Basal cell carcinoma (BCC) is the most common form of cancer globally, accounting for approximately eight out of every ten skin cancer diagnoses. It originates in the epidermis, the top layer of the skin.
The majority of basal cell carcinomas are readily and successfully treated with modern therapies. While it rarely spreads to other parts of the body and is seldom life-threatening, BCCs can cause serious cosmetic damage and functional difficulties, particularly when they occur on the face and are not diagnosed and treated early.
Your risk for developing BCC is primarily influenced by:
Overexposure to ultraviolet (UV) radiation from the sun is the major risk factor. Both UVB (which causes sunburn) and UVA rays (which can travel through glass and clouds and are also found in sun lamps and tanning beds) contribute to skin damage. Exposure during childhood and adolescence, especially with a history of blistering sunburns, significantly increases risk.
Individuals with fair skin, blue or light-coloured eyes, and blond or red hair have less melanin, the protective skin pigment, and are at higher risk. However, BCC can occur in people with any skin colour.
Having had BCC previously increases the risk of developing another skin cancer.
Exposure to radiation treatment may increase the risk for BCC in the treated area five to fifteen years later.
Less common risk factors include long-term exposure to coal tar, arsenic, or other industrial compounds.
People with a weakened immune system (e.g., those with HIV, lymphoma, or leukaemia, or those undergoing chemotherapy or taking anti-rejection drugs after an organ transplant) are at higher risk.
It typically takes a long time for the effects of UV damage to manifest, making older people more susceptible to the disease as the body's ability to repair sun damage decreases with age.
Basal cell carcinomas are most often found on areas frequently exposed to the sun, such as the face, neck, and hands.
The first sign of BCC is usually an unusual growth on the skin. Basal cell carcinoma can appear in one of several ways:
This type of skin cancer rarely causes pain as it develops. However, a spot that bleeds after a minor injury and then heals, repeating this cycle over months or years, should be investigated, as it is easily mistaken for a simple sore or wound.
Since you know your skin best, changes are often first noticed by you or a family member. To determine if you have skin cancer, your doctor will:
This includes questions about your past sun exposure, exposure to other known causes of skin cancer, and your personal or family history of skin conditions, as well as when you first noticed the mark and if it has changed in size or appearance.
Your doctor will examine your skin and may check for enlarged lymph nodes.
If your doctor suspects a patch of skin needs further investigation, a biopsy is typically performed in the doctor's office using a local anaesthetic. The spot or growth is partially or completely removed, and the tissue sample is sent to a pathologist for examination.
If cancer is confirmed, your doctor will discuss treatment options based on the tumour's features. BCCs are classified by their risk of recurrence (the chance of the cancer returning after treatment), which largely depends on the tumour's characteristics and location:
Tumours located in the central part of the face (such as the eyelids, nose, ears, and lips), those that are wider than 2 centimetres, or those that have come back after a previous treatment.
Tumours that are small and superficial (limited to the upper skin layer where they originated), have a clear, defined edge, and have not been treated before.
Basal cell carcinoma is highly curable with currently available surgical and non-surgical treatments, especially when diagnosed and treated early. The choice of therapy depends on the tumour's location, size, and depth, as well as your general health, medical history, and whether the tumour has been treated previously.
At SSCHRC, our experts offer a comprehensive range of treatment options, many of which can be performed in your doctor's office:
A non-surgical treatment where liquid nitrogen is applied to freeze the abnormal tissue, causing the frozen skin to slough off as the underlying skin heals.
A common treatment, most effective for low-risk tumours on the trunk and limbs. The area is numbed with local anaesthetic, and a curette is used to scrape away the cancerous tissue. An electric needle is then used to control bleeding and destroy any remaining cancer cells around the tumour's edge.
The tumour is vaporised with a focused light beam. The use of laser surgery is limited, as it only targets surface cells, meaning close follow-up is essential.
A highly specialised technique often used for high-risk BCCs, such as large or recurrent tumours, and those on areas like the face where preserving normal skin is crucial. The surgeon removes the tumour layer by layer, with each layer mapped and immediately examined under a microscope until all cancer cells are confirmed to be removed. This precise process has the highest cure rate and limits scarring.
High-risk BCCs can be removed via standard surgical excision anywhere on the body. After injecting a local anaesthetic, the surgeon removes the tumour along with a safety margin of surrounding tissue. The wound is then closed with sutures (stitches). The removed tissue can be tested by a pathologist to verify that the entire tumour has been removed.
This treatment uses x-rays or high-energy particles. It can be useful for tumours that are surgically challenging to treat or for patients at a higher risk of complications from surgery. Radiation is sometimes used after surgery to destroy any remaining cancer cells. It is typically delivered in small doses over a period of three to four weeks to minimise burning and improve cosmetic results.
Creams and lotions containing chemotherapy drugs (such as fluorouracil or imiquimod) target damaged skin without affecting surrounding healthy tissue. Cure rates are typically lower than other methods, so these are generally reserved for small, low-risk lesions. As the cancerous tissue is not removed for testing, careful follow-up after treatment is essential.
If the removal of a BCC leaves a wound too large to be closed with simple sutures, reconstructive surgery, such as skin grafts or flaps, may be performed to aid healing and restore the skin's appearance.
Even after successful treatment, BCC can recur. Furthermore, a person who has had one skin cancer is at an elevated risk of developing new skin cancers of all types. If you have been treated for BCC, you must continue to protect yourself from the sun and contact your doctor immediately if you find any new growth, bump, spot, or notice any changes in your skin that could indicate a recurrence.
SSCHRC is dedicated to supporting cancer survivors and their families through services like the Adult Survivorship Programme, the Counseling Centre for emotional well-being, and Integrative Medicine, which offers complementary services like massage, acupuncture, and nutritional counselling. We also provide specialised care for older patients and supportive care specialists who help manage side effects like pain, nausea, and fatigue.