Basal Cell Carcinoma (BCC)

What is basal cell carcinoma?

Basal cell carcinoma (BCC), which used to be called a rodent ulcer, is the commonest skin cancer, and indeed the commonest of all cancers. It develops from basal cells in the lowest part of the outer layer of the skin.

BCCs are slow-growing and only very rarely spread elsewhere, so they hardly ever threaten life. However, if left untreated, they can gradually grow and damage the surrounding skin and tissues, which can make removal more complex, particularly on the face.

Who gets it?

Roughly 30 in every 100 fair-skinned people will have a BCC at some point in their lives. They are most common in older adults, but they are increasingly being diagnosed in younger people. BCCs are much less common in people with brown and black skin, but they do occur and are often pigmented.

What causes it?

Years of ultraviolet (UV) exposure, from sunlight or sunbeds, is the chief cause. Those most at risk are people with pale skin that tends to burn rather than tan, especially if they have red or fair hair; people with heavy sun exposure through outdoor jobs, hobbies or time spent in sunny countries; regular sunbathers and sunbed users; and anyone who has already had a BCC.

Other risk factors include a weakened immune system, particularly after an organ transplant; previous radiotherapy; previous PUVA light treatment; and, rarely, inherited conditions such as Gorlin syndrome, which causes many BCCs from a young age. BCCs can occasionally develop in old scars or areas of long-standing inflammation.

Is it hereditary or contagious?

BCCs themselves are not usually inherited, although the skin type that makes them more likely does run in families. Rare genetic conditions are an exception. BCC is not contagious.

What does it look and feel like?

BCCs vary in appearance. Common features include a spot or scab that bleeds, crusts and does not fully heal, or heals and then breaks down again; a pink, red or pearly, shiny lump that slowly grows, often with tiny visible blood vessels on the surface; a lump with a raised, rolled edge around a central crater or ulcer; a flat, scaly, pink or red patch, which is the typical appearance of superficial BCC, most often on the trunk; and a scar-like, firm, pale or waxy area with poorly defined edges, called morphoeic or infiltrative BCC.

On brown and black skin, BCCs are often pigmented, appearing brown, black or blue-grey, and can be mistaken for a mole.

BCCs most commonly appear on sun-exposed areas, especially the face, nose, ears, scalp, neck and upper back, but can occur anywhere. They are usually painless but may itch or bleed.

How is it diagnosed?

A BCC can often be recognised with a dermatoscope. Sometimes a small skin sample (biopsy) is taken under local anaesthetic to confirm the diagnosis and identify the subtype, which helps guide the most appropriate approach. Each BCC is graded as low or high risk, based on its size, where it is, its subtype, and whether it has recurred after earlier treatment.

What are the treatment options?

Dr Mounsey will examine the lesion with a dermatoscope and may take a biopsy to confirm the diagnosis and subtype. Most BCCs are treated with surgical excision, which he carries out himself and which gives a high chance of complete removal. Other options include curettage and cautery for small, low-risk BCCs, cryotherapy, creams such as imiquimod or 5-fluorouracil for superficial BCCs, and photodynamic therapy. BCCs on the face or with a higher risk of coming back may be best treated with Mohs micrographic surgery, for which he will refer you to a Mohs surgeon colleague. Radiotherapy is an option for some people.

What is the outlook?

BCCs can almost always be cured, especially when found early. Having had one BCC makes another more likely, and about half of people develop a further one within three years. Checking your skin regularly, getting any new, changing or non-healing spot looked at, and protecting your skin from the sun are therefore important.

More information

British Association of Dermatologists patient leaflet: https://www.bad.org.uk/pils/basal-cell-carcinoma

This page gives general information only and is not a substitute for a consultation. Everyone's skin is different, and what is right for you will depend on your own circumstances. If you are worried about a skin problem, please book an appointment with Dr Mounsey or speak to your GP. If you have a mole or skin lesion that is changing, bleeding or growing quickly, please seek medical advice promptly.