BASAL CELL CARCINOMA

What are the aims of this leaflet?

This leaflet has been written to help you understand more about basal cell
carcinomas. It tells you about what they are, what causes them, what can be
done about them and where you can find out more about them.

What is a basal cell carcinoma?

A basal cell carcinoma (BCC) is a type of skin cancer. There are two main
types of skin cancer: melanoma and non-melanoma skin cancer. BCC is a
non-melanoma skin cancer, and is the most common type (greater than 80%)
of all skin cancer (skin cancer incidence is less than 1%) in the UK. BCC are
sometimes referred to as ‘rodent ulcers’.

What causes basal cell carcinoma?

The commonest cause is too much exposure to ultraviolet (UV) light from the
sun or from sunbeds. BCC can occur anywhere on your body, but is most
common on areas that are often exposed to the sun, i.e. your face, head,
neck and ears. It is also possible for a BCC to develop where burns, scars or
ulcers have damaged the skin. BCC is not infectious.
BCC mainly affects fair skinned adults, but other skin types are also at risk.

Those with the highest risk of developing a basal cell carcinoma are:

• People with pale skin who burn easily and rarely tan (generally with
  light coloured or red hair, although some may have dark hair but still
  have fair skin).
• Those who have had a lot of exposure to the sun, such as people with
  outdoor hobbies or outdoor workers, and people who have lived in
  sunny climates.
• People who use sun beds or sunbathe.
• People who have previously had a basal cell carcinoma.

Are basal cell carcinomas hereditary?

Apart from a rare familial condition called Gorlin’s syndrome, BCCs are not
hereditary. However some of the things that increase the risk of getting one
(e.g. a fair skin, a tendency to burn rather than tan, and freckling) do run in
families.

What does a basal cell carcinoma look like?

BCC can vary greatly in their appearance, but people often first become
aware of them as a scab that bleeds occasionally and does not heal
completely. Some BCC are very superficial and look like a scaly red flat mark;
others have a pearl-like rim surrounding a central crater. If left for years the
latter type can eventually erode the skin causing an ulcer; hence the name
“rodent ulcer”. Other BCC are quite lumpy, with one or more shiny nodules
crossed by small but easily seen blood vessels. Most BCC a
to numb the skin. The skin can usually be closed with a few stitches, but
sometimes a small skin graft is needed.

Other types of treatment include:

• Difficult or neglected BCC – Mohs micrographic surgery. This involves
  the excision of the affected skin that is then examined under the
  microscope straight away to see if all the BCC has been removed. If
  any residual BCC is left at the edge of the excision further skin is
  excised from that area and examined under the microscope and this
  process is continued until all the BCC is removed. The site is then
  usually covered with a skin graft. This is a time consuming process and
  only undertaken for certain BCC in difficult anatomical areas if simple
  surgery is not suitable.
• Radiotherapy – shining X-rays onto the area containing the BCC.

Very superficial BCC:

• Curettage and cautery – the skin is numbed with local
  anaesthetic and the BCC is scraped away (curettage) and then
  the skin surface is sealed by heat (cautery).
• Cryotherapy – freezing the BCC with liquid nitrogen.
• Creams – these can be applied to the skin. The two most
  commonly used are 5-fluorouracil (5-FU) and imiquimod.
• Photodynamic therapy – a special cream is applied to the BCC
  which is taken up by the cells that are then destroyed by
  exposure to a specific wavelength of light. This treatment is only
  available in certain dermatology departments (see Patient
  Information Leaflet on Photodynamic Therapy).

Surgical excision is the preferred treatment, but the choice of other treatments
depends on the site and size of the BCC, the condition of the surrounding skin
and number of BCC to be treated (some people have multiple ) as well as the
overall state of health of each person to be treated.

Self care (What can I do?)

Treatment will be much easier if your BCC is detected early. BCC can vary in
their appearance, but it is advisable to see your doctor if you have any marks
or scabs on your skin which are:

• growing
• bleeding and never completely healing
• changing appearance in any way

Check your skin for changes once a month. A friend or family member can
help you particularly with checking areas that you cannot easily inspect, such
as your back.

You can also take some simple precautions to help prevent a BCC appearing:

Top sun safety tips:

• Protect your skin with clothing, and don’t forget to wear a hat that
  protects your face, neck and ears, and a pair of UV protective
  sunglasses.
• Spend time in the shade between 11am and 3pm when it’s sunny. Step
  out of the sun before your skin has a chance to redden or burn.
• When choosing a sunscreen look for a high protection SPF (SPF 30 or
  more) to protect against UVB, and the UVA circle logo and/or 4 or 5
  UVA stars to protect against UVA. Apply plenty of sunscreen 15 to 30
  minutes before going out in the sun, and reapply every two hours and
  straight after swimming and towel-drying.
• Keep babies and young children out of direct sunlight.
• The British Association of Dermatologists recommends that you tell
  your doctor about any changes to a mole or patch of skin. If your GP is
  concerned about your skin, make sure you see a Consultant
• Dermatologist – an expert in diagnosing skin cancer. Your doctor can
  refer you for free through the NHS.
• Sunscreens should not be used as an alternative to clothing and
  shade, rather they offer additional protection. No sunscreen will provide
  100% protection.
• It may be worth taking Vitamin D supplement tablets (available from
  health food stores) as strictly avoiding sunlight can reduce Vitamin D
  levels.

Vitamin D advice

The evidence relating to the health effects of serum Vitamin D levels,
sunlight exposure and Vitamin D intake remains inconclusive. Avoiding all
sunlight exposure if you suffer from light sensitivity, or to reduce the risk of
melanoma and other skin cancers, may be associated with Vitamin D
deficiency.
Individuals avoiding all sun exposure should consider having their serum
Vitamin D measured. If levels are reduced or deficient they may wish to
consider taking supplementary vitamin D3, 10-25 micrograms per day, and
increasing their intake of foods high in Vitamin D such as oily fish, eggs,
meat, fortified margarines and cereals. Vitamin D3 supplements are widely
available from health food shops.

Where can I get more information?

Web links to detailed leaflets:

http://www.skincancer.org/basal-cell-carcinoma.html
http://emedicine.medscape.com/article/276624-overview
http://www.dermnetnz.org/lesions/basal-cell-carcinoma.html

For details of source materials used please contact the Clinical Standards~
Unit (clinicalstandards@bad.org.uk).

This leaflet aims to provide accurate information about the subject and
is a consensus of the views held by representatives of the British
Association of Dermatologists: its contents, however, may occasionally
differ from the advice given to you by your doctor.

This leaflet has been assessed for readability by the British Association of
Dermatologists’ Patient Information Lay Review Panel
BRITISH ASSOCIATION OF DERMATOLOGISTS
PATIENT INFORMATION LEAFLET
PRODUCED SEPTEMBER 2007
UPDATED SEPTEMBER 2008, FEBRUARY 2012
REVIEW DATE FEBRUARY 2015

Download PDF version from the British Association of Dermatologists