Health condition · Clinically reviewed
Basal cell carcinoma, the most common skin cancer — excision, Mohs and topical therapy.
BCC is the most common cancer worldwide. Almost never metastasises but can locally destroy tissue if untreated. Modern management is stratified by risk — from topicals to Mohs micrographic surgery.
Why trust this guide
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Clinically reviewed
Written by our editorial team and reviewed by a registered UK clinician before publication.
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Sourced from guidance
Checked against NICE, BAD and peer-reviewed sources you can see at the end.
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Current for 2026
Reflects modern UK guidance including Mohs micrographic surgery and hedgehog inhibitor therapy.
Key facts
Basal cell carcinoma at a glance.
The essentials, in plain English — what BCC is, how it’s diagnosed, and how it’s treated in the UK today.
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Definition
Locally invasive skin cancer arising from basal cells of the epidermis.
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How common
The most common cancer worldwide — very common in fair-skinned UK adults.
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Subtypes
Nodular, superficial, morphoeic (infiltrative), and pigmented — subtype guides treatment.
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Where it appears
Sun-exposed head and neck are the most common sites.
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Precision surgery
Mohs micrographic surgery for high-risk or cosmetic-critical areas such as nose, eyelid and ear.
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Advanced disease
Vismodegib and sonidegib (hedgehog inhibitors) for locally advanced or metastatic BCC.
Why this guide matters
Notice early, treat precisely.
BCC is common and highly treatable — but the choice between a simple excision, Mohs surgery, a cream or a hedgehog inhibitor depends on subtype, site and risk.
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Risk stratification drives choice
Site, size, subtype and immune status decide whether a lesion is low-risk or high-risk — and which treatment fits.
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Mohs preserves what matters
On the face, eyelid, nose and ear, Mohs offers the highest cure rate while sparing healthy tissue.
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Modern options for advanced BCC
Hedgehog inhibitors have transformed outcomes when surgery and radiotherapy aren’t appropriate.
How the diagnosis is made
From a suspicious lesion to a clear plan.
The steps a UK GP, dermatologist and skin-cancer MDT will normally follow, in order — so you know what to expect and why.
Phase 1 · Noticing
Dermatoscopy, biopsy and subtyping
Phase 2 · Confirming
Risk grading and imaging
Phase 3 · Planning
Specialist referral and MDT decision
- 01
Noticing
Dermatoscopy
A handheld magnifier reveals pearly translucency, arborising vessels and other BCC features at the bedside.
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Noticing
Skin punch or shave biopsy
A small tissue sample under local anaesthetic confirms the diagnosis histologically.
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Noticing
Histological subtyping
The pathologist reports subtype — nodular, superficial, morphoeic or pigmented — which shapes treatment.
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Confirming
Risk stratification (BAD/NICE)
Site, size, subtype, recurrence status and immunosuppression are combined to grade the lesion as low or high risk.
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Confirming
MRI / CT if deep involvement
Cross-sectional imaging is used when bone, cartilage or perineural spread is suspected.
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Planning
Dermatology / plastics referral
High-risk BCCs and those on cosmetically sensitive sites are referred to specialist skin cancer teams.
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Planning
Multidisciplinary decision
The skin cancer MDT agrees the definitive plan — surgery, topical therapy, radiotherapy or systemic therapy.
Typical timeline: from GP referral to a full plan in weeks under the skin cancer pathway.
Symptoms
What BCC actually looks like.
The classic patterns of nodular, superficial, morphoeic and pigmented BCC — and the features that mean it’s time to escalate to urgent dermatology.
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Pearly rolled edge
A translucent, waxy rim around a slow-growing papule — the classic sign of nodular BCC.
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Telangiectasia over lesion
Fine branching vessels running across the surface — a strong dermatoscopic clue to BCC.
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Nodular
A firm, dome-shaped, pearly nodule — the commonest BCC subtype, typically on the face.
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Ulcerated centre (rodent ulcer)
A central non-healing ulcer with a raised rolled edge — the historical “rodent ulcer”.
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Superficial red patch
A slow-growing, scaly, erythematous plaque — often on the trunk, easily mistaken for eczema.
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Morphoeic scar-like
An ill-defined, pale, indurated plaque resembling a scar — deeply infiltrative and hard to delineate.
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Pigmented BCC
A brown or blue-grey lesion that can mimic melanoma — dermatoscopy shows leaf-like or blue-grey ovoid nests.
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Red flag
Rapidly growing lesion, bleeding, or lesion in a high-risk area (nose, eye, ear) — urgent dermatology referral.
Treatment
How BCC is treated in the UK.
A ladder from creams and destructive techniques through standard excision and Mohs to targeted systemic therapy — matched to the risk of the lesion.
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Cryotherapy
Liquid nitrogen for small, superficial low-risk BCCs — quick, in-clinic and requires no anaesthetic.
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Curettage + electrodesiccation
Scraping followed by cautery — a good option for small, low-risk lesions on the trunk and limbs.
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Standard excision (5 mm margin)
Surgical removal with a defined margin — the workhorse treatment for most low-risk BCCs.
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Mohs micrographic surgery
Layer-by-layer excision with immediate microscopy — preserves tissue on the face and other cosmetically critical sites.
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Photodynamic therapy
A photosensitiser plus red light for selected superficial BCCs — excellent cosmetic outcome.
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Topical 5-fluorouracil
A chemotherapy cream for superficial BCCs — applied at home over several weeks.
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Topical imiquimod
An immune-response modifier cream for superficial BCCs — stimulates the local immune reaction.
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Vismodegib / sonidegib
Oral hedgehog pathway inhibitors for locally advanced or metastatic BCC when surgery and radiotherapy aren’t appropriate.
What this guide is based on
The sources behind every claim on this page.
UK national guidance and specialist society standards, current at the time of last review.
Key references
Guidelines and standards we relied on.
A quiet reminder
This guide is for information, not medical advice.
Your GP or dermatologist knows your skin and history and can tell you which parts apply to you. If in doubt, get seen.
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British Association of Dermatologists (BAD). Guidelines for the management of basal cell carcinoma.
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NICE. Skin cancer: prevention, detection and management (NG12).
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British Association of Skin Cancer Nurses (BASCN). Patient information standards.
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European Dermatology Forum. Guideline on basal cell carcinoma.
Red flags
When a BCC needs specialist attention.
Most BCCs are straightforward. These are the situations where they aren’t — and where specialist input changes the plan.
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Rapidly enlarging BCC
Fast growth is unusual for BCC — it warrants urgent dermatology assessment and consideration of aggressive subtypes.
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Recurrent BCC
BCCs that come back after previous treatment are higher-risk and often need Mohs surgery.
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Perineural invasion
Nerve involvement on histology signals a higher risk of local recurrence and may need adjuvant radiotherapy.
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Bone or cartilage involvement
Deep invasion into underlying structures requires cross-sectional imaging and complex reconstructive planning.
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Multiple BCCs (Gorlin syndrome)
A young patient with multiple BCCs should be assessed for basal cell naevus (Gorlin) syndrome.
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BCC in immunosuppressed patients
Transplant recipients and patients on long-term immunosuppression develop more numerous and more aggressive BCCs.
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Post-Mohs reconstruction complications
Complex defects on the face may need plastics-led flap or graft reconstruction with careful follow-up.
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Radiotherapy candidacy
Older or frail patients unsuitable for surgery may be offered definitive radiotherapy with excellent local control.
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Metastatic BCC (rare)
Spread beyond the skin is exceptional — when it occurs, systemic hedgehog inhibitor therapy is the standard.
Living with it
Prevention, vigilance, and steady follow-up.
Four things that make the biggest difference day to day — sun protection, monthly self-checks, prompt escalation, and keeping your surveillance appointments.
A quiet reminder
A second BCC is common.
After one BCC, the risk of another rises — which is why regular skin surveillance and sun protection matter for years after treatment.
- 01 Sun
Protect the skin you have
SPF 30+ daily on exposed skin, hats and shade at midday, and no sunbeds — the single biggest modifiable risk.
- 02 Check
Monthly self-exams
A quick head-to-toe check once a month, with a partner or a mirror for hard-to-see areas.
- 03 Escalate
Don’t wait on a non-healing spot
A pearly bump or scab that hasn’t healed after four weeks deserves a GP or dermatology review.
- 04 Follow-up
Keep your surveillance visits
After a BCC diagnosis, follow-up appointments detect recurrence and new primaries early — when they are most treatable.
Frequently asked
Everything we get asked about basal cell carcinoma.
Quick answers on Mohs surgery, topical treatments, hedgehog inhibitors and when to worry.
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Is basal cell carcinoma dangerous?
BCC almost never spreads to distant sites, but it can be locally destructive if untreated — invading skin, cartilage and even bone. Treated early, cure rates are very high.
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What is Mohs micrographic surgery?
A precision technique where the tumour is removed layer by layer, with each layer checked under the microscope immediately. It offers the highest cure rate while preserving the maximum amount of healthy tissue — ideal for the face, eyelids, nose and ears.
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Can BCC be treated with a cream?
Yes — superficial BCCs can be treated with topical 5-fluorouracil or imiquimod applied at home over several weeks. These options are only suitable for carefully selected, low-risk lesions.
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What are vismodegib and sonidegib?
Oral hedgehog pathway inhibitors used for locally advanced or metastatic BCC when surgery and radiotherapy aren’t appropriate. They can shrink extensive tumours dramatically.
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How is BCC different from melanoma?
BCC arises from basal keratinocytes and almost never metastasises. Melanoma arises from pigment-producing melanocytes and can spread aggressively. Both are driven by UV exposure but behave and are treated very differently.
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When should I see a GP urgently?
A rapidly growing lesion, a lesion that bleeds, or any suspicious lesion on the nose, eyelid or ear warrants urgent dermatology review — ask your GP about the skin cancer pathway.