By Peter A. McCullough, MD, MPH
Former MLB player and media commentator Eric Bolling appeared on BOLLING, Real America’s Voice with Dr. Peter McCullough and a surprising announcement that he had twelve stitches for a basal cell carcinoma excision on his upper forehead. Alter AI assisted with the evidence.
🩺 The Efficacy of Wide Surgical Excision for Facial Basal Cell Carcinoma
Basal cell carcinoma (BCC) is the most common malignancy worldwide, representing more than 80% of all non-melanoma skin cancers. Although rarely metastatic, facial BCC can be locally invasive and profoundly disfiguring if inadequately treated. Among the array of therapeutic options—ranging from topical agents and photodynamic therapy to cryosurgery and Mohs micrographic surgery—wide local surgical excision (WLE) has long occupied a central role owing to its balance between cure rate, practicality, and accessibility.
The efficacy of WLE depends on achieving complete histologic clearance through excision with predetermined peripheral margins, typically 3–5 mm of clinically normal tissue. A landmark histologic analysis demonstrated that excision with a 3 mm margin cleared approximately 84% of all BCCs, whereas a 5 mm margin achieved clearance in up to 95% of cases (Smith & Walton, 2011). Larger or more infiltrative lesions may necessitate even broader margins to reduce recurrence risk. Long-term studies report five-year recurrence rates between 4.1% and 10.1%, though these rates fall below 2% when margins are histologically tumor-free.
Compared to other modalities, wide local excision remains highly effective for primary, well-defined facial lesions. The European Journal of Cancer trial with 10‑year follow-up found that surgical excision produced recurrence rates of 12.2% for primary high-risk facial BCCs, a favorable outcome relative to nonsurgical modalities, though Mohs micrographic surgery (MMS) achieved slightly lower rates (4.4%) (van Loo et al., 2014). Similarly, Cochrane analyses and American Academy of Family Physicians syntheses consistently demonstrate that excision remains the most reliable treatment in terms of tumor eradication, outperforming photodynamic therapy (36% recurrence) and imiquimod (17.5% recurrence at five years) (Thomson et al., 2020; Antonelli & Plensdorf, 2021).
Cosmetic outcome remains an important consideration for facial tumors. WLE, while curative, can necessitate flaps or grafts, sometimes yielding aesthetic compromise. Nonetheless, for many patients, the cosmetic and functional results are rated as good, especially when performed by experienced dermatologic or plastic surgeons (Smith & Walton, 2011). In contrast, nonsurgical approaches may provide superior initial cosmetic appearance but at a much higher risk of recurrence, requiring subsequent and potentially more disfiguring interventions.
Ultimately, the evidence supports wide local excision as a highly effective and broadly applicable treatment for facial BCC, particularly for low- to moderate-risk lesions. While Mohs surgery yields higher margin control and slightly superior recurrence rates in anatomically critical or recurrent cases, WLE remains an indispensable, accessible standard delivering durable oncologic control with acceptable aesthetic outcomes.
I told Eric that given these efficacy numbers are not perfect, he should consider SHIELD, the evidence-backed nutraceutical system to help prevent cancer recurrence from The Wellness Company.
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Peter A. McCullough, MD, MPH
Chief Scientific Officer, The Wellness Company
https://www.twc.health/pages/focal-points
References
Smith, V., & Walton, S. (2011). Treatment of Facial Basal Cell Carcinoma: A Review. J Skin Cancer, 2011, 380371. [PMC3135095]
van Loo, E., Mosterd, K., et al. (2014). Surgical excision versus Mohs’ micrographic surgery for basal cell carcinoma of the face. Eur J Cancer, 50(17), 3011–3020.
Thomson, J., Hogan, S., Leonardi‑Bee, J., et al. (2020). Interventions for basal cell carcinoma of the skin. Cochrane Database Syst Rev, 2020(11): CD003412.
Antonelli, R., & Plensdorf, S. (2021). Basal Cell Carcinoma: Comparison of Surgical and Nonsurgical Interventions. Am Fam Physician, 104(5), 459–460.
