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Full-length video Where can I learn more about simpler skin-cancer treatments?

A complete visual guide

Watch the full explanation on YouTube A complete visual review with the supporting clinical context.
What question should come before choosing a treatment?

Start With the Right Question

Patients often hear that a skin cancer can be “scraped,” “burned,” treated with a cream, exposed to a special light, frozen, radiated, watched, cut out, or removed with Mohs surgery. Those verbs make the decision sound like a menu of equivalent techniques.

They are not equivalent.

The first question is not, “Which treatment is easiest?” It is:

A superficial basal cell carcinoma on the trunk and a recurrent infiltrative BCC beside the nose may share a diagnostic name, but they do not share the same risk. Squamous cell carcinoma in situ and invasive squamous cell carcinoma are even more important to separate. One is confined to the epidermis; the other has crossed into deeper skin.

“Simpler” should mean appropriately matched to a lower-risk problem, not “chosen before the risk is known.”

What treatment terms should I understand first?

The Minimum Vocabulary

Superficial or in situ disease

Superficial BCC grows mainly near the skin surface, although a partial biopsy can occasionally miss a deeper component elsewhere in the tumor.1

Squamous cell carcinoma in situ, also called Bowen disease, contains malignant keratinocytes within the epidermis—the outermost layer of skin. It has not yet crossed the basement membrane into the dermis.

Invasive disease

Invasive SCC has entered deeper skin. Its behavior depends on depth, differentiation, size, location, nerve involvement, recurrence, immune status, and other features. Some invasive SCCs are readily cured; high-risk tumors can recur, spread to lymph nodes, and cause death.2,3

Clinical clearance versus histologic clearance

Clinical clearance means no obvious tumor is seen or felt after treatment. Histologic clearance means tissue examined under a microscope shows no tumor in the area assessed. A smooth-looking surface after a cream is not the same endpoint as a complete negative surgical margin.

Recurrence, cure, and sustained clearance

A percentage means little unless four boundaries travel with it:

  1. Population: Which patients and tumors were studied?
  2. Comparator: What was the treatment measured against?
  3. Endpoint: Was the result short-term visible clearance, tumor-free survival, recurrence, or another outcome?
  4. Time: Was it measured at three months, one year, four years, five years, or ten years?

A 90% response at 12 weeks cannot be relabeled a 90% five-year cure.

Surgical margin

The peripheral margin surrounds the sides of a tumor; the deep margin lies underneath. Standard excision removes a planned rim and submits tissue for pathology, usually using representative vertical sections. Mohs surgery examines a mapped en-face peripheral and deep margin during the operation and removes additional tissue only where cancer remains.4

How should I compare the simpler treatment options?

Define the Options Before Comparing Them

Electrodesiccation and curettage (ED&C)

The clinician uses a curette—a ring-shaped scraping instrument—to remove friable tumor, then applies electrical energy to desiccate the base and edge. The cycle may be repeated. ED&C can be effective for carefully selected low-risk tumors in experienced hands.

Its central limitation is structural: it does not produce an oriented specimen showing a complete peripheral and deep margin. Success depends heavily on tumor selection, location, technique, and the operator's ability to distinguish tumor from normal tissue by feel.

Topical imiquimod

Imiquimod is an immune-response modifier applied to the skin on a defined schedule. It produces inflammation as the immune system reacts. It is most relevant to selected superficial BCC and SCC in situ—not deeply invasive or high-risk tumors. Treatment lasts weeks, the reaction can be intense, adherence matters, and the final surface appearance does not prove a complete margin.

Topical 5-fluorouracil

5-fluorouracil, or 5-FU, is a topical antimetabolite that preferentially injures rapidly dividing abnormal cells. It is used for selected superficial BCC and SCC in situ. Like imiquimod, it requires a treatment course, visible inflammation, adherence, and follow-up. It does not provide a surgical margin specimen.

Photodynamic therapy

Photodynamic therapy, or PDT, applies a light-sensitizing medication and then activates it with a particular light. It can treat a broad superficial field and may offer a favorable cosmetic result. Pain during illumination, repeat sessions, and lower long-term tumor-free survival than surgery are important tradeoffs in BCC and SCC in situ.5,6

Cryotherapy

Cryotherapy uses extreme cold—usually liquid nitrogen—to destroy tissue. It may fit selected small, superficial, well-defined lesions when the diagnosis and depth are secure. Freeze depth can be difficult to standardize, no complete margin is examined, and healing can include blistering, pigment change, or scarring. It is not a routine answer for an uncertain, invasive, recurrent, or high-risk cancer.

Radiation therapy

Radiation uses ionizing energy to kill cancer cells over one or more sessions. It can be a valuable definitive treatment when surgery would be unusually burdensome or is not medically appropriate, and it can be added after surgery for selected high-risk features. It is not merely a “simpler office treatment”: it may require many visits, provides no surgical margin specimen, causes early and late skin effects, and can make treatment of a recurrence more complex.7

Observation

Observation means a deliberate, documented decision not to treat immediately, with a defined follow-up plan and trigger to reconsider. It can fit a genuinely limited setting—for example, a biopsy-proven low-risk BCC growing slowly in a frail patient whose competing health risks and goals make treatment burden greater than likely benefit.8

Observation is not reassurance from an uncertain photograph. It is not appropriate merely because a lesion is painless. It is generally a poor choice for an aggressive, symptomatic, rapidly growing, invasive, high-risk, or function-threatening cancer in a patient who can benefit from curative treatment.

How does risk change the BCC evidence?

Basal Cell Carcinoma: The Evidence Depends on the Risk Group

BCC rarely spreads to distant organs, but it can invade and destroy nearby tissue. The main treatment goal is durable local control with an acceptable functional and cosmetic result. Risk varies with subtype, size, location, border, recurrence, prior radiation, immune status, and other features.9–11

The table below intentionally does not rank all treatments using one pooled “cure rate.” The studies enrolled different BCC populations. Each number keeps its own population, endpoint, and time boundary.

Basal Cell Carcinoma: The Evidence Depends on the Risk Group
Treatment and study settingPopulation and risk boundaryPublished endpointFollow-upWhat it means—and does not mean
Mohs surgery in the randomized facial-BCC trialRecurrent facial BCC, a high-risk setting after prior treatment3.9% recurrence after Mohs versus 13.5% after standard excision10 yearsStrong long-term evidence favoring Mohs for recurrent facial BCC. It is not a universal rate for every primary low-risk BCC.12
Standard surgical excision in the SINS randomized trialPrimary low-risk superficial or nodular BCC at low-risk sites97.7% treatment success with surgery versus 82.5% with imiquimod5 yearsIn selected lower-risk BCC, surgery produced more durable success than imiquimod. This trial did not test Mohs in high-risk facial disease.13
ED&C / curettage with or without electrodesiccation in a nationwide dermatology-practice cohort47,358 BCCs treated in routine Danish dermatology practices; observational selection, not randomized9.9% recurrence at 5 years and 13.3% at 8 years overall; 25.1% at 8 years for head-and-neck tumors5 and 8 yearsCurettage can work well in selected disease, but location and selection matter. The high head-and-neck recurrence estimate argues against treating a high-stakes facial BCC as a routine scrape-and-burn lesion.14
Topical imiquimod in SINSPrimary low-risk superficial or nodular BCC at low-risk sites82.5% treatment success versus 97.7% with surgery5 yearsImiquimod can be effective for selected low-risk BCC, but it did not match surgery's durable result.13
Imiquimod, 5-FU, and MAL-PDT in a randomized superficial-BCC trial601 patients with primary superficial BCC80.5% tumor-free survival with imiquimod, 70.0% with 5-FU, and 62.7% with methyl-aminolevulinate PDT5 yearsThese are long-term estimates for superficial BCC. They support imiquimod over the two nonsurgical comparators in this trial; they do not make any option appropriate for infiltrative, recurrent, or other high-risk BCC.5

The stark comparison is not “Mohs versus cream for the same patient.” Most trials did not randomize high-risk recurrent facial tumors to a topical treatment because the risk groups do not belong in the same treatment lane.

The practical conclusions are stronger:

  • For a selected low-risk superficial BCC, a topical option can be medically reasonable when the patient accepts a lower durable success rate, no margin confirmation, a visible treatment reaction, and follow-up.
  • For a small, well-defined, lower-risk BCC in a favorable location, standard excision is an excellent benchmark.
  • For a recurrent, aggressive, poorly defined, or tissue-sensitive BCC, Mohs is usually the stronger choice because it couples high local control with mapped complete margin assessment and tissue preservation.
What evidence applies to SCC in situ?

Squamous Cell Carcinoma in Situ: Keep the Evidence in Its Lane

SCC in situ is surface-confined disease. That creates a legitimate role for excision, ED&C, topical treatment, PDT, and sometimes cryotherapy. Yet “in situ” does not make every lesion low consequence. Size, site, immune status, recurrence, clinical thickness, adnexal extension, diagnostic confidence, and the possibility of unrecognized invasion still matter.

Squamous Cell Carcinoma in Situ: Keep the Evidence in Its Lane
Treatment and study settingPopulation and selection boundaryPublished endpointFollow-upPatient meaning
Surgical excision in a randomized trial250 adults with one primary, histologically proven Bowen disease lesion 4–40 mm; suspected invasion and several higher-stakes settings were excluded97.5% tumor-free survival4 yearsSurgery provided the most durable result in this trial of selected primary SCC in situ.6
Topical 5-FU in the same randomized trialSame selected primary SCC in situ population86.2% tumor-free survival4 years5-FU was a credible nonsurgical option but did not match excision's numerical result. Adherence, reaction, and follow-up matter.6
MAL-PDT in the same randomized trialSame selected primary SCC in situ population82.7% tumor-free survival4 yearsPDT avoided excision but had the lowest four-year tumor-free estimate among the three study groups.6
ED&C in a retrospective cohort510 SCC in situ tumors treated at one academic center; treatment and site selection were not randomized5.3% recurrence5 yearsED&C can perform well in appropriately selected SCC in situ, but the observational design cannot guarantee the same result for high-risk sites or patients.15
Imiquimod or cryotherapySelected SCC in situ in guideline-supported practice; protocols and comparative long-term evidence varyNo single locked, directly comparable long-term estimate is used hereVariesThese may fit selected lesions, but a short-term visible response should not be presented as equivalent to four- or five-year tumor-free survival.

The randomized SCC-in-situ comparison excluded suspected invasive disease. That boundary is the teaching point, not a footnote. If the lesion is thick, tender, indurated, rapidly growing, ulcerated, recurrent, clinically discordant, or inadequately sampled, the clinician should reconsider whether the biopsy has safely established an in-situ problem.

Why is invasive SCC a separate treatment decision?

Invasive SCC: Do Not Borrow the SCC-in-Situ Numbers

Once SCC enters the dermis, it gains access to deeper structures. Risk increases with depth, poor differentiation, diameter, location, recurrence, perineural invasion, immune suppression, and other features.2,3

The four-year 97.5%, 86.2%, and 82.7% SCC-in-situ results above cannot be transferred to invasive SCC. The trial did not answer whether 5-FU or PDT controls an invasive tumor, a high-risk cSCC, a tumor around a nerve, or a cancer in an immunosuppressed patient.6

For invasive cSCC:

  • Surgery is generally the curative foundation when the tumor is resectable.
  • Standard excision can fit a well-defined lower-risk tumor when an adequate margin can be removed and assessed.
  • Mohs or another appropriate complete-margin approach is generally favored for high-risk, very-high-risk, recurrent, poorly defined, tissue-sensitive, or aggressive tumors.
  • ED&C belongs only to a narrow, carefully selected low-risk lane and does not provide complete margin knowledge.
  • Topical 5-FU, imiquimod, PDT, and cryotherapy are not substitutes for margin-assessed surgery in invasive high-risk SCC.
  • Radiation may be definitive when surgery is not appropriate or may be added for selected adverse features, but it solves a different problem than an excised, microscopically examined margin.7

In a 2,752-tumor observational cohort of NCCN very-high-risk cSCC, complete margin assessment was associated at three years with lower local recurrence (5.9% versus 12.5%), nodal metastasis (6.0% versus 11.6%), distant metastasis (1.9% versus 4.3%), and disease-specific death (3.3% versus 6.2%) than vertical-section excision.16

Those are not SCC-in-situ results and not randomized proof. They are high-risk invasive-cancer outcomes. Their practical meaning is that the way a very-high-risk SCC margin is examined may matter far beyond convenience.

When is a simpler option reasonable, and when is surgery stronger?

When a Simpler Option Is Reasonable—and When Surgery Is Stronger

When a Simpler Option Is Reasonable—and When Surgery Is Stronger
Decision featureA simpler option may be reasonable when…Mohs or standard excision is the stronger choice when…
Diagnostic certaintyBiopsy securely establishes the correct superficial or low-risk diagnosis and the clinical lesion agreesSampling is shallow, partial, discordant, or may have missed invasion or an aggressive component
DepthDisease is truly surface-confined or belongs to a validated low-risk ED&C pathwayDisease is invasive, indurated, thick, fixed, or otherwise deeper than a surface treatment can reliably address
Tumor riskPrimary, small, well-defined, nonaggressive, and in a favorable locationRecurrent, aggressive, poorly defined, large for the site, high risk, or very high risk
AnatomySite is forgiving and recurrence would remain readily detectable and treatableEyelid, nose, lip, ear, hand, foot, genital area, central face, or another functionally or cosmetically high-stakes site
Margin needThe expected benefit of avoiding surgery reasonably outweighs the value of a complete marginProving clearance before repair or conserving tissue through a mapped margin could change care
Patient health and goalsPatient understands the lower-certainty tradeoff, can complete the course, and will return for surveillancePatient wants the strongest one-procedure clearance strategy and can safely undergo surgery
Consequences of failurePersistence or recurrence is likely to remain recognizable and salvageable without major added harmDelay or recurrence could enlarge the operation, threaten function, involve a nerve, or increase metastatic risk
What numbers help compare simpler treatments?

Evidence by the Numbers

Evidence by the NumbersSurgery set the durable benchmark for selected low-risk BCC

Surgery set the durable benchmark for selected low-risk BCC

97.7% vs 82.5%

Population
Patients in the SINS randomized trial with primary low-risk superficial or nodular basal cell carcinoma at low-risk sites
Outcome
Treatment success with standard surgery versus topical imiquimod
Time horizon
Five years

What it means: Imiquimod can be reasonable for selected low-risk BCC, but surgery produced the more durable result.

Limitations: This trial did not compare imiquimod with Mohs for recurrent, aggressive, or high-risk facial BCC.

References: 13

Evidence by the NumbersSuperficial BCC treatments separate over time

Superficial BCC treatments separate over time

80.5% vs 70.0% vs 62.7%

Population
601 patients in a randomized trial with primary superficial basal cell carcinoma
Outcome
Tumor-free survival with imiquimod, topical 5-fluorouracil, and methyl-aminolevulinate photodynamic therapy
Time horizon
Five years

What it means: Among these nonsurgical choices for superficial BCC, imiquimod had the strongest long-term result in this trial.

Limitations: These rates do not apply to infiltrative, recurrent, aggressive, deeply invasive, or other high-risk BCC and do not establish a complete microscopic margin.

References: 5

Evidence by the NumbersCurettage outcomes depended strongly on where the BCC was treated

Curettage outcomes depended strongly on where the BCC was treated

13.3% overall vs 25.1% head and neck

Population
47,358 BCCs treated with curettage with or without electrodesiccation in Danish dermatology practices
Outcome
Recurrence overall versus recurrence among head-and-neck tumors
Time horizon
Eight years

What it means: Curettage can fit selected BCC, but a high-stakes head-and-neck tumor should not be treated like a routine low-risk lesion.

Limitations: This was an observational cohort with clinician selection, not a randomized comparison with Mohs or excision; five-year recurrence was 9.9% overall.

References: 14

Evidence by the NumbersExcision produced the strongest four-year SCC-in-situ result

Excision produced the strongest four-year SCC-in-situ result

97.5% vs 86.2% vs 82.7%

Population
250 adults in a randomized trial with one primary, histologically proven Bowen disease lesion 4–40 mm; suspected invasion and several higher-stakes settings were excluded
Outcome
Tumor-free survival with surgical excision, topical 5-fluorouracil, and methylaminolevulinate photodynamic therapy
Time horizon
Four years

What it means: 5-FU and PDT can be credible options for selected SCC in situ, but excision gave the most durable result in this comparison.

Limitations: These data cannot be transferred to invasive or high-risk SCC; loss to follow-up was material and the trial's exclusions define its applicability.

References: 6

Evidence by the NumbersED&C can control carefully selected SCC in situ

ED&C can control carefully selected SCC in situ

5.3% recurrence

Population
510 squamous cell carcinomas in situ treated with electrodesiccation and curettage at one academic center
Outcome
Local recurrence after ED&C; recurrence was 3.0% in low-risk, 8.2% in moderate-risk, and 6.0% in high-risk anatomic zones without a statistically significant zone difference
Time horizon
Five years

What it means: ED&C can work well for selected SCC in situ, but the result depends on appropriate diagnosis, site selection, and technique.

Limitations: This was a retrospective single-center cohort, not a randomized comparison with surgery, and it does not support ED&C for invasive high-risk SCC.

References: 15

Evidence by the NumbersInvasive very-high-risk SCC belongs in a different treatment lane

Invasive very-high-risk SCC belongs in a different treatment lane

5.9% vs 12.5% local recurrence

Population
A retrospective cohort of 2,752 NCCN very-high-risk invasive cutaneous squamous cell carcinomas treated surgically
Outcome
Local recurrence with complete margin assessment versus vertical-section excision; nodal metastasis was 6.0% vs 11.6%, distant metastasis 1.9% vs 4.3%, and disease-specific death 3.3% vs 6.2%
Time horizon
Three years

What it means: For very-high-risk invasive cSCC, the evidence supports comprehensive margin assessment rather than borrowing success rates from surface-confined SCC in situ.

Limitations: This was an observational comparison, not randomized proof, and it does not imply that every low-risk invasive SCC requires Mohs.

References: 16

How does treatment selection work in examples?

Five Examples That Show Selection in Practice

1. A primary superficial BCC on the trunk

The biopsy is adequately sampled, the lesion is thin and well defined, and the site is low risk. Standard excision offers the most durable benchmark. Imiquimod, 5-FU, or ED&C may be reasonable alternatives after discussing the lower long-term success or lack of margin confirmation. This is where preference can legitimately influence the choice.

2. A recurrent BCC on the nose

Recurrence, facial anatomy, scar, and an uncertain border move the decision out of the simple-treatment lane. Mohs is usually the strongest option. A topical response on the surface would not solve the question of hidden tumor at the edge or base.

3. A biopsy-proven SCC in situ on a favorable site

Excision gives the highest four-year tumor-free estimate in the randomized comparison. 5-FU, PDT, ED&C, imiquimod, or cryotherapy may still be appropriate depending on size, site, pathology, health, priorities, and clinician expertise. The patient should know which endpoint supports the recommendation and how recurrence will be recognized.

4. A tender, rapidly growing lesion labeled SCC in situ on a shallow biopsy

The behavior and palpated depth do not fit a purely surface-confined problem. Reconciliation comes before a cream: deeper sampling, pathology review, or excision may be needed to exclude invasion. Clinical-pathologic discordance is a reason to investigate, not to average the two impressions.

5. A biopsy-proven low-risk BCC in a frail older adult with major competing illness

If the tumor is growing slowly and unlikely to cause trouble within the person's health horizon, documented observation can be reasonable. The plan should name what will be watched, when it will be reassessed, and what symptom or growth would trigger treatment. Age alone is not a reason to withhold curative care.

What should I ask before choosing?

Questions to Ask Before Choosing

  1. Is this BCC, SCC in situ, or invasive SCC?
  2. Was the biopsy deep and broad enough to answer that question?
  3. Which feature makes the tumor lower risk or higher risk?
  4. What population produced the percentage being quoted to me?
  5. Does that percentage mean short-term clinical clearance, treatment success, recurrence, or long-term tumor-free survival?
  6. How long were patients followed?
  7. Will this treatment provide a complete peripheral and deep margin?
  8. If no margin is examined, how will persistence or recurrence be recognized?
  9. What would surgery offer at this site, and what would it cost in tissue or recovery?
  10. If the first treatment fails, will the next treatment become more difficult?
Frequently asked questions about simpler treatments

Frequently Asked Questions

Is ED&C the same as Mohs surgery?

No. ED&C removes and destroys tissue using tactile and visual judgment; it does not create a mapped complete margin. Mohs removes oriented layers, examines the complete peripheral and deep margin, and returns only to mapped positive areas.

Are topical creams chemotherapy?

Topical 5-FU is a local antimetabolite; imiquimod is an immune-response modifier. Both can be appropriate for selected superficial disease. Their local use, treatment reactions, and risk profile differ from intravenous cancer chemotherapy.

If the spot disappears after a cream, is it cured?

Not necessarily. Disappearance is encouraging clinical clearance, but it is not a microscopic margin. Long-term follow-up data and surveillance are needed because residual tumor or recurrence may not be immediately visible.

Which topical treatment works best for superficial BCC?

In one randomized trial followed for five years, imiquimod had higher tumor-free survival (80.5%) than 5-FU (70.0%) or MAL-PDT (62.7%) for primary superficial BCC.5 That does not make imiquimod appropriate for an invasive, recurrent, aggressive, or high-risk BCC.

Why not use a cream first and save surgery for recurrence?

That can be reasonable for a carefully selected superficial low-risk tumor. It is a poor strategy when recurrence could grow through scar, make the border harder to see, enlarge the future operation, threaten function, or delay control of an invasive high-risk cancer.

Is standard excision the same as wide local excision?

Both describe surgical removal with a planned margin. “Wide local excision” is especially common in melanoma teaching, where the margin width follows tumor thickness. For BCC and cSCC, “standard surgical excision” is usually the clearer term. Neither label alone tells you how much of the microscopic margin will be examined.

Can SCC in situ spread to lymph nodes?

True SCC in situ is confined to the epidermis and does not have access to lymphatic channels in deeper skin. The safety issue is whether the lesion has an unrecognized invasive focus or later progresses, which is why adequate sampling and clinical-pathologic agreement matter.

Is radiation easier than surgery?

Not automatically. Radiation avoids surgical removal but often requires repeated visits, creates acute and late skin effects, provides no surgical margin, and can complicate future treatment. It is highly valuable in the right setting, not a universally simpler substitute.

When is observation reasonable?

Observation fits a deliberate, documented decision for a secure low-risk diagnosis when health, life expectancy, treatment burden, tumor behavior, and patient goals make immediate treatment less beneficial. It requires a follow-up interval and a trigger to act.

Who should help make this decision?

A dermatologist can reconcile the clinical lesion with the biopsy and risk group. A dermatologic surgeon or fellowship-trained Mohs surgeon adds expertise in margin assessment, tumor removal, and reconstruction when surgery is under consideration. Complex high-risk disease may also require dermatopathology, radiation oncology, surgical oncology, or medical oncology.

Where should I go next in the Patient Journey?

Next Steps in the Patient Journey

Before accepting a “simple” treatment, ask for the diagnosis, risk category, endpoint, follow-up time, and margin tradeoff in one sentence. When the tumor is high risk, recurrent, aggressive, poorly defined, invasive, or on high-stakes anatomy, ask specifically whether Mohs or another complete-margin surgical approach offers the safer path.

Continue with the question that fits you now

Who reviewed and authored this treatment guide?
Portrait of Dr. Thomas L.H. Hocker

About the Author

Dr. Thomas L.H. Hocker is a Harvard- and Mayo Clinic-trained, triple board-certified dermatologist, Mohs surgeon, and dermatopathologist. He is the Founding Director of Dermatologic Surgery at the UMKC School of Medicine and University Health and an Iron Surgeon lecturer at the American Society for Dermatologic Surgery. His work focuses on Mohs surgery for melanoma, complex and rare skin tumors, and aesthetic reconstruction after skin-cancer treatment. He co-authored the best-selling textbook Review of Dermatology and created Skin Trust to give patients and clinicians free access to clear, current, evidence-based education.

Read Dr. Hocker's background and mission

Dr. Hocker earned his bachelor's degree with honors from Yale University, where he was inducted into Phi Beta Kappa. As a Winston Churchill Scholar, he then studied at the University of Cambridge and earned an M.Phil. in Organic Chemistry. He received his M.D. with honors from Harvard Medical School, where his research focused on melanoma genetics. He completed dermatology residency at Mayo Clinic, a dermatopathology fellowship at the University of Michigan, and a Mohs micrographic and reconstructive surgery fellowship at Mayo Clinic. He is board-certified in Dermatology, Dermatopathology, and Mohs Micrographic Surgery.

Dr. Hocker serves as the Founding Director of Dermatologic Surgery at the UMKC School of Medicine and University Health. He is an internationally invited lecturer and speaker who teaches about Mohs surgery for melanoma, complex and rare tumors, dermatopathology, and aesthetic reconstruction after skin-cancer treatment. He has also been selected as an Iron Surgeon lecturer by the American Society for Dermatologic Surgery. He is the co-author of Review of Dermatology, a best-selling dermatology review textbook, and he continues to teach and mentor medical students, residents, and physicians.

Skin Trust exists because Dr. Hocker believes access to excellent medical knowledge should not depend on geography, wealth, or proximity to a major academic center. After training at several of the world's leading institutions, he sees that education as both a gift and a responsibility: to translate current evidence, expert judgment, and hard-won clinical experience into guidance that patients, families, and clinicians can actually use.

The mission is to increase awareness, reduce avoidable suffering, and give every person equal access to trustworthy, up-to-date information that can help them make the best decisions for their life. Skin Trust also extends Dr. Hocker's lifelong commitment to teaching, writing, and mentoring medical students and residents as they build lives and careers of purpose and service.

For Dr. Hocker, this work is also an expression of faith. He regards the opportunities to learn at Yale, Cambridge, Harvard, Mayo Clinic, and the University of Michigan as blessings from God. Teaching, writing, mentoring, and building Skin Trust are ways to pay those blessings forward in service to patients, learners, and the broader community. His faith is the personal motivation to do this work carefully, generously, and with integrity; it is not a condition of using or benefiting from this free resource.

View Review of Dermatology Read Dr. Hocker's full biography
References for this simpler-treatment guide

References

  1. Moon D, Randall G, Higgins S, Sutton AV, Wysong A. Misclassification of aggressive basal cell carcinoma subtypes and implications for management. Dermatol Surg. 2021. PMID: 33905389.
  2. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Squamous Cell Skin Cancer. Version 2.2026. Updated March 17, 2026.
  3. Kim JYS, Kozlow JH, Mittal B, et al. Guidelines of care for the management of cutaneous squamous cell carcinoma. J Am Acad Dermatol. 2018;78(3):560-578. PMID: 29331386. DOI: 10.1016/j.jaad.2017.10.007.
  4. Tolkachjov SN, Brodland DG, Coldiron BM, et al. Understanding Mohs micrographic surgery: a review and practical guide for the nondermatologist. Mayo Clin Proc. 2017;92(8):1261-1271. PMID: 28778259. DOI: 10.1016/j.mayocp.2017.04.009.
  5. Jansen MHE, Mosterd K, Arits AHMM, et al. Five-year results of a randomized controlled trial comparing photodynamic therapy, topical imiquimod, and topical 5-fluorouracil in superficial basal cell carcinoma. J Invest Dermatol. 2018;138(3):527-533. PMID: 29045820. DOI: 10.1016/j.jid.2017.09.033.
  6. Moermans MMG, Ahmady S, Nelemans PJ, et al. Surgical excision versus topical 5% 5-fluorouracil and photodynamic therapy in the treatment of Bowen's disease: long-term results of a multicenter randomized controlled trial. J Am Acad Dermatol. 2026;94(5):1447-1453. PMID: 41391634. DOI: 10.1016/j.jaad.2025.12.034. ClinicalTrials.gov: NCT03909646.
  7. Likhacheva A, Awan M, Barker CA, et al. Definitive and postoperative radiation therapy for basal and squamous cell cancers of the skin: executive summary of an ASTRO clinical practice guideline. Pract Radiat Oncol. 2020.
  8. van Winden MEC, Hetterschijt CR, Bronkhorst EM, et al. Evaluation of watchful waiting and tumor behavior in patients with basal cell carcinoma. JAMA Dermatol. 2021. PMID: 34495284. DOI: 10.1001/jamadermatol.2021.3020.
  9. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Basal Cell Skin Cancer. Version 2.2026.
  10. Kim JYS, Kozlow JH, Mittal B, et al. Guidelines of care for the management of basal cell carcinoma. J Am Acad Dermatol. 2018;78(3):540-559.
  11. Nehal KS, Bichakjian CK. Update on keratinocyte carcinomas. N Engl J Med. 2018.
  12. van Loo E, Mosterd K, Krekels GA, et al. Surgical excision versus Mohs micrographic surgery for basal cell carcinoma of the face: a randomized clinical trial with 10-year follow-up. Eur J Cancer. 2014;50(17):3011-3020. PMID: 25262378. DOI: 10.1016/j.ejca.2014.08.018.
  13. Williams HC, Bath-Hextall F, Ozolins M, et al. Surgery versus 5% imiquimod for nodular and superficial basal cell carcinoma: five-year results of the SINS randomized controlled trial. J Invest Dermatol. 2017;137(3):614-619. PMID: 27932240. DOI: 10.1016/j.jid.2016.10.019.
  14. Kjeldsen EW, Kjær SK, Sieborg J, Sølvsten H, Hædersdal M. Long-term recurrence after curettage ± electrodesiccation for basal cell carcinoma: a nationwide cohort study of 47,358 tumours from dermatology practices. Acta Derm Venereol. 2026;106:adv20250079. DOI: 10.2340/actadv.v106.adv-2025-0079.
  15. Veverka KK, Stratman EJ. Electrodesiccation and curettage for squamous cell carcinoma in situ: the effect of anatomic location on local recurrence. Dermatol Surg. 2023;49(9):821-824. DOI: 10.1097/DSS.0000000000003855.
  16. Wang DM, Ran NA, Granger EE, et al. Excision with total margin control versus vertical section margin assessment for NCCN very high-risk cutaneous squamous cell carcinoma. J Natl Compr Canc Netw. 2025;23(12):531-537. PMID: 41671454. DOI: 10.6004/jnccn.2025.7072.