BASAL CELL CARCINOMA
Do you have a non healing scab or small red lump that can bleed? You should probably get it checked by a dermatologist.
Basal cell carcinoma (BCC) is the UK’s most common form of cancer. There are a number of curative treatment options, depending on the type and location of the BCC. Seeking treatment early is important.
Get in touch today to find out how the team at The Dermatology Clinic, London can help.
What is Basal Cell Carcinoma?
Basal cell carcinoma develops in the basal cells, which sit at the bottom layer of your epidermis (the outermost layer of skin). These cells have an important job: they continuously produce new skin cells that gradually push older cells toward the surface. When these basal cells develop abnormal changes in their DNA which is mainly as a result of sun exposure, they can begin growing out of control, forming a cancerous lesion.
According to the British Association of Dermatologists (https://www.bad.org.uk/non-melanoma-skin-cancer-deaths-will-overtake-melanoma-deaths-research-predicts), there are approximately 180,000 new cases of BCC diagnosed in the UK each year, making it by far the most frequently occurring cancer in Britain. BCC accounts for more than 80% of all skin cancers in the UK. Research indicates that one in five people in England will develop a non-melanoma skin cancer at some point in their lifetime.
The condition affects men slightly more often than women, and while it can develop at any age, most cases appear in people over 40. The good news is that BCC grows slowly and very rarely spreads to other parts of the body, with metastasis occurring in only 0.0028% to 0.55% of cases. With proper treatment, cure rates exceed 95%.
Unlike more aggressive cancers, BCC tends to stay localised to where it started. However, this doesn't mean you should ignore it. Left untreated, a BCC can grow deeper into the skin, damaging surrounding tissue, nerves, and even bone in some cases. This is why dermatologists stress the importance of having any suspicious skin changes examined promptly.
Basal cell carcinoma can potentially occur anywhere on the skin, but is most often found on the face, neck or torso. While not generally a life-threatening cancer, treating basal cell carcinoma early can help avoid complications and minimise scarring, as well as putting your mind at ease. Find more information below on the condition and its causes, and treatments available at The Dermatology Clinic London.
Recognising Basal Cell Carcinoma: Signs and Symptoms
Knowing what to look for can help you spot BCC early, when it's easiest to treat. The British Association of Dermatologists describes several common warning signs you should watch for.
WARNING SIGNS:
Pearly Bump
- Shiny, translucent bump (red/pink/skin-coloured on light skin, brown/glossy black on darker skin)
- May show tiny blood vessels
Open Sore
- Sore that bleeds, oozes, crusts over but never fully heals
Red/Pink Patch
- Flat, scaly patch with slightly raised border (may resemble eczema)
White Scar-like Area
- Waxy appearance with poorly defined borders
Pigmented Lesion
- Brown, blue, or black lesion with dark spots
SEE A DERMATOLOGIST IMMEDIATELY IF YOU NOTICE:
- Any new growth on sun-exposed areas
- A scab that doesn't heal after 3-4 weeks
- A spot that repeatedly bleeds and crusts
- Changes in existing moles or lesions
Most BCCs appear on areas that receive regular sun exposure, particularly the face, ears, neck, scalp, shoulders, and back.
What Causes BCC?
The primary cause of BCC is ultraviolet (UV) radiation damage to the DNA in basal cells. The British Association of Dermatologists Clinical Standards Unit confirms that chronic UV exposure from both sunlight and artificial light sources is the major risk factor for BCC development. This damage accumulates over years of sun exposure, which is why BCC typically develops later in life, even though the initial damage may have occurred during childhood and adolescence.
When UV radiation penetrates your skin, it can cause mutations in the genes that control cell growth and division. Both UVA and UVB rays contribute to skin cancer development:
- UVB rays: Directly damage DNA and are the main cause of sunburn
- UVA rays: Penetrate deeper into the skin and contribute to premature ageing and skin cancer development
TANNING BEDS pose a particular risk because they expose your skin to concentrated UV radiation. The World Health Organisation has classified tanning beds as a Group 1 carcinogen, placing them in the same category as tobacco.
Who's at Higher Risk?
HIGH-RISK FACTORS:
- Fair skin, light eyes, blonde/red hair
- History of severe sunburns (especially blistering)
- Extensive sun exposure during childhood
- Previous skin cancer diagnosis - approximately 40% of people develop another BCC within 5 years
- Tanning bed use
- Age over 50
- Immunosuppression - organ transplant recipients face 10x higher risk
- Family history of skin cancer
- Previous radiation therapy
- Rare genetic conditions e.g Gorlin syndrome
- Exposure to arsenic
The estimated lifetime risk for BCC in the white population is 33-39% for men and 23-28% for women.
What Causes BCC?
The primary cause of BCC is ultraviolet (UV) radiation damage to the DNA in basal cells. The British Association of Dermatologists Clinical Standards Unit confirms that chronic UV exposure from both sunlight and artificial light sources is the major risk factor for BCC development. This damage accumulates over years of sun exposure, which is why BCC typically develops later in life, even though the initial damage may have occurred during childhood and adolescence.
When UV radiation penetrates your skin, it can cause mutations in the genes that control cell growth and division. Both UVA and UVB rays contribute to skin cancer development:
- UVB rays: Directly damage DNA and are the main cause of sunburn
- UVA rays: Penetrate deeper into the skin and contribute to premature ageing and skin cancer development
TANNING BEDS pose a particular risk because they expose your skin to concentrated UV radiation. The World Health Organisation has classified tanning beds as a Group 1 carcinogen, placing them in the same category as tobacco.
Basal cell carcinoma sub-types
There are three main variants of BCC, but all of them usually occur in areas commonly exposed to the sun.
Appearance: Flat, scaly, pink/red patches that resemble eczema
Location: Usually trunk (chest, back, shoulders)
Characteristics: Grows across skin surface, not deep
Appearance: Firm, raised, rounded red nodule with pearly quality
Characteristics: Grows downward and outward; may develop central crater that bleeds
Treatment response: Responds well to surgical removal
Special note: Most common type; can invade deeper if untreated
Appearance: Flat, firm, pale/yellow or white areas resembling scar tissue
Characteristics: Poorly defined edges; grows finger-like extensions deep into tissue
Treatment response: Requires careful surgical removal with wider margins
Preferred treatment: Mohs micrographic surgery for best outcomes
“ Skin cancer rates have been steadily on the rise over the past 30 years, it’s essential for people to check their skin regularly, making it a part of their routine. Early detection saves lives. ”
Basal cell carcinoma treatment
At The Dermatology Clinic, we can begin helping you plan your treatment as soon as a diagnosis is confirmed. We use a number of methods to destroy the cancer cells and the best option for you will depend on the size, location and sub-type of the BCC. Our team will also take into consideration your age, medical history and health status before recommending the best course of action.
Procedures for treating BCCs are usually minor and you shouldn’t feel a lot of discomfort during your treatment.
This procedure has a very high success rate. We will use a scalpel to remove the cancerous tissue before closing the wound with sutures. This is usually carried out under local anaesthetic to ensure you remain comfortable during treatment.
Best For: Most BCCs
Cure Rate: 95-98%
Recovery: Stitches removed after 5-14 days
If you have a superficial BCC, it’s worth considering curettage and cautery. During this procedure we will use a curette to gently scrape off the tumour. This will cause bleeding, but this is stopped using electrocautery. The curettage and cautery method is carried out under local anaesthetic and can be just as effective as excision in successfully removing the cancerous cells.
Best For: Small, superficial BCCs in low-risk areas
Cure Rate: 90-95%
Recovery: Heals over 2-3 weeks
During cryosurgery, we will apply cold liquid nitrogen to the lesion to destroy the cancerous cells. This type of treatment is effective if you have a superficial BCC. You may be invited back to the clinic for review and possible repeat treatment to ensure all the cancerous tissue is removed.
Best For: Small, superficial BCCs
Cure Rate: 85-90%
Recovery: Blistering, crusting; heals in 3-4 weeks
If the BCC is located near your eyes, nose or mouth, we may recommend this as the most appropriate treatment, particularly if it’s difficult to determine the edge of the lesion. The procedure involves removing the skin layer within the BCC. The specimen will be frozen and examined under a microscope to make sure the BCC has been removed entirely.
Best For: High-risk, facial, recurrent, or large BCCs
Cure Rate: 99% (primary), 95% (recurrent)
Recovery: Same-day results; minimal tissue removal
What is Mohs Micrographic Surgery?
Mohs surgery offers the highest cure rate while removing the least healthy tissue. This technique is particularly valuable for high-risk BCCs. The surgeon removes thin layers of tissue and examines 100% of margins under a microscope during the procedure. Additional layers are removed only where cancer remains, ensuring complete removal with maximum tissue preservation.
IDEAL FOR:
- BCCs on face, ears, nose, lips, eyelids
- Morphoeic/infiltrative BCCs
- Recurrent BCCs
- Large BCCs where tissue conservation matters
SUCCESS RATES: 99% cure rate for primary BCCs, 95% for recurrent cases.
Non-surgical procedures
In some cases, BCC can be treated without surgery. If your BCC is superficial, you could benefit from applying a topical cream called Imiqimod. This treatment has a high success rate and all you need to do is rub the cream onto the lesion five times a week for around six weeks.
Our dermatologists might recommend an alternative topical cream called 5-Fluorouracil. The success rate is similar to Imiqimod but you’ll need to apply the cream twice a day for around one month.
If you’re worried about any kind of skin lesion, it’s important to see a qualified dermatologist as soon as possible. The team at The Dermatology Clinic London are here to put your mind at rest and provide the best treatment for you. Contact us today to arrange a consultation.
Topical Treatment Comparison
How It Works: Stimulates immune system to attack cancer cells
Application: 5 times/week for 6 weeks
Success Rate: 70-90%
How It Works: Chemotherapy drug that stops cancer cells from dividing
Application: Twice daily for 4 weeks
Success Rate: 70-90%
How It Works: Chemotherapy drug that stops cancer cells from dividing
Application: Twice daily for 4 weeks
Success Rate: 70-90%
WHAT TO EXPECT: Both creams cause redness, swelling, and irritation during treatment (this means they're working). Excellent cosmetic results with minimal scarring.
BEST FOR: Low-risk, superficial BCCs where surgery might be overly aggressive.
Prevention: Reduce Your Risk
The Dermatolgoy Clinic London emphasizes the importance of sun protection and regular skin checks for preventing BCCs.
Daily SUn Protection:
- Apply SPF 50 broad-spectrum sunscreen daily
- Reapply every 2 hours (more if swimming/sweating)
- Wear wide-brimmed hat, long sleeves, UV-protective clothing
- Seek shade between 11am-3pm
Monthly Self Checks:
- Examine your entire body, including scalp and between toes
- Look for new growths or changing spots
- Use mirrors or ask a partner to check hard-to-see areas
- Take photos to track changes over time
NEVER USE TANNING BEDS - they significantly increase skin cancer risk.
If You've had BCC Before: Schedule regular dermatology check-ups every 6 months initially, then annually. Research shows that 40% of people develop another BCC within 5 years of their first diagnosis.
What Happens if BCC is Left Untreated?
While BCC rarely metastasises (less than 0.1% of cases - https://pmc.ncbi.nlm.nih.gov/articles/PMC6952217/), untreated lesions can cause serious local problems:
- Local invasion: Grows deeper into fat, muscle, cartilage, or bone
- Tissue destruction: Particularly problematic on face, near eyes, or on nose/ears
- Nerve involvement: Can cause numbness, tingling, or pain
- Functional problems: Large BCCs can affect mobility or vision depending on location
- Rare metastasis: When metastasis does occur (https://pmc.ncbi.nlm.nih.gov/articles/PMC5723960/), it most commonly affects regional lymph nodes (45%), lungs (35%), and bones (22%)
THE GOOD NEWS: All complications are preventable with prompt treatment. Even large BCCs can be successfully treated.
If you're worried about any kind of skin lesion, it's important to see a qualified dermatologist as soon as possible. The team at The Dermatology Clinic London are here to put your mind at rest and provide the best treatment for you. Contact us today to arrange a consultation.
References
- British Association of Dermatologists. (2024). Non-melanoma skin cancer deaths will overtake melanoma deaths, research predicts.
https://www.bad.org.uk/non-melanoma-skin-cancer-deaths-will-overtake-melanoma-deaths-research-predicts
- Venables, Z., Nijsten, T., Wong, K.F., et al. (2019). Epidemiology of basal and cutaneous squamous cell carcinoma in the UK 2013–15: a cohort study. British Journal of Dermatology, 181(3), 474-482.
https://pmc.ncbi.nlm.nih.gov/articles/PMC7379277/
- Salih, K., Kyriacou, H., Butt, A., et al. (2023). An updated report on the incidence and epidemiological trends of keratinocyte cancers in the United Kingdom 2013–2018. British Journal of Dermatology, 186(4), 684-692.
https://pmc.ncbi.nlm.nih.gov/articles/PMC9060124/
- British Association of Dermatologists. (2015). Basal Cell Carcinoma Patient Information Leaflet.
https://cdn.bad.org.uk/uploads/2021/11/29200310/Basal-Cell-Carcinoma-Update-May-2015-lay-reviewed-March-20155.pdf
- Primary Care Dermatology Society. Basal cell carcinoma - an overview.
https://www.pcds.org.uk/clinical-guidance/basal-cell-carcinoma-an-overview
- Nasr, I., McGrath, E.J., Harwood, C.A., et al. (2021). British Association of Dermatologists guidelines for the management of adults with basal cell carcinoma 2021. British Journal of Dermatology, 185(5), 899-920.
https://pubmed.ncbi.nlm.nih.gov/34050920/
- Danial, C., Lingala, B., Balise, R.R., et al. (2013). Markedly improved overall survival in 10 consecutive patients with metastatic basal cell carcinoma. British Journal of Dermatology, 169(3), 673-676.
https://pmc.ncbi.nlm.nih.gov/articles/PMC4006071/
- Telfer, N.R., Colver, G.B., Morton, C.A. (2008). Guidelines for the management of basal cell carcinoma. British Journal of Dermatology, 159(1), 35-48.
https://pmc.ncbi.nlm.nih.gov/articles/PMC214105/
- Peris, K., Fargnoli, M.C., Garbe, C., et al. (2019). Diagnosis and treatment of basal cell carcinoma: European consensus-based interdisciplinary guidelines. European Journal of Cancer, 118, 10-34.
https://www.ncbi.nlm.nih.gov/books/NBK482439/
