Basal cell carcinoma

The most common cause is exposure to ultraviolet (UV) light. Those with the highest risk are:

• People with pale skin who burn easily and rarely tan; particularly those with naturally light or red hair. However, other skin types are also affected.
• People who have had a lot of sun exposure – for example, from outdoor hobbies or jobs, and those who have lived in sunny climates.
• People who use sun beds or sunbathe regularly
• People who have previously had a BCC.

BCCs can occur anywhere on the body.  However, they most commonly appear on parts of the body that are exposed to the sun such as the face, head, neck, and ears.

BCCs are usually diagnosed in older adults. However, recent findings show that more young people are being diagnosed each year. This may be because people are spending more time in the sun.

Rarely, BCCs can develop in an old scar or an area of chronic inflammation. Other factors that can increase your risk of developing BCC are:

• having a weakened immune system (especially after an organ transplant)
• having had previous radiotherapy (particularly for childhood cancers)
• having had previous treatment with PUVA (a type of medical light treatment).

Are basal cell carcinomas hereditary?

BCCs themselves do not usually run in families, however factors which increase the risk of developing a BCC (for example, fair skin and freckles) do run in families.

In a very small number of cases, BCCs can be associated with inherited genetic conditions (such as Gorlin syndrome).

Patients who have previously had a BCC have an increased risk of developing further skin cancers. Treatment of all skin cancers is more straightforward if they are detected early. Because of this, it is advisable to check your skin for changes once a month. A friend or family member could help with areas that you cannot easily see, such as your back.

You should see your GP if you notice any moles, marks, or scabs that are growing, changing, bleeding or not healing. You should also see your GP if you’re concerned about changes where a BCC was previously treated. If your GP is concerned, you should be referred to see a dermatologist through the NHS.

You can also help to reduce the risk of a BCC (and other types of skin cancer), by limiting your sun exposure. Further advice sheets on this are suggested below, however key tips include:

Vitamin D advice

People who avoid sun exposure may be at risk of vitamin D deficiency and should have their vitamin D levels checked. If the levels are low, they may consider:

• Vitamin D supplements (dosing advice can be obtained from the GP)
• Increasing intake of food rich in vitamin D such as oily fish, eggs, meat and cereals

BCCs can vary in their appearance.  People often first become aware of a scab that bleeds and does not heal completely, or a pink/red or pearly lump on the skin that does not go away. There may be tiny red blood vessels present across the surface.

Some BCCs may have a thickened rim around a central crater or crust and sometimes they can develop an ulcer.

Some BCCs are 'superficial' – this means they appear as a scaly pink/red flat mark on the surface of the skin.

BCCs can look different from one another because there are several different types. The specific type of BCC may determine which treatment options are offered. The exact type can usually be confirmed by a biopsy.

Most BCCs are painless, although sometimes they can be itchy or bleed.

Images DermNetNZ.

Sometimes the diagnosis of BCC is clear from the appearance, and you may progress straight to treatment.

Sometimes a small initial skin sample (biopsy) will be taken to confirm the diagnosis and type of BCC before definitive treatment is arranged. This involves a local anaesthetic injection into the affected skin area to make it numb, then a small piece of skin will be removed for testing. This is usually followed by a stitch or cautery to seal the skin.

Can basal cell carcinomas be cured?

BCCs can almost always be cured. However, treatment can be more complicated if:

• the BCC has been left untreated for a long time
• the BCC is large at the time of diagnosis
• the BCC occurs in an awkward place to remove skin, such as close to the eye or on the nose or ear.

Larger BCCs may also result larger scars after surgery, which may cause concern, especially if they are on prominent areas such as the face.

How can a basal cell carcinoma be treated?

The most common treatment is surgery. This is usually performed under local anaesthetic. This means you will be awake for the procedure. However, there are also non-surgical options. The choice of treatment depends on many factors. These include:

• The features of the BCC such as size, type and location. These features can increase the risk of the BCC coming back after treatment.
• The number of BCCs to be treated (some people have more than one)
• Patient preferences and needs, age and overall health

In some cases, it may be reasonable not to treat the BCC at all – for example, if the BCC is growing slowly on a non-critical area of the body or if the person would be unable to tolerate or recover from treatment due to other health issues.