SKIN CANCERS
Basal cell carcinoma
Basal cell carcinoma (BCC) is the most common skin cancer in Australia, usually appearing as a pink lump or non-healing sore.
- Common on sun-exposed skin
- Typically slow growing
- Rarely spreads but can cause local damage if untreated
- Highly treatable when detected early
Basal cell carcinoma arises from cells in the basal layer of the epidermis. It most commonly occurs on chronically sun-exposed areas such as the face, ears, scalp, neck and arms, but may also appear on the trunk.
Management is individualised and depends on subtype, size, anatomical location, and patient factors.
The three most common types of skin cancer are melanoma, basal cell carcinoma and squamous cell carcinoma.
What does basal cell carcinoma look like?
The appearance of BCC varies depending on subtype.
Nodular basal cell carcinoma
The most common subtype.
Often presents as a pink or skin-coloured lump with a pearly or translucent edge. Fine surface blood vessels may be visible. Over time, the centre may ulcerate or crust.
A lesion that repeatedly heals and reopens should be assessed.
Superficial basal cell carcinoma
Usually presents as a thin pink or red scaly patch. Learn more about superficial basal cell carcinoma.
It may resemble dermatitis, eczema or a persistent rash.
Commonly occurs on the trunk.
Infiltrative (morphoeic) basal cell carcinoma
Less common but more locally aggressive.
Margins may be indistinct and the lesion can extend beyond what is visible on the surface. Careful surgical planning is often required. In selected cases, referral for Mohs micrographic surgery may be appropriate.
Any persistent sore, lump or patch that does not heal should be assessed by a doctor experienced in skin cancer detection.
How is basal cell carcinoma diagnosed?
Basal cell carcinoma is usually suspected during clinical examination using dermoscopy, a magnified technique that helps doctors assess skin lesions.
In many cases the lesion is removed so that the tissue can be examined under a microscope by a pathologist to confirm the diagnosis.
MBBS, MA (Virtual Comm), Grad Cert Hlth Info, Grad Dip Comp Inf Sci
Nodular basal cell carcinoma on the back of the scalp
Overview of basal cell carcinoma behind the right shoulder of a young man.
Nodular basal cell carcinoma on the side of the nose
Basal cell carcinoma on the upper back.
Dermoscopic view of the BCC shown in the image on the left
Dermoscopic view of a basal cell carcinoma showing characteristic branching bright red blood vessels.
What happens if basal cell carcinoma is untreated?
Without treatment, BCC typically enlarges slowly over months to years.
While it rarely spreads to distant organs, untreated lesions may progressively enlarge and result in:
- Persistent non-healing ulcers
- Bleeding or crusting lesions
- Invasion into underlying tissues such as muscle, cartilage or bone
- Functional or cosmetic damage, particularly on the face
Early treatment reduces the risk of progressive local damage.
How is basal cell carcinoma treated?
Management depends on subtype, anatomical location, size and patient factors.
Treatment options include:
- Surgical excision
- Curettage in selected cases
- Cryotherapy for appropriate superficial lesions
- Photodynamic therapy for selected superficial BCC
- Topical prescription treatments in carefully selected superficial cases
The most appropriate treatment is determined following clinical assessment and, where required, confirmation by pathology.
See our full range of skin cancer treatments.
Risk factors for basal cell carcinoma
Risk factors include:
- Cumulative ultraviolet (UV) exposure
- Fair skin that burns easily
- History of blistering sunburn
- Increasing age
- Previous BCC
- Immunosuppression
- Solarium use
- Prior radiotherapy
- Genetic predisposition
Prevention and future risk
Individuals who have had one BCC are at increased risk of developing additional lesions.
The risk of additional skin cancers remains increased, so your doctor will recommend ongoing checks according to your history and risk.
Sun protection remains the most important preventive measure:
- Avoid excessive UV exposure
- Use broad-spectrum sunscreen
- Wear protective clothing and hats
- Seek shade
Your doctor may recommend oral nicotinamide (vitamin B3) after a previous BCC or SCC. It may reduce new nonmelanoma skin cancers in this group, but does not replace sun protection or skin checks. Discuss whether it is suitable for you.
Regular full-body skin examinations support early detection and treatment.
Related conditions
Other skin lesions may resemble basal cell carcinoma or occur in the same patients.
• Superficial basal cell carcinoma
• Squamous cell carcinoma
References
Staples MP, Elwood M, Burton RC, Williams JL, Marks R, Giles GG Non-melanoma skin cancer in Australia: the 2002 national survey and trends since 1985 Med J Aust 2006 Jan 2;184(1):6-10
Cancer Council Australia Optimal care pathway for people with keratinocyte cancer (basal cell carcinoma or squamous cell carcinoma), second edition Optimal cancer care pathways 2021
Concerned about a spot that won't heal?
Basal cell carcinoma is highly treatable when detected early. A full body skin check or spot assessment can determine whether a lesion requires further management.
Find out about our skin cancer checks