Basal Cell Carcinoma (BCC)

What Is Basal Cell Carcinoma?

BCC develops in the basal cells — the deepest layer of the epidermis, the outermost layer of skin. It arises from long-term UV exposure and is most often seen in people with fair skin who have spent years in the Australian sun. A BCC doctor can usually recognise a BCC clinically, and the diagnosis is confirmed either by dermoscopy or by a small biopsy.

Two things characterise BCC behaviour. First, it is locally invasive: given time it erodes the tissue around it, which is why older descriptions called it a "rodent ulcer". Second, it rarely metastasises — unlike melanoma or SCC, BCC almost never spreads to lymph nodes or distant organs when detected and treated at an ordinary size.

What Does BCC Look Like?

BCC has several clinical subtypes, and they can look quite different from one another:

• Nodular BCC — the most common type: a pearly or flesh-coloured lump with a shiny surface, fine visible blood vessels (telangiectasia), and sometimes a central crater that bleeds or scabs, then heals and breaks down again
• Superficial BCC — a slowly enlarging, slightly scaly, thin red or pink patch, often mistaken for eczema; common on the trunk, shoulders and upper back
• Infiltrating or morphoeic BCC — a firmer, scar-like or waxy plaque with ill-defined edges; this type grows invisibly beneath the surface and needs margin-controlled excision
• Ulcerated BCC — any BCC left untreated may eventually break down into a painless ulcer that bleeds easily and never fully heals

Where Does BCC Appear?

BCC develops on sun-exposed skin. The most common sites are the face — especially the nose, cheeks, forehead and ears — followed by the scalp, neck, shoulders and trunk. Because the head and neck carry the heaviest lifetime UV dose, roughly four in five BCCs occur above the shoulders. Older men who have worked outdoors are the group most frequently diagnosed, though anyone with significant sun exposure can develop one.

Why Early BCC Treatment Matters

Because BCC grows slowly, it is tempting to watch and wait. This is a mistake. A small nodule on the nose can be treated with a quick, simple procedure in the doctor's rooms; the same tumour five years later may have eroded cartilage and require extensive skin cancer surgery, sometimes with reconstructive flaps or grafts. Larger tumours also carry a higher risk of incomplete removal and recurrence.

Early BCC treatment also means simpler options: cryotherapy, curettage or topical therapy may be enough for a small superficial lesion, whereas larger or infiltrating tumours require formal BCC surgery. Patients who have had one BCC have an increased chance of developing further skin cancers, so ongoing monitoring matters as much as the first treatment.

BCC Treatment Options

There is no single best BCC treatment — the right choice depends on the subtype, size and location of the tumour, and on your general health and preferences. Options include:

• Cryotherapy — freezing the lesion with liquid nitrogen; suitable for small, low-risk superficial BCCs
• Curettage and cautery — scraping the tumour away and sealing the base; effective for selected nodular or superficial lesions on the trunk and limbs
• Surgical excision — the lesion is removed with a measured margin of healthy skin and the wound closed with stitches; the standard BCC surgery for most nodular tumours
• Staged margin-controlled surgery — the tumour is removed and the margins examined under the microscope the same day, repeating until all edges are clear; reserved for tumours on the face and other high-risk sites. See staged margin-controlled surgery for details.
• Topical therapy — prescription creams applied over several weeks for some superficial BCCs in suitable patients
• Photodynamic therapy (PDT) — a light-activated treatment useful for superficial BCC and broader sun-damaged areas; see our page on PDT

Radiotherapy and oral targeted-tablet therapy exist for the small minority of very large or inoperable BCCs, and would be arranged in consultation with other treating doctors when required.

Recovery & Follow-Up

Recovery after BCC surgery is usually straightforward. Small excisions need stitches for one to two weeks; wounds on the back and shoulders may need a little longer. Curettage and cryotherapy leave a shallow wound that heals under a scab over two to four weeks. Most patients return to normal daily activities the same day or the next.

Follow-up matters for two reasons. First, any BCC treatment carries a small recurrence risk, so the treated site is usually reviewed within the first year. Second, people who have had one BCC have roughly a one-in-three chance of another skin cancer within five years, so a full-body skin check every six to twelve months is generally recommended. Your BCC doctor will set an interval that suits your risk profile.

Prevention

• Daily broad-spectrum SPF 50+ sunscreen on the face, neck, ears and hands — including in winter and on cloudy days
• Wide-brimmed hats, sunglasses and shade during outdoor activities
• Avoid deliberate sun exposure and never use solariums
• Regular skin checks, since a history of BCC means higher risk of new lesions

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