and when to seek help.
- Lifelong sun protection: cover up, use high-factor sunscreen and avoid sunbeds
- Regular skin self-checks for new or changing spots
- Attend any follow-up skin-cancer appointments offered
- Report any new lesion, or change at the scar, to your GP or team promptly
Revision and secondary surgery reality
- If the laboratory finds cancer at the edges, a further excision (or Mohs) is usually advised to complete treatment.
- A graft or flap that partly fails may need redressing, time to heal, or a further small procedure.
- Recurrent BCCs are generally harder to treat and more likely to be referred for Mohs surgery.
- Scars can sometimes be revised later if they heal poorly, once the area is confirmed clear.
Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.
What good aftercare looks like
- Clear wound-care instructions and a named contact for problems.
- A defined process for giving you the laboratory results and explaining what they mean.
- A plan for further surgery if the edges are not clear.
- Advice on sun protection and how to check your own skin.
- Appropriate skin-cancer follow-up for higher-risk lesions.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- The method used (standard excision, Mohs micrographic surgery, or curettage and cautery)
- The size, type and site of the BCC, and whether it is recurrent
- Whether the wound is closed directly or needs a flap or skin graft
- Local anaesthetic versus general anaesthetic and facility or theatre fees
- Laboratory (histopathology) fees for checking the margins
- Follow-up appointments, wound checks and any further surgery if edges are not clear
- The surgeon's fee and which technique is included
- Laboratory (histology) fees for examining the removed tissue
- Whether reconstruction (flap or graft) is included or charged separately
- Anaesthetic or sedation fees if relevant
- Follow-up appointments and stitch removal
- What happens, and what it costs, if the edges are not clear and more surgery is needed
- How results are given and who to contact with problems
On the NHS? Basal cell carcinoma is routinely treated on the NHS once diagnosed; private care may be used for speed, choice of surgeon or a second opinion, but should follow the same guidelines.
You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not explaining that 'removed' is only confirmed once the laboratory report shows clear edges.
- Choosing a destructive method (freezing or curettage) without a tissue diagnosis when the diagnosis is uncertain.
- Not discussing the scar, or the need for a graft or flap, before surgery.
- Implying cure is guaranteed, with no mention of recurrence or new skin cancers.
- No clear plan for who gives the results and what happens if margins are involved.
Marketing red flags
- Claims of 'scarless' skin cancer removal.
- Promising a guaranteed cure or that the cancer can never come back.
- Offering destructive treatments without first confirming the diagnosis with a biopsy.
- Pushing a particular technique without explaining why it suits your lesion.
- No mention of margins, histology or follow-up.
Choosing a surgeon safely
- Check your surgeon is on the GMC Specialist Register for this area.
- Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
- You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
- Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good surgeon will welcome every one of these.
- Which method do you recommend for my BCC, and why (excision, Mohs, or curettage)?
- How will the wound be closed — stitches, a flap, or a graft — and what scar should I expect?
- When and how will I get my results, and what happens if the edges are not clear?
- Is this a high-risk or recurrent type, and does that change the plan?
- Will I need skin-cancer follow-up, and how should I check my own skin?
- How will you manage my blood thinners or pacemaker around the procedure?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the surgeon who carries out my operation, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this operation not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Is basal cell carcinoma dangerous?
Will I be awake during the surgery?
What happens if the edges are not clear?
Can I have this on the NHS or do I need to go private?
Will it leave a scar?
Could it come back?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS — Treatment for non-melanoma skin cancer Cancer Research UK — Surgery for skin cancer Non-melanoma skin cancer: UK National Multidisciplinary Guidelines (PMC) Surgical margins and reoperation in BCC recurrence: 3036 cases (PMC) Surgical margin of excision in BCC: systematic review (PMC) Basal cell carcinoma — StatPearls (NCBI)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
Related guides: Melanoma surgery (wide local excision) · Skin graft · Local flap reconstruction · Scar revision · Burns reconstruction