Basal cell carcinoma

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 16 Mar 2025

Last updated: 20 Feb 2025

Basal cell carcinoma (BCC) clinically presents as a pearly white/pink papulo-nodule or firm plaque.

Patient usually has prominent solar damage or a history of considerable ultraviolet (UV) radiation exposure.

Can be locally aggressive, but rarely metastasises.

Diagnosis of a cancer is histological. Findings are of dermal masses of varying sizes and shapes composed of basophilic cells with large oval rather uniform nuclei and scant cytoplasm. These masses exhibit a peripheral cell layer demonstrating a palisading pattern of nuclei.

Most BCCs are successfully treated with surgery, with low recurrence rates.

Definition

BCC of the skin is a common neoplasm, related to exposure to sunlight.[1][2][Figure caption and citation for the preceding image starts]: Nodular basal cell carcinoma on the cheek, on background of diffuse solar damage with marked solar elastosisFrom the collection of Prof. Robert A. Schwartz [Citation ends]. com.bmj.content.model.Caption@664fd697 BCC can be locally aggressive, but rarely metastasises. While certain factors can result in higher-grade behaviour, in most cases early detection and treatment have made extensive local invasion and destruction from this neoplasm a thing of the past.[3]

History and exam

Key diagnostic factors

presence of risk factors
papules with associated telangiectasias
plaques, nodules, and tumours with rolled borders
small crusts and non-healing wounds
non-healing scabs
pearly papules and/or plaques

Other diagnostic factors

metastases associated with large or neglected BCC
local destruction with advanced lesion

Risk factors

Ultraviolet (UV) radiation
sun exposure
x-ray exposure
arsenic exposure
aberrant hedgehog signalling pathway
xeroderma pigmentosum
nevoid basal cell carcinoma (Gorlin-Goltz) syndrome
history of non-melanona skin cancer
childhood cancer survivors
transplant recipient

Diagnostic investigations

1st investigations to order

biopsy for dermatohistopathology

Emerging tests

in vivo multiphoton microscopy

Treatment algorithm

INITIAL

nevoid basal cell carcinoma (Gorlin-Goltz) syndrome

ACUTE

low-risk subtype in non-cosmetically challenging location

low-risk subtype in cosmetically challenging location

high-risk subtype

ONGOING

positive margins on initial procedure

complicated BCC recurrences and/or site not accessible to surgical and topical therapies

advanced disease

Contributors

Authors

Robert A. Schwartz, MD, MPH, DSc (Hon), MAE, FAAD, FRCP (Edin)

Robert A. Schwartz

Professor & Head

Dermatology

Rutgers University New Jersey Medical School

Newark

NJ

Disclosures

RAS declares that he has no competing interests. RAS is an author of a number of references cited in this topic.

Acknowledgements

Professor Robert A. Schwartz would like to gratefully acknowledge Dr James R. DeBloom and Dr Drazen Jukic, the previous contributors to this topic.

Disclosures

JRD and DJ declare that they have no competing interests.

Peer reviewers

Richard Bull, BMBCh

Consultant Dermatologist

Homerton University Hospital NHS Foundation Trust

London

UK

Disclosures

RB declares that he has no competing interests.

David Cassarino, MD, PhD

Assistant Professor

Department of Pathology and Laboratory Medicine

University of California

Los Angeles

CA

Disclosures

DC declares that he has no competing interests.

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