Basal Cell Carcinoma (BCC)

A basal cell carcinoma (BCC) is a type of skin cancer and is the most common type (greater than 80%) of all skin cancer in the UK. BCC are sometimes referred to as ‘rodent ulcers’.

The most common cause is too much exposure to ultraviolet (UV) light from the sun or from sunbeds. BCC can occur anywhere but is most common on skin that is exposed to the sun, i.e. your face, head, neck and ears. It is also possible for a BCC to develop where burns, scars or ulcers have damaged the skin. BCC is not infectious and it mainly affects fair skinned adults, but other skin types are also at risk. Those with the highest risk of developing a basal cell carcinoma are:

  • People with pale skin who burn easily and rarely
  • Those who have had a lot of exposure to the sun, such as outdoor workers, people who undertake regular outdoor activities and people who have lived in hot climates.
  • People who use sun beds or sunbathe.
  • People who have previously had a basal cell carcinoma.

BCC can often first present as a scab that sometimes bleeds and does not heal completely. Some BCC are very superficial and look like a scaly red flat mark; others have a pearly outer border surrounding a central crater. If left for years the latter type can eventually erode the skin causing an ulcer.

BCCs can be cured in almost every case, although treatment can be complicated if they have been neglected for a very long time, or if they are in an awkward place, such as near the eye, nose or ear. BCCs never spread to other parts of the body except very rarely if neglected for years. Hence, although it is a type of skin cancer it never endangers life.

The commonest treatment for BCC is surgery. This means cutting away the BCC, along with some clear skin around it under local anaesthetic. The skin can usually be closed with a few stitches, but sometimes a small skin graft or flap is needed.

Other types of treatment include:

  • Difficult or neglected BCC- Mohs micrographic surgery. This involves the excision of the affected skin that is then examined under the microscope straight away to see if all the BCC has been removed. If any residual BCC is left at the edge of the excision further skin is excised from that area and examined under the microscope and this process is continued until all the BCC is removed.
  • Radiotherapy- shining X-rays onto the area containing the BCC.

Very superficial BCC:

  • Curettage and cautery- the skin is numbed with local anaesthetic and the BCC is scraped away and then the skin surface is sealed by heat (cautery).
  • Cryotherapy- freezing the BCC with liquid nitrogen.
  • Creams- these can be applied to the skin. The two most commonly used are 5-fluorouracil (5-FU) and imiquimod.
  • Photodynamic therapy- a special cream is applied to the BCC which is taken up by the cells that are then destroyed by exposure to a specific wavelength of light (see tab on Photodynamic Therapy).

Surgical excision is the preferred treatment, but the choice of other treatments depends on the site and size of the BCC, the condition of the surrounding skin and number of BCC to be treated (some people have multiple ) as well as the overall state of health of each person to be treated.

Squamous Cell Carcinoma (SCC)

A squamous cell carcinoma is a type of skin cancer and is the second most common type of skin cancer in the UK.

The most common cause is too much exposure to ultraviolet (UV) light from the sun or from sunbeds. This causes certain cells (keratinocytes) in the outer layer of the skin (the epidermis) to grow out of control into a tumour.

SCC can occur anywhere on the body, but it is most common on sun exposed areas i.e. your head and neck (including the lips and ears) and the backs of your hands. SCC can also develop where the skin has been damaged by X-rays and ulcers. SCC is not contagious.

SCC mainly affects the following groups:

  • Older people – even those who tend to avoid the sun
  • Builders, farmers, surfers, sailors and people who often are out in the sun, can develop a SCC when they are quite young.
  • Those with a fair skin are more at risk of developing SCC than people with a darker skin.
  • Anyone who has had a lot of ultraviolet (UV) light treatment for skin conditions such as psoriasis will also be at increased risk of getting an SCC.
  • Those whose immune system has been suppressed by medication taken after an organ transplant, or by treatment for leukaemia or a lymphoma.

SCC can vary greatly in their appearance, but most SCC’s usually appears as a scaly or crusty area of skin or lump, with a red, inflamed base. SCC’s are often tender, but some small SCC’s are not painful.

SCC can be cured if they are detected early. If an SCC is left untreated for too long there is a small risk (2-10 %) that it may spread to other parts of the body, and this can be serious.

Surgery is the first choice of treatment and several different methods are available. To select the right one, your surgeon will take into account the size of the SCC, where it is, what type it is, and how long you have had it. The most common surgical technique is simply to cut the SCC away, along with some clear skin around it, under local anaesthetic. The skin can usually be closed with a few stitches, but sometimes a small skin graft or flap is needed.

Other types of treatment include:

  • The removal of lymph nodes- this is unusual but may be needed if there are concerns that the SCC has spread.
  • Radiotherapy (treatment with X-rays) may be used if the SCC is large or in an awkward place. You may be offered this on its own or alongside surgery.
  • Chemotherapy (treatment with drugs) is only used when a SCC has spread to other parts of the body.