Basal cell carcinoma

Basal cell carcinoma (BCC) is the most common, and one of the least serious, forms of skin cancer. It tends to grow slowly and rarely spreads to other organs.

Also known as

BCC, rodent ulcer, keratinocyte cancer, non-melanoma skin cancer, NMSC, nodular basal cell carcinoma, nBCC

Symptoms and signs

  • Pink or skin-coloured lump with pearly consistency
  • Irritated, sore or rough patch of skin which bleeds and/or forms a crust which does not heal after 3 months

Risk factors

  • Exposure to ultraviolet light, often prolonged daily exposure (e.g. occupational); solarium (artificial tanning) use
  • Fair skin
  • Increasing age
  • Exposure to arsenic or arc welding (often occupational)

Prognosis / outcome

BCC is usually cured relatively easily with few adverse effects. In people with poor wound healing, it may cause an ulcer or sore which is difficult to treat. Death from BCC is extremely rare in Australia.

Progression

BCC usually grows slowly over many months or years. It tends to remain in the original site without spreading via the blood or lymphatic system to other parts of the body. Without treatment, the BCC develops into an ulcer or sore, which can slowly invade deeper tissues.

Medications for

 

Basal cell carcinoma

Prevention of

 

Basal cell carcinoma

  • Avoid unnecessary prolonged exposure to sunlight. Protect against ultraviolet radiation with sunscreen, hats, protective clothing, sunglasses and shade.
  • Nicotinamide (vitamin B3): 1000mg per day reduces the risk of future basal cell carcinoma
  • Yearly full-body skin check allows basal cell carcinoma to be detected at an early, more easily treated stage

More information

Recommended web links

Clinical images of
Basal cell carcinoma
Click on an image to view it in greater detail.

Basal cell carcinoma (BCC) affects approximately 50 per cent of Australians (Staples 2006). It tends to grow slowly and almost always remains confined to one location. BCC can be treated by surgical removal and, in some cases, cryotherapy (freezing) or applying a cream.

What does BCC look like?

Basal cell carcinomas can be thin or thick and their appearance varies. They are most common on areas that have long-term exposure to the sun, such as the face and arms, although they are also common on the back and chest.

Nodular basal cell carcinoma

Nodular basal cell carcinoma (nBCC) often appears as a pink lump with a pearly consistency. Close-up, it may appear to have prominent blood vessels on its surface.

If it has been present for a long time, the BCC may spread outward and the surface becomes ulcerated or crusted.  This is why sores that take a long time to heal are suspicious for skin cancer.

Superficial basal cell carcinoma

Superficial basal cell carcinoma (sBCC) is thin and affects the uppermost level of the skin. It may appear as a pink or red rough patch and can easily be mistaken for dermatitis or another type of rash.

Infiltrative basal cell carcinoma

Infiltrative BCC (also called morpheic BCC) is a less common variant with edges that cannot always be clearly seen. This type of BCC can be difficult to remove surgically and often needs to be removed by a plastic surgeon or dermatologist specialising in Moh's surgery (where the removed tissue is examined microscopically during the procedure to ensure that the entire BCC has been removed)..

What happens if basal cell carcinoma is untreated?

Without treatment, basal cell carcinoma usually grows slowly. It it sometimes present for years before it is noticed.

Basal cell carcinoma tends to remain in one location without spreading to other parts of the body. As it grows, it causes damage to the area, including:

  • sores that bleed and don't heal (This type of sore used to be called a rodent ulcer because it looks like the skin has been chewed by a rat or mouse!)
  • damage to underlying tissues such as muscles, blood vessels and nerves

How is basal cell carcinoma treated?

Nodular basal cell carcinoma is treated by surgical removal.

Superficial basal cell carcinoma can be treated by surgical removal, application of a cream or cryotherapy (freezing).

Risk factors for BCC

Risk factors for developing basal cell carcinoma include:

  • outdoor occupations
  • previous radiotherapy
  • solarium use
  • fair or red hair colour
  • skin that burns and does not tan
  • tendency to freckle
  • a history of blistering sunburn
  • a previous BCC
  • increasing age
  • past exposure to arsenic

Prevention of basal cell carcinoma

People with a history of basal call carcinoma are at high risk of developing future BCCs (as well as having an increased risk of melanoma). Because many of the risk factors for basal cell carcinoma cannot be reversed, prevention of future BCCs can be difficult. Up to 60 per cent of people with BCC will develop another within three year (Cancer Council 2018).

Vitamin B3 (nicotinamide) taken orally has been shown to reduce the rate of basal cell carcinoma and squamous cell carcinoma by 20-30 per cent.

References

Staples MP, Elwood M, Burton RC, Williams JL, Marks R, Giles GG
Non-melanoma skin cancer in Australia: the 2002 national survey and trends since 1985
Med J Aust 2006 Jan 2;184(1):6-10
2006
https://www.mja.com.au/journal/2006/184/1/non-melanoma-skin-cancer-australia-2002-national-survey-and-trends-1985
Date accessed:
January 1, 2021
Cancer Council Australia
Optimal care pathway for people with basal cell carcinoma or squamous cell carcinoma
Optimal cancer care pathways
2018
https://www.cancer.org.au/assets/pdf/basal-cell-carcinoma-or-squamous-cell-carcinoma-optimal-cancer-care-pathway
Date accessed:
January 1, 2021