How Serious is a Basal Cell Carcinoma (BCC)?
Early Action Supports Better Outcomes
How Serious is a Basal Cell Carcinoma?
A diagnosis of basal cell carcinoma can feel frightening, but it is important to know that this is the most common and most treatable form of skin cancer in the UK. The vast majority of patients who receive prompt, specialist treatment go on to make a full recovery. This article explains what basal cell carcinoma is, how serious it is, what causes it, and what your treatment options are.
Key Takeaways
- Basal cell carcinoma is the most common form of skin cancer in the UK, and it is more straightforward to treat when it is found early
- BCC grows slowly and very rarely spreads to other parts of the body: published estimates range from 0.0028% to 0.55% of cases (StatPearls)
- Left untreated, BCC can invade deeper layers of skin, tissue, and bone, making early assessment essential
- The most common cause is long-term and childhood UV exposure from sunlight or sunbeds, though genetics and other factors also play a role
- Treatment options include surgical excision, Mohs micrographic surgery, curettage and cautery, radiotherapy, and topical creams — your specialist will recommend the most appropriate approach
- Mohs micrographic surgery checks the full margin of each layer under the microscope during the procedure, before the wound is closed
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A Treatable Form of Skin Cancer
What Is a Basal Cell Carcinoma?
Basal cell carcinoma (BCC) is a type of skin cancer that develops in the basal cells, which sit in the deepest layer of the outer skin (the epidermis). It is the most common form of skin cancer in the UK, accounting for around 75% of all skin cancer diagnoses.
BCCs tend to grow slowly and, in most cases, stay localised to the area where they first appeared. They very rarely spread to other parts of the body, which is what makes them the least aggressive type of skin cancer. That said, they should never be left untreated. Some patients may choose to live with BCC if it is asymptomatic but this is usually after consulting with a specialist and perhaps a diagnostic biopsy for reassurance.
BCCs most commonly appear on areas of the skin that receive the most sun exposure, including:
- The face, particularly around the nose, eyes, and ears
- The neck and scalp
- The shoulders and upper back
- The hands and forearms
Spotting the Early Warning Signs
What are the signs of basal cell carcinoma?
In terms of appearance, a BCC may look like a pearly or translucent bump, a flat flesh-coloured or brownish scar-like patch, or a sore that bleeds, crusts over, and repeatedly fails to heal. If you have noticed any of these signs, it is important to have your skin assessed by a specialist as soon as possible.
BCC Fast Facts
There are around 156,000 new cases of non-melanoma skin cancer in the UK each year (Cancer Research UK, 2016 to 2018 figures).
Around 75 out of every 100 non-melanoma skin cancers are BCCs (Cancer Research UK).
BCC very rarely spreads to other parts of the body.
BCC is most common in people over 50, though cases in younger adults are increasing.
The full surgical margin is checked under the microscope during Mohs micrographic surgery for primary BCCs
What Causes Basal Cell Carcinoma?
The most common cause of BCC is long-term or repeated exposure to ultraviolet (UV) radiation from sunlight or sunbeds. Over time, UV radiation damages the DNA in basal cells, which can cause them to grow in an uncontrolled way.
Several factors can increase your risk of developing a BCC:
- Sun exposure — cumulative UV damage over many years is the primary cause
- Sunbed use — artificial UV radiation carries the same risks as natural sunlight
- Fair skin, light eyes, or light hair — less melanin in the skin means less natural protection against UV radiation
- A history of sunburn — particularly severe sunburn during childhood
- A weakened immune system — including patients taking immunosuppressant medication following an organ transplant
- A personal or family history of skin cancer
- Exposure to arsenic — through certain occupational or environmental sources
- Certain inherited conditions — such as Gorlin syndrome, which significantly increases the risk of developing multiple BCCs
Can Basal Cell Carcinoma Be Fatal?
The risk of dying from basal cell carcinoma is extremely low. Published estimates put the share of BCCs that spread (metastasise) at between 0.0028% and 0.55% (StatPearls).
In the rare cases where BCC does spread, it is almost always associated with very large tumours, advanced neglect over many years, or recurrent cases that have gone through multiple unsuccessful treatments. Metastatic BCC, when it does occur, can affect the lymph nodes, lungs, and bones.
The key message is this: BCC becomes dangerous primarily when it is left untreated for a prolonged period. Early assessment matters because treatment is more complicated when a BCC has been left untreated for a long time or is large by the time it is diagnosed (British Association of Dermatologists).
How Is BCC Diagnosed?
If you or your GP suspects a BCC, you will be referred to a specialist (dermatologist or plastic surgeon) for a clinical assessment. The specialist will examine the lesion and, in most cases, perform a skin biopsy to confirm the diagnosis. This involves removing a small sample of tissue from the lesion, which is then examined under a microscope in a laboratory.
Biopsy results are typically available within one to two weeks. Once a diagnosis is confirmed, your specialist will discuss the most appropriate treatment options based on the size, location, and subtype of your BCC.
It is always better to seek an assessment early. The smaller and more superficial a BCC is at the time of treatment, the simpler the procedure and the better the outcome.
How Is Basal Cell Carcinoma Treated?
Treatment for BCC depends on several factors, including the size, location, depth, and subtype of the tumour. Your specialist will recommend the most appropriate approach for your individual circumstances.
Treatment for BCC depends on several factors, including the size, location, depth, and subtype of the tumour. Your specialist will recommend the most appropriate approach for your individual circumstances.
The main treatment options include:
For BCCs on the face or in cosmetically sensitive areas, Mohs micrographic surgery checks the margin of each layer under the microscope during the procedure, so only tissue that still contains cancer is removed.
Mohs Micrographic Surgery
The gold-standard treatment for BCC, particularly for lesions on the face and other cosmetically sensitive areas. The surgeon examines the full margin of each layer under the microscope during the procedure, so the margin is confirmed clear before the wound is closed.
Surgical Excision
The lesion is removed with a margin of healthy surrounding tissue and the wound is closed with sutures. Suitable for many BCCs in lower-risk locations.
Curettage & Cautery
A scraping and burning technique used for superficial BCCs in low-risk areas.
Radiotherapy
Used in cases where surgery is not suitable, such as in elderly patients or those with other medical conditions.
Topical Treatments
Creams such as imiquimod or 5-fluorouracil may be used for small, superficial BCCs in non-sensitive locations.
Why Mohs Surgery Is the Gold Standard for BCC Treatment
Mohs micrographic surgery is used for basal cell carcinoma on and near the face, where there is little spare skin to close the wound.
During the procedure, the surgeon removes the tumour layer by layer, examining each layer under a microscope in real time. This continues until no cancer cells are seen at the margin, which allows as much healthy surrounding tissue as possible to be preserved.
- The full surgical margin is examined under the microscope during the procedure, not days afterwards in a laboratory
- Healthy skin spared wherever possible — particularly important on the face, around the eyes, nose, ears, and lips
- Same-day results — the margins are checked during the procedure, so there is no wait for laboratory results
- Reconstruction in the same session — the surgical defect is repaired immediately, with no need for a separate procedure or a second surgeon
Miss Rakhee Nayar is a consultant plastic surgeon specialising in Mohs micrographic surgery. As one of fewer than 10 women in the UK dual-trained in both plastic surgery and Mohs micrographic surgery, she brings a rare level of precision and aesthetic expertise to every procedure.
With over 20 years of surgical experience, she carries out both the excision and the reconstruction herself.
In a specialty where only 17% of consultants are women, Miss Rakhee offers a reassuring and deeply compassionate perspective.
One of fewer than 10 women in the UK dual-trained in both plastic surgery and Mohs micrographic surgery
Over 20 years of surgical experience in skin cancer surgery and facial reconstruction
MBChB with Honours, MRCS, FRCS Plast, and MD (Doctorate in Cancer Studies)
European Board of Hand Surgery Diploma (EBHS), allowing Mohs surgery on the hand
Chair, Mohs Surgery Training Interface Group (JCST), since January 2024
Member of BAPRAS, the Royal College of Surgeons of Edinburgh, BMA, CBS, and the Training Interface Group (TIG)
What Happens If BCC Is Left Untreated?
BCC will not resolve on its own. Whilst it grows slowly, it grows continuously and can cause increasing damage the longer it is left without treatment.
Over time, an untreated BCC can:
- Invade deeper layers of skin, underlying muscle, and in advanced cases, bone
- Cause significant functional damage if located near the eyes, nose, or ears
- Become considerably more difficult to treat, requiring more extensive surgery
- Increase the risk of recurrence following treatment
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Frequently Asked Questions
Common Questions About BCC
is basal cell carcinoma curable?
Yes. The British Association of Dermatologists states that BCCs can almost always be cured. With Mohs micrographic surgery the full margin of each layer is checked under the microscope during the procedure, before the wound is closed.
Can BCC spread to other parts of the body?
It is extremely rare for BCC to spread. Published estimates range from 0.0028% to 0.55% of cases (StatPearls). However, an untreated BCC can invade the surrounding skin, tissue, and bone, which is why prompt treatment is important.
What does a basal cell carcinoma look like?
BCCs can appear as a pearly or translucent bump, a flat scar-like patch, or a sore that bleeds and repeatedly fails to heal. They most commonly appear on sun-exposed areas of the face, neck, and scalp.
How long does Mohs surgery take?
Mohs surgery is performed as a day-case procedure. The length of time depends on the size and complexity of the lesion, but most procedures take four or more hours. You are able to go home the same day.
Do I need a GP referral to see Miss Rakhee?
No. You can book a consultation directly, either in person at one of Miss Rakhee’s clinics or via e-Consultation from anywhere in the UK.
Will I have a scar after BCC removal?
All surgical procedures leave a scar. However, Miss Rakhee’s dual training in plastic surgery means that every reconstruction is carried out with your cosmetic outcome in mind.