Basal Cell Carcinoma UK: Symptoms, Treatment and What to Expect

Basal cell carcinoma (BCC) is a malignant skin tumour arising from basal cells in the deepest layer of the epidermis. It is the most common cancer in the UK, with around 300,000 diagnoses per year. BCC is slow-growing and very rarely spreads to other parts of the body. When diagnosed early, it is almost always curable.

BCC most commonly appears as a pearly, shiny or translucent bump on sun-exposed skin — particularly the face, scalp, ears and neck. It may look pink, white or skin-coloured. Other presentations include: a flat, pale scar-like area; a pink or red growth with raised, rolled edges; a sore that bleeds or oozes without obvious cause and then heals, only to recur; or a dark, pigmented lesion resembling a mole. Any non-healing skin lesion should be assessed by a GP.

BCC is the most common cancer in the UK, with approximately 300,000 new cases diagnosed each year — accounting for over 75% of all skin cancer diagnoses. Incidence has been rising steadily for decades, driven by increased UV exposure, sunbed use and an ageing population. BCC is more common in men than women and in people over 50, though rates in younger people are rising.

Cumulative exposure to ultraviolet (UV) radiation from the sun or sunbeds is responsible for the vast majority of BCCs. UV radiation damages the DNA in basal cells, causing mutations that allow uncontrolled growth. The risk relates to total lifetime UV exposure, making BCC most common in older adults, outdoor workers and those with a history of significant sun exposure. Sunburn, particularly in childhood, also contributes to lifetime risk.

Risk is highest in people with: fair or freckled skin, light eyes or red/blonde hair; a history of prolonged sun exposure or regular sunbed use; previous skin cancer; immunosuppression (organ transplant recipients or people with HIV); a family history of BCC; exposure to ionising radiation or arsenic; or Gorlin syndrome. BCC is rare in people with dark skin due to higher melanin content, though it can occur.

Diagnosis is typically made by a dermatologist or GP with a special interest in dermatology through clinical examination, often aided by dermoscopy (a magnifying instrument with polarised light). A skin biopsy (punch or shave biopsy under local anaesthetic) provides histological confirmation and determines the BCC subtype, which guides treatment choice. Most BCCs are diagnosed without the need for any imaging.

BCC is rarely life-threatening. It almost never spreads to lymph nodes or distant organs (metastatic BCC occurs in fewer than 0.1% of cases). However, it is not harmless: left untreated, BCC can grow deep into surrounding skin, cartilage, muscle and bone — causing significant disfigurement, particularly on the face. Lesions near the eye, nose or ear can invade critical structures. Early treatment is always preferable.

Metastatic spread of BCC is extremely rare — occurring in fewer than 0.1% of cases, usually involving very large, neglected, high-risk tumours or the rare basosquamous variant. This is one of the key features that distinguishes BCC from melanoma and squamous cell carcinoma. The main risk of BCC is local invasion and tissue destruction, not distant spread. Treatment prevents this from occurring.

The main subtypes are: nodular BCC (the most common — a pearly, raised bump with rolled edges and sometimes surface blood vessels); superficial BCC (a flat, pink or red scaly patch, often on the trunk); morphoeic/sclerosing BCC (a pale, scar-like, ill-defined lesion that may be underestimated in size — the highest-risk subtype); pigmented BCC (may resemble a mole and contain dark pigment); and basosquamous carcinoma (an aggressive hybrid of BCC and squamous cell carcinoma). Subtype affects treatment choice and risk of recurrence.

Standard treatment for primary BCC is surgical excision under local anaesthetic with a margin of healthy tissue, achieving cure rates exceeding 95%. Mohs micrographic surgery is preferred for high-risk or recurrent BCCs on the face. Non-surgical options include: cryotherapy; curettage and electrodesiccation; topical imiquimod or 5-fluorouracil for superficial BCC; photodynamic therapy (PDT); and radiotherapy for patients unfit for surgery. Vismodegib or sonidegib (hedgehog pathway inhibitors) are used for advanced or metastatic BCC.

Mohs surgery is a specialised surgical technique in which the skin cancer is removed one thin layer at a time. Each layer is immediately examined under a microscope by the surgeon, who maps which areas still contain cancer cells. Only those precise areas are removed in the next layer. The process continues until completely clear margins are confirmed. Mohs surgery achieves the highest cure rates (>98%) for primary BCC and is used for high-risk sites (nose, eyelids, ears), large tumours and recurrent BCC.

PDT is a non-surgical treatment for superficial and thin nodular BCC. A photosensitising cream (aminolevulinic acid or methyl aminolevulinate) is applied to the lesion and left for several hours. The skin is then exposed to a specific wavelength of light, which activates the cream and destroys the cancer cells. PDT is effective for superficial BCC with good cosmetic results, is performed as an outpatient procedure and is particularly useful for larger or multiple lesions on the trunk.

Untreated BCC continues to grow slowly. Over months to years, it can invade deeper layers of skin, cartilage, muscle and bone. On the face, this can result in destruction of the eyelid, nose, ear or surrounding tissue — causing significant disfigurement and functional impairment. Large neglected BCCs are more difficult to treat and may require extensive reconstructive surgery. Although BCC very rarely spreads internally, the local damage it causes makes treatment important even for apparently small lesions.

Most BCCs are removed under local anaesthetic in an outpatient setting. Standard excision involves cutting out the lesion with a margin of normal skin and closing the wound with stitches. For larger or high-risk BCCs, Mohs micrographic surgery is performed. For superficial lesions, non-excisional methods including curettage and cautery, cryotherapy or topical treatments may be used. A small scar remains after excision, which usually fades over time.

Recurrence rates depend on the treatment used, the BCC subtype and location. For standard surgical excision, recurrence rates are approximately 2–5% at five years. For Mohs surgery, recurrence rates are less than 1%. Higher recurrence rates are seen with non-surgical treatments (cryotherapy, curettage), morphoeic BCC subtype, facial lesions and previously treated tumours. Long-term dermatological follow-up is recommended for patients with multiple or high-risk BCCs.

BCC is largely preventable through consistent sun protection. The NHS advises: using sunscreen of at least SPF 30 (SPF 50 for children and those with fair skin); wearing protective clothing, a wide-brimmed hat and UV-blocking sunglasses; seeking shade during the hours of 11am–3pm; and avoiding sunbeds entirely. The WHO classifies sunbeds as a Group 1 carcinogen. Regular skin checks to identify new or changing lesions allow early diagnosis and treatment before lesions grow large.

The survival rate for basal cell carcinoma is excellent. The vast majority of patients — over 95% — are cured with initial treatment, and BCC-specific mortality is extremely rare. Death from BCC most commonly occurs in the very small minority of patients who develop metastatic BCC, or in those in whom extensive local invasion affects critical structures. The NHS does not report a standard five-year survival statistic for BCC in the same way as other cancers because cure rates are so high.

Gorlin syndrome (naevoid basal cell carcinoma syndrome) is a rare inherited condition caused by mutations in the PTCH1 gene. It causes a predisposition to develop multiple BCCs — sometimes hundreds — beginning from early adult life or even childhood. People with Gorlin syndrome also have increased risk of other tumours including medulloblastoma (a brain cancer), jaw cysts and cardiac fibromas. Vismodegib (a hedgehog pathway inhibitor) is specifically approved for BCC in patients with Gorlin syndrome. Genetic counselling is available through NHS genetics services.

Yes. Regular use of broad-spectrum sunscreen (protecting against both UVA and UVB radiation) at SPF 30 or higher significantly reduces the risk of BCC and other skin cancers. The NHS advises applying sunscreen generously to all exposed skin, reapplying every two hours and after swimming. Sunscreen should be used alongside other protective measures — shade, clothing and avoiding peak UV hours — rather than as the sole form of sun protection.

In low-income countries, dermatology services are highly concentrated in urban centres, meaning patients in rural areas often present with large, advanced BCCs that have caused significant local tissue destruction. Mohs surgery and PDT are unavailable in most settings. Even standard excision may be difficult to access. World Aid Network funds cancer treatment — including skin cancer — for poor patients through locally-licensed doctors, helping to close this treatment gap.