Basal cell carcinoma (BCC) is a very common type of skin cancer that is incredibly slow growing - usually not spreading to other parts of the body. In the past, basal cell carcinomas were actually called 'rodent ulcers' because of their slow but persistent 'gnawing' way of developing. Globally, over 4 million people were diagnosed with basal cell carcinoma in 2021 and, in some regions, as many as 1 in 3 people will develop basal cell carcinoma.
Is basal cell carcinoma a type of skin cancer?
Skin cancers are usually grouped into two categories:
- Melanoma skin cancer. These develop from cells that produce melanin, called melanocytes. They often develop from a mole.
- Non-melanoma skin cancers. These develop from other types of skin cells in the top layers of the skin. The two main types are basal cell carcinoma and squamous cell carcinoma.
About 75% of non-melanoma skin cancers are basal cell carcinoma. Developing from basal cells, which sit deep in the epidermis (the protective layer that provides new cells to replenish the surface of our skin) it is usually slow growing, and rarely metastasises. But very occasionally, it can grow more quickly and spread to other parts of the body.
We still need more research to find out why this sometimes happens, and find new ways to prevent it.
What causes basal cell carcinoma?
Like all cancers, basal cell carcinoma starts when our cells sustain too much DNA damage and no longer work properly. With this type of cancer, it is the basal cells in the skin that become damaged.
DNA acts like a tiny instruction booklet, and most of our cells contain their own copy. But when these DNA instructions no longer work, the cell becomes less able to self-regulate. They begin to divide out of control, forming lumps, or tumours.
With basal cell carcinoma, the main cause of DNA damage is exposure to ultraviolet (UV) light. This comes from sunlight, it is also produced by sunbeds and tanning booths. You are more likely to develop skin cancer if you use sunbeds, or have a history of lots of sun exposure and sunburn.
Basal cell carcinomas can affect people at any age, but adults who are middle-aged or older are most likely to be diagnosed.
Despite this, recent research suggests that more younger people are developing basal cell carcinomas, perhaps because of changing lifestyle trends. You are also more likely to develop basal cell carcinoma and other types of skin cancer if you have fair hair and skin that can burn easily in the sun, and a family history of skin cancer.
Researchers are still figuring out exactly how UV light exposure and other risk factors fit together to lead to basal cell carcinoma, and why more young people seem to be developing the condition. For example, scientists are investigating how some genetic factors might make people more likely to develop it after long-term sun exposure, compared to others.
What are the symptoms of basal cell carcinoma?
There are different types of basal carcinoma, and these can also look different from patient to patient. You might notice small, shiny bumps on the skin, or a scab that bleeds and does not heal. They are most commonly found on areas exposed to the sun, such as the face, neck, and head.
Some basal cell carcinomas have a central ‘crater’, while others may appear quite flat, like a scaly pink mark on the skin. Most do not hurt, though they can sometimes feel itchy.
How is basal cell carcinoma diagnosed?
Skin examinations. Sometimes basal cell carcinoma can be diagnosed just by appearance. Your doctor may use a special type of magnifying glass called a ‘dermatoscope’. This helps them to inspect any changes very closely.
Biopsy and laboratory testing. You might also need a biopsy. This is when a tiny piece of skin is taken and sent for testing in a laboratory - or sometimes the whole lesion may be removed and taken for testing. A biopsy can help to rule out skin cancer or, if cancer is confirmed, it can help to determine the type of cancer and treatment needed.
Is basal cell carcinoma curable?
The success rate of treatment for basal cell carcinoma is very high, and nearly all cases can be completely cured. But treatment can sometimes be more complicated, and basal cell carcinoma may occasionally come back after treatment. More rarely, it can sometimes spread to deeper layers of skin, or other parts of the body.
This is why it is very important to get anything you are unsure of checked out by a doctor as soon as possible - the earlier that basal cell carcinoma is diagnosed and treated, the better the chance of a successful outcome.
Treating these tumours earlier, while they are still very small, can also help to minimise scarring following removal. This can be especially important to patients as this type of cancer is commonly found on the face and neck.
How is basal cell carcinoma treated?
Surgery is the most common and effective treatment for basal cell carcinoma, usually performed under local anaesthetic. This is when an injection is given to numb the area before the area of skin is removed, and you stay awake during the procedure.
Sometimes the basal cell carcinoma may not be treated. This is more likely if there are other conditions that would make treatment more complicated for the patient, or if the cancer is very slow growing.
The choice of treatment for basal cell carcinoma can depend on different factors, including how many tumours there are, whether they are at risk of returning, and patient needs and preferences.
There are also some non-surgical options for some types of basal cell carcinoma, particularly ‘low-risk’ types that are not likely to come back:
Cryotherapy
A commonly performed procedure that uses extremely low temperatures to destroy lesions by freezing them off using liquid nitrogen.
Topical creams
Sometimes creams can be applied to the basal cell carcinoma to remove it. For example, Imiquimod works by helping our own immune system to target the cancer cells, and 5-Fluorouracil is a chemotherapy cream which works by destroying fast growing and damaged cells.
Photodynamic therapy
This treatment, pioneered with the help of Curestarter funding, uses drugs that make the cancer cells more sensitive to light and lasers to shine light on the cancer and activate the drug.
Other therapies
Occasionally other therapies like radiotherapy might also be used to treat basal cell carcinoma.
Can basal cell carcinoma return after treatment?
Basal cell carcinoma does not usually come back after treatment. In one study, which followed patients who had been treated for basal cell carcinoma for between 1 and 12 years, around 96 in 100 cases (96%) did not return.
But for some people, basal cell carcinoma may have a higher risk of returning after treatment. Factors affecting whether the cancer has a ‘high-risk’ of returning can include:
- Specific characteristics of the basal cell carcinoma, for example if it is larger, faster growing, or more deeply rooted in the skin.
- If the cancer has been treated before and returned.
- If the person has a weak immune system, perhaps due to another health condition.
In these cases it is especially important to make sure that all of the cancer is removed with treatment. This can influence treatment choice. For example, more specialist surgical techniques may be used.
Why is research into basal cell carcinoma still important?
Basal cell carcinoma is an extremely common cancer and every single diagnosis of cancer brings prolonged worry for the people and families affected. Even though it is almost always curable, the most effective treatment is still removal with surgery, which can be a worry due to the risk of scarring and other side effects.
And, even though it is rare, it is still possible for basal cell carcinoma to spread, or return after treatment. We still need better understanding of exactly how basal cell carcinoma grows, and new ways to detect the cancer that do not require invasive biopsies. We also need kinder treatments that effectively remove basal cell carcinomas, and reduce any risk of them returning.
International cancer research to understand exactly how cancer grows and develops, and how we can stop it, is where we will begin to find answers to these problems.
What progress is Worldwide Cancer Research making?
Thanks to our Curestarters, several projects have been funded around the world that have the potential to improve the lives of people with skin cancer.
These include projects investigating the potential of developing a new type of vaccine against melanoma skin cancer, and how we can make immunotherapy treatments more effective.
And our funding has already helped Professor Stephen Bown to develop a treatment called photodynamic therapy - a type of light therapy that can be used to target some head and neck cancers - and which is now sometimes able to treat basal cell carcinoma.
By giving cancer researchers the funding they need to start answering the questions that matter, we can continue to search for new tests, and new cures, and get to the bottom of exactly how and why cancers like basal cell carcinoma develop.
At Worldwide Cancer Research we are proud to be able to green-light so much discovery research into cancer - but none of it would be possible without the generosity of supporters like you.
Your basal cell carcinoma FAQs:
What is basal cell carcinoma?
Basal cell carcinoma is the most common type of skin cancer. It usually affects areas of the skin that are often exposed to the sun.
How common is basal cell carcinoma?
Basal cell carcinoma is very common, as many as 75,000 people in the UK are diagnosed with the cancer every year. In 2021, around 4 million people worldwide were diagnosed with basal cell carcinoma.
Is basal cell carcinoma caused by the sun?
Yes, exposure to ultraviolet (UV) light is the main cause of basal cell carcinoma. UV light is found in sunlight, and also in the light used by sunbeds and tanning salons.
How does research improve outcomes for basal cell carcinoma?
Research has helped us to understand much more about the causes of basal cell carcinoma, and the best way to prevent and treat it. Researchers are working hard to develop new treatments, like vismodegib, a new type of chemotherapy that can be sometimes be used to treat more complex types of basal cell carcinoma. Our Curestarters also supported vital early research which made basal cell carcinoma treatment photodynamic therapy possible, too.
How does Worldwide Cancer Research support skin cancer research?
At Worldwide Cancer Research we’re proud to fund ground-breaking research into any new cancer cures, anywhere in the world. We currently support several projects that have the potential to improve the lives of people with skin cancer. These include projects investigating the potential of developing a new type of vaccine against melanoma skin cancer, and how we can make immunotherapy treatments more effective.
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