Curative or Conservative Approaches: A Systematic Review of Surgical and Nonsurgical Treatments for Basal Cell Carcinoma.

Basal cell carcinoma (BCC) is the predominant kind of skin cancer globally, with a consistently increasing prevalence attributed to heightened ultraviolet (UV) exposure, aging demographics, and enhanced diagnostic techniques. Surgical excision is considered the gold standard for BCC treatment; however, various nonsurgical alternatives, such as topical therapies, photodynamic therapy (PDT), cryotherapy, and ablative techniques, are increasingly utilized, especially in patients with low-risk lesions or contraindications to surgery. Comparative assessments of various modalities are crucial for informing evidence-based, patient-centered treatment choices. To comprehensively evaluate the effectiveness, recurrence rates, cosmetic outcomes, safety profiles, and clinical applicability of surgical and nonsurgical treatment options for basal cell carcinoma, this systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Extensive literature searches were performed in PubMed, ScienceDirect, and the Cochrane Library up to May 29, 2025, using keywords related to "surgical excision," "basal cell carcinoma," and associated comparative terms. Studies were eligible if they involved human participants and directly compared surgical and nonsurgical interventions. The risk of bias was evaluated with the Risk of Bias In Non-randomized Studies of Interventions (ROBINS-I) and Risk of Bias 2 (RoB-2) instruments. Eleven papers fulfilled the inclusion criteria for qualitative synthesis. Surgical excision consistently exhibited enhanced long-term effectiveness and reduced recurrence rates in comparison to nonsurgical interventions. Nonetheless, nonsurgical approaches, especially topical imiquimod and PDT, demonstrated similar efficacy in addressing superficial or low-risk lesions while providing markedly superior esthetic results. In older or medically challenged individuals, conservative therapies were well-tolerated and clinically efficacious. Nonetheless, recurrence risks were often elevated with nonsurgical methods, especially in nodular or deeper tumors. The findings confirm that surgical excision is the ultimate therapy for basal cell carcinoma, particularly in high-risk or aggressive cases. Nevertheless, nonsurgical treatments provide significant advantages regarding esthetics, tolerability, and patient comfort, rendering them appropriate options in some instances. The variability of studies and the scarcity of long-term data highlight the necessity for more research utilizing standardized metrics and prolonged follow-up durations. In conclusion, surgical excision is the most successful and dependable treatment for basal cell carcinoma; nonetheless, nonsurgical alternatives are significant for specific patient populations. Customized treatment planning, guided by lesion attributes, patient comorbidities, and esthetic factors, is crucial for enhancing results and facilitating collaborative decision-making in clinical practice.