Basal cell carcinoma (BCC): treatment, symptoms and what it looks like

BAD says the most common treatment is surgery, usually performed under local anaesthetic, which means you are awake for the procedure. There are also non-surgical options. The choice depends on the features of the BCC (size, type and location), the number of BCCs to be treated, and your preferences, age and overall health.

In some cases, BAD says it may be reasonable not to treat the BCC at all, for example if it is growing slowly on a non-critical area or if you would be unable to tolerate or recover from treatment because of other health issues.

BAD describes low-risk and high-risk BCCs. Low-risk BCCs are generally small and have clearly visible edges, and are of nodular or superficial subtype, and are less likely to come back. High-risk BCCs are those that are large, have unclear edges, have grown back despite previous treatment, or are of infiltrative or morphoeic subtype; they are also more likely to come back in people with weak immune systems.

BAD says BCCs can vary in appearance because there are several different types. People often first notice a scab that bleeds and does not heal completely, or a pink or red, or pearly lump on the skin that does not go away, which may have tiny red blood vessels across the surface.

Some BCCs have a thickened rim around a central crater or crust and sometimes they can develop an ulcer. Superficial BCCs appear as a scaly pink or red flat mark on the skin. BAD says most BCCs are painless, although sometimes they can be itchy or bleed.

The NHS describes non-melanoma skin cancer, which includes BCC, as a growth or unusual patch on the skin that can vary in colour, size and texture. It says growths may be raised and smooth with clear edges, bumpy, rough or crusty, or start as a flat discoloured patch, and patches can be purple, brown or red and may be darker on brown or black skin.

BAD describes basal cell carcinoma as the most common type of skin cancer and notes that it is also the most common cancer worldwide. It says about 3 in 10 people with fair skin will develop a BCC in their lifetime and that the number of people developing BCC is rising.

BCCs can occur anywhere on the body but most commonly appear on sun-exposed parts such as the face, head, neck and ears. They are usually diagnosed in older adults, although BAD says more young people are being diagnosed each year. The NHS groups BCC with squamous cell carcinoma as non-melanoma skin cancer, and says a new or changing mole may instead be a sign of melanoma, a more serious type of skin cancer.

BAD says the most common cause is exposure to UV light. The NHS says UV light comes from the sun and is used in sunbeds, and that non-melanoma skin cancer is more common in older people but younger people can also get it.

• Pale skin that burns easily and rarely tans, especially with naturally light or red hair (BAD); the NHS also lists blue or green eyes and many freckles or moles.

• A lot of sun exposure, for example from outdoor hobbies or jobs, or living in sunny climates, and past sunburn.

• Using sun beds or sunbathing regularly.

• Having previously had a BCC.

• A weakened immune system, especially after an organ transplant.

• Previous radiotherapy, particularly for childhood cancers, or previous PUVA treatment.

• A family history of skin cancer. BAD says BCCs themselves do not usually run in families, but factors such as fair skin and freckles do, and in a very small number of cases BCCs are linked with inherited conditions such as Gorlin syndrome.

BAD says sometimes the diagnosis is clear from the appearance and you may go straight to treatment. Sometimes a small skin sample (a biopsy) is taken to confirm the diagnosis and type before definitive treatment is arranged. This involves a local anaesthetic injection to numb the skin, then a small piece of skin is removed for testing, usually followed by a stitch or cautery to seal the skin.

The NHS says that at the GP appointment you may be asked questions about your health, symptoms and how much time you spend in the sun, and the GP will look at the area. They may ask to take a photograph to send to a specialist (dermatologist), and you may get an urgent referral if the GP thinks it could be cancer, which does not definitely mean you have cancer.

BAD says BCCs very rarely spread to other parts of the body and are almost never a danger to life, and that they can almost always be cured. Treatment may be more complicated if the BCC has been left untreated for a long time, is large when diagnosed, or is in an awkward place such as close to the eye or on the nose or ear. Larger BCCs may also result in larger scars after surgery.

BAD says people who have previously had a BCC have an increased risk of developing further skin cancers. Not everyone needs dermatology follow-up after treatment; follow-up may be considered for people with advanced BCC, those at high risk of the BCC coming back, and those at high risk of developing multiple skin cancers, such as people with weakened immune systems.

BAD advises checking your skin for changes once a month, with a friend or family member helping with areas you cannot see, and seeing your GP if you notice any moles, marks or scabs that are growing, changing, bleeding or not healing.

The NHS and BAD give similar sun safety advice, summarised below. BAD also says that people who avoid sun exposure may be at risk of vitamin D deficiency and should have their levels checked.

• Stay out of the sun during the hottest part of the day (11am to 3pm in the UK).

• Cover up with clothing, a wide-brimmed hat and sunglasses that provide UV protection.

• Use a sunscreen with SPF of at least 30 and at least 4-star UVA protection, applied generously and reapplied regularly.

• Avoid sunbeds and tanning machines. BAD says even a tan is a sign of skin damage.

• Protect babies and children, whose skin is much more sensitive.

The NHS says to see a GP if you have a growth on your skin that is getting bigger or has changed colour or texture, or a growth or area of skin that hurts, itches, bleeds, crusts or scabs for more than 4 weeks. It says finding non-melanoma skin cancer early can mean it is easier to treat.

BAD also advises seeing your GP if you are concerned about changes where a BCC was previously treated, and says a GP who is concerned should refer you to a dermatologist through the NHS.

On the NHS, a GP can examine the skin, take a photograph and refer you to a dermatology team, where a biopsy and treatment are arranged. BAD says Mohs surgery is a specialist process and is not always available.

Some people choose a private dermatologist or dermatological surgeon for quicker review or surgery. Whichever route you take, ask which treatment is recommended for your BCC type and risk group, what scar to expect, and what follow-up is planned, and make sure your GP is informed of the result.