Basal Cell Carcinoma (BCC): Symptoms and Treatment

What is basal cell carcinoma?

Basal cell carcinoma, or BCC for short, is a malignant tumor that develops in the skin and is the most common type of skin cancer.

It usually grows slowly and metastasizes to distant organs very rarely. However, this does not mean that BCC is insignificant.

If left untreated, it can grow in the affected area:

subcutaneous tissues,

to cartilage,

till,

to the bone,

in some cases around the nerve

It can progress and cause serious local tissue damage. (American Academy of Dermatology)

Therefore, the correct message for BCC is:

It is a skin cancer with a very low potential for metastasis, but it can be locally destructive and requires treatment.

Briefly, what you need to know

BCC is a type of skin cancer.

It usually grows slowly.

Metastasis is extremely rare.

If left untreated, it can spread to surrounding tissues.

It most commonly occurs in areas exposed to the sun.

Not all BCCs have the same risk level.

Dermoscopy is helpful in diagnosis; biopsy and histopathology are necessary when required.

Surgery forms the basis of treatment for most patients.

Not every BCC needs to be treated with Mohs surgery.

Non-surgical methods can be used in selected superficial, low-risk BCCs.

What does BCC look like?

There isn't a single image of BCC.

Traditionally:

small, pearly/shiny-looking bumps,

A lesion in which fine blood vessels are visible on the surface.,

a wound that doesn't heal,

recurrent crusting,

easily bleeding formation,

slow-growing pink or red plaque

It can be seen in this way.

Pigmented BCCs may also have brown or near-black colors.

Therefore, it can sometimes be confused with moles or other pigmented lesions.

“"It gets wounded, it heals, it opens again." Does it matter?

Yes, this could be one of BCC's classic patient stories.

For example, a small area on the nose:

“"It scabs over, falls off, I think it's healed; then a few weeks later it bleeds again."”

It can be described as follows.

A lesion that doesn't completely heal, especially over several months, or that repeatedly recurs in the same spot, warrants dermatological evaluation. The AAD also lists recurrent bleeding, crusting, and a non-healing, wound-like appearance as possible signs of BCC. (American Academy of Dermatology)

Where is BCC most commonly found?

Especially susceptible to chronic UV exposure:

face,

nose,

ear,

scalp,

neck

It is frequently seen in regions such as these.

However, it can also appear on the trunk and other areas.

“"If it's in an area that doesn't get sunlight, it's not skin cancer."”

There is no such rule.

What causes BCC?

One of the most important environmental factors is ultraviolet radiation.

Lifetime accumulated UV damage plays a significant role in the development of BCC.

In addition:

light skin phenotype,

old age,

having previously had BCC,

some genetic syndromes,

immunosuppression,

History of ionizing radiation

Factors such as these can affect the risk.

Is BCC contagious?

No.

Basal cell carcinoma is not an infection and is not contagious.

Is BCC melanoma?

No.

They are two different types of skin cancer.

While melanoma develops from melanocytes, BCC has a different cellular origin.

Their biological behaviors are also different.

While melanoma has significant metastatic potential, distant metastasis of BCC is very rare; the main problem in BCC is local growth and tissue destruction in most patients. (American Academy of Dermatology)

How is BCC diagnosed?

First step:

It consists of clinical examination + dermoscopic evaluation.

Dermoscopy may reveal various vascular and pigmented structures that could be characteristic of BCC.

However, histopathological examination is performed when a definitive diagnosis is required.

According to the 2023 European consensus, while clinical and dermoscopic features are fundamental for diagnosis, histopathological confirmation is required in suspected/equivocal lesions.

How is a biopsy performed?

The lesion:

its size,

in its place,

clinical characteristics,

planned treatment

The biopsy method may vary depending on the patient.

Punch, shave, or excisional methods, whichever is most suitable, can be used.

There is an important difference here compared to melanoma:

Not every suspicious BCC needs to be completely removed by excisional biopsy, as is the case with melanoma.

However, accurate sampling is important because the histopathological subtype can alter the treatment plan.

Are there different types of BCCs?

Yes.

There are clinically and histopathologically distinct subtypes.

For example:

Nodular BCC

It is one of the most common classic forms.

It can appear as a shiny, pearly nodule, sometimes with veins on its surface.

Surface BCC

It usually appears as thin, reddish-pink, scaly plaques.

It can be confused with inflammatory diseases such as eczema or psoriasis.

Morpheaform / infiltrative BCC

These are more indistinct, limited, and infiltrative growth patterns, representing a high risk.

The visible tumor boundary in these images may not fully reflect the true microscopic extent.

Because:

Not only the size of BCC, but also its histological subtype can influence treatment decisions.

What do “low risk” and “high risk” mean in BCC?

This distinction will be central to the treatment.

In risk assessment:

the anatomical region where the tumor is located,

size,

the clarity of its boundaries,

whether it is a first-time tumor or a recurring tumor,

histopathological subtype,

patient's immune status

These features are evaluated together.

The 2023 European consensus uses a clinical approach that roughly divides BCCs into easily treatable and difficult-to-treat groups for treatment planning.

“"There is only one standard treatment for BCC."”

How is basal cell carcinoma treated?

The goal of treatment is to completely eliminate the tumor while preserving as much healthy tissue as possible.

Surgical excision

It is one of the basic methods of BCC treatment.

The tumor is removed with appropriate surgical margins, and the removed tissue is evaluated histopathologically.

The 2023 European consensus includes complete surgical excision as the first-line treatment for BCC.

What is Mohs surgery?

In Mohs micrographic surgery, the tumor is removed in stages, and the surgical boundaries of the removed tissue are evaluated under a microscope during the procedure.

A thin layer of tissue is taken again from the area where cancer cells are found.

This process will continue until the borders are cleared.

1. High level of control over tumor margins 2. Preservation of healthy tissue as much as possible

Therefore, it is particularly valuable in anatomical areas where tissue preservation is important. (American Academy of Dermatology)

Should Mohs testing be performed on every BCC?

No.

This is important.

Mohs in particular:

high-risk BCC,

recurring BCC,

tumor with ill-defined borders,

aggressive histological subtype,

critical anatomical areas such as the nose, eyelids, and ears

It is an important option.

The 2023 European guidelines also recommend micrographically controlled surgery for high-risk, recurrent, and critically located BCCs.

We do not treat a small, low-risk trunk BCC the same way as recurrent infiltrative BCC in the nasal wing.

Can curettage and electrocautery be used?

In selected low-risk BCCs, destructive surgical techniques such as curettage and electrodesiccation may be used.

The AAD states that this is a treatment option, especially when applied by an experienced physician in small, low-risk, and appropriate anatomical areas. (American Academy of Dermatology)

But here's the important difference:

In destructive methods, unlike surgical excision, there is no histopathological examination of all peripheral and deep margins.

Therefore, patient selection is important.

Is cryotherapy a viable option?

It can be used in some selected low-risk lesions.

However, it may have disadvantages in terms of recurrence compared to surgical methods and does not provide histopathological margin control.

Because:

“"Let's freeze it, the cancer will go away."”

Such a haphazard approach is not correct.

The AAD also considers cryosurgery as an option in select low-risk BCCs where more effective treatments are not feasible. (American Academy of Dermatology)

Can BCC be treated with cream?

Some BCCs can be obtained.

Topical treatments may be considered, especially for certain superficial, low-risk BCCs.

For example, in suitable patients:

imiquimod,

5-fluorouracil

Treatments such as these can be used.

However:

BCC = cream-treated skin cancer

Such a generalization is incorrect.

Non-surgical methods generally have lower long-term cure rates than surgery, and patient/tumor selection is important. (American Academy of Dermatology)

Is photodynamic therapy available?

Yes.

Photodynamic therapy (PDT) can be used particularly in selected superficial and some low-risk nodular BCCs.

A photosensitizing agent is applied and then activated with appropriate light, aiming to destroy the tumor cells.

The 2023 European consensus considers PDT as one of the effective options for superficial and low-risk nodular BCC.

Can BCC be burned with a laser or plasma energy?

The approach to actinic keratosis differs from that of warts; the premalignant potential of the lesion is taken into consideration.

A wart is a benign viral lesion; BCC, on the other hand, is a malignant tumor.

A lesion suspected of being BCC:

CO₂ laser,

Er:YAG,

plasma energy,

radiofrequency

It is not correct to destroy the tissue using methods such as these without first establishing a diagnosis and oncological treatment plan.

In low-risk BCC, some controlled destructive methods may have a place; however, the 2023 European guidelines state that the first-line treatment is full surgery, and destructive approaches are limited to selected low-risk superficial BCCs.

The availability of a device does not constitute an indication for treatment; the choice of method should be made according to the characteristics of the tumor.

Is radiotherapy a viable option?

Yes.

Especially:

unsuitable for surgery,

those who do not want surgery,

having specific anatomical or clinical characteristics

Radiotherapy can be considered for patients.

The 2023 European consensus recognizes radiotherapy as a viable alternative, particularly in patients who are not candidates for surgery or who refuse surgery.

Is there a drug treatment for advanced BCC?

Yes.

The vast majority of BCCs are managed with local treatment.

However, locally advanced or metastatic BCC can rarely develop.

These patients target the Hedgehog signaling pathway:

vismodegib

sonidegib

Systemic treatments such as these can be used.

In certain situations where hedgehog inhibitors are unsuitable, not tolerated, or where the disease has progressed, anti-PD-1 immunotherapy is also among the treatment options.

We will not be converting this section into a drug catalog on the patient page.

Key point:

Targeted and immunological systemic therapies are currently available for advanced BCC as well.

Can BCC metastasize?

It's possible, but it's very rare.

The AAD states that BCC extradermal dissemination occurs below the %1 threshold. (American Academy of Dermatology)

Therefore, the main danger of BCC in most patients is not metastasis:

It is local tissue destruction in delayed diagnosis.

BCC, especially if allowed to grow for years in critical areas of the face, may require much more extensive surgery.

Is BCC completely curable?

In most cases, yes.

BCC, when detected early and treated appropriately, has an excellent prognosis. (American Academy of Dermatology)

However, after treatment:

recurrence in the same region,

New BCC in another part of the body,

other skin cancers

It can develop.

Therefore, follow-up is important.

If I've had BCC once, can I get it again?

It could be.

Having developed a BCC indicates an increased risk of developing another BCC or other skin cancer in the future.

The AAD (American Academy of Dermatology) recommends regular skin examinations for new primary skin cancers after a BCC diagnosis.

The frequency of follow-up should be determined by the patient's:

tumor risk,

number of tumors,

previous skin cancers,

other risk factors

It would be more accurate to individualize it accordingly.

Is it possible to protect oneself from BCC?

It is not possible to block all BCCs.

However, reducing UV exposure helps lower the risk:

avoiding intense sun exposure,

shadow,

protective clothing and hats,

suitable sunscreen,

Avoiding tanning beds

They should be considered together.

In addition, noticing new, growing, or non-healing lesions on one's skin is important for early diagnosis.

When should you consult a dermatologist?

Especially:

a wound that doesn't heal for weeks/months,

the same lesion that heals and reopens,

recurrent unexplained bleeding,

a slowly but steadily growing swelling,

new lesion with a shiny/pearly appearance,

a formation that has existed for a long time but is beginning to change

If available, a dermatological evaluation is appropriate.

Frequently Asked Questions

Is BCC cancer? Yes. Basal cell carcinoma is a type of skin cancer.

Can BCC kill? Metastasis of BCC is very rare, and the prognosis is excellent with early, appropriate treatment. However, if left untreated, it can cause serious local tissue damage. (American Academy of Dermatology)

Is BCC melanoma? No. They are two different types of skin cancer.

Does BCC resolve on its own? It is not recommended to leave it untreated. BCC can continue to grow and spread to surrounding tissues. (American Academy of Dermatology)

Should every BCC be surgically treated? Surgery is the primary treatment; however, non-surgical methods may be used for selected low-risk BCCs.

Does every BCC require Mohs testing? No. Mohs testing is particularly important for tumors in high-risk, recurrent, or critical anatomical locations.

Can BCC recur? Yes. Recurrence is possible, and people who have had BCC have an increased risk of developing new skin cancer. (American Academy of Dermatology)

Can BCC be burned off with a laser? Lesions suspected of being BCC should not be removed with cosmetic/destructive methods before a diagnosis is made. While some destructive methods may have a place in selected low-risk BCCs, surgical treatment generally has a higher cure rate.