Basal cell carcinoma (BCC)

What is basal cell carcinoma?

Basal cell carcinoma is a form of skin cancer caused by uncontrolled growth of basal cells, which are normally responsible for producing new skin cells when the old ones die off. BCC usually develops on areas of skin that are frequently exposed to the sun, such as the face, ears, neck, scalp, shoulders and back. Despite its slow growth and low chance of spreading, basal cell carcinoma can damage surrounding tissues and can have significant aesthetic and functional consequences if it is not treated.

The diagnosis and treatment of basal cell carcinoma fall under regular, specialist medical care and take place in hospital. Early recognition and timely treatment are important to prevent local damage and complications.

How does basal cell carcinoma develop?

Basal cell carcinoma is mainly caused by prolonged exposure to ultraviolet (UV) radiation from the sun or sunbeds. UV radiation can cause DNA damage in skin cells, which can lead to uncontrolled cell growth and the formation of cancer. People with fair skin, blue eyes and a history of sunburn have an increased risk of developing BCC. Other risk factors include a weakened immune system, exposure to harmful chemicals, and hereditary syndromes such as basal cell naevus syndrome (Gorlin syndrome).

What are the symptoms of basal cell carcinoma?

Basal cell carcinoma can present in different ways, depending on the type and location. The most common symptoms are:

• Pearly or waxy bump: A smooth, shiny bump with a pearly or translucent appearance, often with visible small blood vessels (telangiectasias).
• Flat, scaly patch: A skin-coloured or light brown patch that resembles a scar or a scaly patch, often with a slightly raised edge.
• Open sore: A wound that does not heal, keeps bleeding or comes back after healing.
• Red or irritated patch: A red, itchy or irritated patch of skin that does not heal.
• Dark lesion: BCC can sometimes appear as a dark, pigmented lesion, especially in people with a darker skin tone.

How is basal cell carcinoma treated?

The treatment of basal cell carcinoma depends on the size, location and type of the tumour, as well as the patient's general health. The most common treatment options are:

• Surgical excision: The most common treatment, in which the tumour is cut out together with a margin of healthy tissue to remove the cancer completely.
• Mohs micrographic surgery: A specialised technique in which the tumour is removed layer by layer and immediately examined under the microscope until no more cancer cells are found. This is particularly effective for BCC in cosmetically sensitive areas such as the face.
• Cryotherapy: A method in which the tumour is frozen with liquid nitrogen to destroy cancer cells.
• Topical therapies: Creams or ointments applied directly to the skin to treat small superficial BCCs.
• Radiotherapy: Sometimes used for patients who cannot undergo surgery or as additional therapy after surgery.
• Photodynamic therapy (PDT): A technique in which a light-sensitive substance is applied to the skin, followed by exposure to a special lamp to destroy cancer cells.
• Medication: In rare cases, systemic treatment with oral medication, such as vismodegib or sonidegib, may be used for advanced basal cell carcinoma that cannot be treated with surgery or radiotherapy.

Prognosis and prevention

Basal cell carcinoma generally has a very good prognosis when it is detected and treated early. Most cases of BCC can be removed completely without serious complications. However, recurrence is possible, and patients who have had one BCC have an increased risk of developing new skin cancers in the future.

Preventive measures include:

• Sun protection: Regular use of sunscreen with a high SPF, wearing protective clothing, and avoiding direct sunlight, especially during peak hours.
• Regular skin checks: Self-examination of the skin and regular checks by a dermatologist to detect early signs of skin cancer.
• Avoiding sunbeds: Avoid sunbeds, as they can emit significant amounts of harmful UV radiation.

What is the difference between basal cell carcinoma and other forms of skin cancer?

Basal cell carcinoma is the most common and least aggressive form of skin cancer compared with other types, such as squamous cell carcinoma and melanoma. While BCC rarely spreads, it can be locally destructive. Squamous cell carcinoma has a slightly higher risk of spreading, and melanoma is the deadliest form of skin cancer, with a much greater chance of spreading.

Basal cell carcinoma is a common but usually treatable form of skin cancer. With early detection and the right treatment, most damage can be prevented and the skin can stay healthy.

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