Basal Cell Carcinoma (BCC)

British Association of Dermatologists guidelines for the management of adults with basal cell carcinoma 2021

NICE guideline [NG12] Suspected cancer: recognition and referral. 1.7 Skin cancers. Last updated: Apr 2026.

PCDS Clinical guidance Basal cell carcinoma – an overview. Last updated: Dec 2025.

PCDS Clinical guidance Basal cell carcinoma: solid (syn. nodular / cystic). Last updated: Jan 2026.

Article Last Updated:12/05/2026

Basal Cell Carcinoma (BCC)

Basal cell carcinoma (BCC) is the most common type of skin cancer, arising from basal keratinocytes of the epidermis.

This updated UKMLA guide to basal cell carcinoma (BCC) is based on BAD, NICE, and PCDS guidance, which covers risk factors, clinical features, referral criteria, diagnosis and management.

Causes and Risk Factors

BCC is the most common type of skin cancer, accounting for ~70% of all skin cancers.

Key risk factors:

Cumulative lifetime UV exposure – major risk factor
- Sunlight
- Sunbeds
- Artificial UV exposure (e.g. psoriasis management)
Fair-skin type (type 1-2)
Advancing age
Males

Clinical Features

Typical feature of nodular BCC.

Location

Most common in the “mask areas” of the face or “H zone”:

Central face
Peri-orbital region
Nose
Lips
Peri-ocular region
Ears (including post-auricular area)

Appearance

Often raised (can also be flat)
Shiny / translucent (“pearly”)
Rolled edges
Presence of telangiectasia (esp. in the peripheries)
Later features
- Central ulceration
- Increase in irregularity
- Bleeding / crusting possible (a non-healing lesion)

Progression

Slow-growing
Increase by ~2-4 mm per year

Disclaimer:

This section focuses on the classic features of nodular BCC, which is the most common BCC subtype. Other BCC subtypes exist, including superficial, morphoeic (infiltrative), and mixed BCC, but these are omitted here to keep the article focused on high-yield, non-specialist recognition.

Complications

BCC very rarely metastasises (unlike malignant melanoma and squamous cell carcinoma)

BCC mainly causes local tissue invasion and destruction, particularly on the head and neck

Red Flags and When to Refer

Consider routine referral (to dermatology) if there is a suspected basal cell carcinoma skin lesion.

Since BCC is less dangerous, it only warrants routine referral, while malignant melanoma and squamous cell carcinoma warrant suspected cancer pathway referral.

Investigation and Diagnosis

Dermatologists and other skin cancer specialists can usually diagnose BCC clinically without immediately needing a biopsy

Thorough skin examination
Medical photography +/- dermoscopy

Tissue biopsy (most commonly shave or curette biopsy) is NOT strictly mandatory to diagnose BCC, key indications:

Diagnostic uncertainty
High-risk type (based on the size and location)
Suspected recurrence
To confirm histological subtype (e.g. superficial vs infiltrative), which will impact management

Management

1st line treatment: surgical excision

Surgery-sparing options (e.g. patient unfit for surgery, patient declines surgery)

Low-risk BCC: topical 5-fluorouracil / imiquimod, cryosurgery, curettage and cautery, photodynamic therapy
High-risk BCC: radiotherapy (do NOT offer the options for low-risk BCC)

Mohs micrographic surgery may be used for high-risk BCCs (e.g. recurrent lesions or lesions in cosmetically sensitive areas such as the face).

It is a specialised form of surgical excision involving staged removal with immediate microscopic margin assessment.