Background: Basal cell carcinoma (BCC) is a locally destructive form of skin cancer, mainly affecting Caucasians. In the last few years non-surgical treatments of BCC have become widely used and non-invasive methods for treatment monitoring and follow-up are therefore becoming increasingly warranted. The objective of this study was to investigate the utility of adjunct use of non-invasive optical coherence tomography (OCT) imaging for the detection of recurrent BCC over clinical and dermoscopic examination alone, in a real-world setting. Methods: A total of 58 patients, previously treated with curettage and/or MAL-PDT for BCC, were included in the study. The patients were examined clinically and dermoscopically for recurrence by a dermatologist before joining the study. The included patients were then OCT scanned and if the OCT images raised suspicion of recurrent BCC the area was biopsied. Results: In 6 cases the clinical examination revealed suspicions recurrent lesions and OCT correctly identified all of these (6/6). In 49 cases the follow-up examinations showed no clinical or dermoscopic signs of recurrence, but in 12.2% (6/49) of these cases the subsequent OCT examination revealed a subclinical recurrent BCC lesion. These were all confirmed by histology. In 3 cases both the clinical and the OCT diagnosis was unclear and recurrent BCC could not be ruled out, but histology showed no sign of malignancy. Conclusions: These results suggest that the adjunct use of OCT increases the detection rate of recurrent BCC over clinical/dermoscopy examination alone.