Basal Cell Carcinoma Symptoms and Treatment. Patient | Patient

Basal cell carcinomas (BCCs) are slow-growing, locally invasive malignant epidermal skin tumours which are thought to arise from hair follicles. The tumour infiltrates local tissues through the slow irregular growth of subclinical finger-like outgrowths and morbidity results from local tissue invasion and destruction, especially on areas of chronic sun exposure, such as the face, head and neck.[1]

Metastasis is relatively rare with a metastasis rate of 0.0028% to 0.5%. However, there is a 2% incidence of metastasis for tumours larger than 3 cm in diameter, 25% for tumours larger than 5 cm and 50% for tumours larger than 10 cm in diameter.[2]

There are good photographs of basal cell carcinomas (BCCs) on the Dermatology Information System (DermIS) website.[6]

There is a good photograph of a superficial BCC on the DermIS website.[7]

The National Institute for Health and Clinical Excellence (NICE) recommends that low-risk BCCs be managed in primary care as long as the GP meets the requirements to perform skin surgery within the framework of the Direct Enhanced Services and Local Enhanced Services. There should be no diagnostic uncertainty that the lesion is a primary nodular low-risk BCC and meets the following criteria:

If the BCC does not meet the above criteria, or there is any diagnostic doubt, following discussion with the patient they should be referred to a member of the local hospital skin cancer multidisciplinary team (LSMDT).

If the lesion is thought to be a superficial BCC, the GP should ensure that the patient is offered the full range of medical treatments (eg photodynamic therapy (PDT)) and this may require referral to a member of the LSMDT. Incompletely excised BCCs should be discussed with a member of the LSMDT.

Surgery and radiotherapy appear to be the most effective treatments, with surgery showing the lowest failure rates. There is only limited evidence of the effectiveness of other treatment modalities compared with surgery.[11] Recurrent BCC is more difficult to cure than primary lesions.[1]

Sometimes, especially in the very elderly and debilitated, it may be appropriate to provide no treatment (given the slow growth and low risk of many superficial BCCs) or palliative (debulking or radiotherapy) treatment if the tumour is symptomatic.

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Basal Cell Carcinoma Symptoms and Treatment. Patient | Patient