Basal Cell Carcinoma (BCC): Is it on Your Radar?
Published: 25 August 2020
Published: 25 August 2020
If addressed early, BCC can be easily resolved in most cases (CC 2020a).
Non-melanoma skin cancer (NMSC), which comprises BCC and squamous cell carcinoma (cSCC) (along with very rare skin cancers such as Merkel cell carcinoma), is the most common type of cancer in Australia and accounts for about 98% of all skin cancer cases (CC 2020a).
BCC has several features distinguishing it from cSCC and melanoma. Awareness of these differences can assist with timely referral and treatment, thereby reducing morbidity associated with aggressive tumours and enhancing overall patient outcomes. All healthcare professionals should be able to identify lesions and refer appropriately.
BCC is triggered by DNA mutation (caused by UV radiation, usually from the sun) to the block-like basal cells located in the lower layer of the epidermis, which causes the cells to grow and change abnormally. (Skin Cancer Foundation 2019; CCV 2018).
BCC has a comparatively slow growth rate to cSCC, usually developing over several months or years, and rarely spreads to other areas of the body. It is possible for BCCs to grow rapidly or metastasise, but this is a rare occurrence (CC 2020a; Oakley 2015).
NSMCs as a whole, have a low mortality rate of about 1.9 deaths per 100 000 patients (Khong, Gorayski & Roos 2020).
Despite this, neither patients nor healthcare staff should be complacent when addressing any kind of skin cancer as it is possible for untreated BCC to grow deeper into the skin and cause tissue damage, complicating treatment (Khong, Gorayski & Roos 2020; CCa 2020).
A past history of BCC increases the likelihood of developing another BCC, with approximately 50% of patients developing a new lesion within three years of treatment. An individual can also have more than one BCC simultaneously (Oakley 2015; CC 2020a).
BCCs can develop anywhere on the body but are most commonly found in areas that receive frequent sun exposure, including:
BCC accounts for about 70% of the 980 000 NSMCs that are treated every year in Australia. It is most common in those over 40 years of age but can affect anyone (CC 2020a).
In 2018 the total number of mortalities from NMSCs (including BCCs, cSCCs and other rare cancers) was 665 (CC 2020b).
The most common type of BCC is nodular BCC, which accounts for more than 60% of cases. It commonly presents as a shiny, firm, dome-shaped nodule ranging from a few millimetres to several centimetres in diameter. It is generally pearly, pink, skin-coloured or translucent in colour with a smooth surface. It may bleed or ulcerate spontaneously, then form a scab and appear to heal like a normal wound (Bader 2020; Oakley 2015; Wells 2019).
Some less common types of BCC include:
(Wells 2019; Oakley 2015; Bader 2020; Anand, Collins & Chapman 2017)
(CC 2020a; Oakley 2015)
BCCs can be diagnosed through physical examination and biopsy if required. They rarely require staging (Wells 2019; CC 2020a).
If detected early, BCCs can almost always be treated successfully. The treatment method will depend on the specific lesion, however, surgical excision is usually the most appropriate choice. Sometimes a biopsy will have already removed the entirety of the cancer. Other options include:
(Wells 2019; Oakley 2015; CC 2020a)
Advanced, recurrent or metastatic BCCs may require a combination of surgery, radiotherapy, targeted therapies or other treatments (Oakley 2015).
Due to the likelihood of developing another BCC, melanoma or other skin cancer post-treatment, patients are encouraged to undergo annual skin checks (Oakley 2015).
Although BCCs are usually easy to treat and are not overly aggressive, they should be addressed early in order to reduce the likelihood of complications, and patients should be regularly assessed post-treatment to ensure any new skin cancers are quickly resolved.
Being able to identify and appropriately respond to BCCs is not only integral to treatment, but also ensures lesions can be differentiated from more aggressive and dangerous cancers that require urgent action.
Question 1 of 3
True or false? BCCs rarely need to be staged.
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