Basal cell carcinoma, or BCC, is a cancer of the cells at the bottom of the skin's outermost layer.
The skin is the largest organ in the body. It’s main purposes are to:
- Act as a barrier to protect the body from injury and keeps out infection.
- Keep in necessary fluids and proteins.
- Protect the body from the harmful effects of ultraviolet light.Help to control our body temperature.
Basal cell carcinoma is not infectious and cannot be passed on to other people.
There are two main layers in the skin:
- The epidermis
- underneath that, the dermis
The epidermis contains three types of cells:
- On the surface are flat cells, known as squamous cells.
- Under the layer of squamous cells are rounder cells called basal cells.
- In between the basal cells are melanocytes.
Most basal cell carcinomas are slow-growing and almost never spread. However, if they are left untreated they can damage the skin and cause an ulcer, known as a rodent ulcer (like a mouse!).
A small number of rodent ulcers may come back on the same area of skin after treatment. This is known as a local recurrence.
What causes Basal Cell Carcinoma?
There are risk factors that increase the probability of getting basal cell carcinoma:
- Exposure to Ultra Violet (UV) rays from the sun or a sun bed.
- Previous radiotherapy.
- Overexposure to chemicals. Coal tar, soot, pitch, asphalt, creosotes, paraffin waxes, petroleum derivatives, hair dyes, cutting oils or arsenic.
- Family history of BCC.
- Reduced immunity: e.g. if a person has HIV or is taking immune suppressant drugs post organ transplant.
What are the symptoms?
Basal cell carcinomas can appear in a variety of forms. They are usually painless and grow slowly. They can appear anywhere on your body but are most likely to occur on exposed skin, especially your face.
Basal cell cancers can develop as a small lump on your skin.
- be smooth and pearly
- look waxy
- be a firm, red lump
- bleed sometimes
- develop a crust
- begin to show signs of healing and yet never quite heal
- may be itchy
- look like a flat, red spot, which is scaly and crusty.
TIP: If you have any of these symptoms you should have them checked by your doctor - but remember, they are common to many illnesses other than BCC.
How is it diagnosed?
After visiting a GP a referral will probably be made to a hospital for some tests.
These may include:
If the results of the tests show basal cell carcinoma, another referral will be made to a doctor who specialises in the treatment of the skin.
The stage of a cancer is a term used to describe its size and whether it has spread beyond its original site.
A commonly used staging system for basal cell carcinoma is:
- Stage 0: Also called carcinoma in situ. Carcinoma in situ means that abnormal cells are present, but they are all contained in a small area in the top layer of skin (the epidermis).
- Stage 1 Cancer is less than 2cm across and has not spread.
- Stage 2 Cancer is more than 2cm across and has not spread.
- Stage 3 Cancer has spread into the tissues under the skin and possibly to nearby lymph nodes.
- Stage 4 Cancer has spread to another part of the body. This very rarely occurs with basal cell cancers of the skin.
How is it treated?
A team of doctors and other staff at the hospital will plan treatment.
Treatment may be coordinated by an oncologist (a doctor who specialises in treating cancer with chemotherapy), a Dermatologist ( a doctor that specialises in the treatment of the skin) and a radiologist (a doctor who specialises in treating cancer with radiation).
Treatment may involve:
- Photodynamic therapy
- Curettage and Electrodesiccation
Radiotherapy for Basal Cell Carcinoma
Radiotherapy is often given to people with Basal Cell Carcinoma before and/or after surgery. This is to shrink and destroy the tumour. For more information about radiotherapy, go to our radiotherapy fact sheet.
Surgery for Basal Cell Carcinoma
The aim of surgery is to remove the tumour. When larger tumours are removed, skin grafts are sometimes needed to replace the removed skin. A skin graft is a thin layer of healthy skin taken from another part of the body. This is done under either a local or general anaesthetic.
In many cases, surgery is the only treatment needed. For more information about surgery, go to our surgery fact sheet.
Photodynamic therapy for Basal Cell Carcinoma
Photodynamic therapy (PDT) is a newer treatment for skin cancer. PDT uses laser, or other light sources, combined with a light-sensitive drug (sometimes called a photosensitising agent) to destroy cancer cells.
Cryotherapy for Basal Cell Carcinoma
If the cancer is very small and only affecting the surface layers of the skin it may be possible to remove it by freezing it. This is called cryotherapy or cryosurgery. Liquid nitrogen is sprayed on to the cancer to freeze it.
The cold can be a bit painful when the liquid nitrogen is applied (some patients describe the feeling as like a bee-sting).
Curettage and Electrodesiccation
This is when the cancerous growth is scraped off with a curette (a sharp, ring-shaped instrument). An electrocautery needle produces heat to destroy the residual tumor and control the bleeding.