Basal Cell Carcinoma of the skin

Sinonimi: BCCBasaliomaEpitheliomaNon-melanoma skin cancer

What is skin BCC?

BCC is a kind of skin carcinoma which develops in the epidermis. BCC is the most common carcinoma of the human population, it develops slowly, it’s locally invasive and metastasizes relatively rarely.

BCC on the forehead skin

Dermoscopic finding

How does BCC develop?

Skiin BCC develops from damaging the keratocitnih ćelija on their DNA level. Genetic predisposition and skin damage originating from excessive UV radiation are the two most important reasons for developing skin BCC. This process begins at birth, with the first exposure to the Sun, skin UV radiation damages get accumulated and eventually lead to developing skin BCC.

BCC of nose skin

Dermoscopic finding

What are the first signs of skin BCC?

Appearance of a reddish spot, or a skin lesion like a light or pinkish nodule with a flaking crust are often the first signs that can be noted.

Skin BCC in the form of
a “reddish spot”

Dermoscopic finding

Skin BCC In the form
of a “light nodule with crust”

Dermoscopic finding

Skin BCC in the form
of a “pinkish oval formation
with an elevated ridge”

Dermoscopic finding

Skin BCC in the form of
a “light scar”

Dermoscopic finding

Skin BCC In the form
of a “wound”

Dermoscopic finding

Is there a sex, age or body region specificity?

BCC is a carcinoma that is more common in men than in women, but over the last 20 years that gap seems to be closing. Number of cases involving young people is also increasing. Still, the probability of it occurring is greatest after the age of 50. It’s usually located on Sun exposed regions: face, forehead, hands and back, but BCC can occur on any other skin region of the body.

How dangerous is it?

Skin BCC metastasizes relatively rarely. In comparison to other carcinomas, on any region or organ, skin BCC has arguably the lowest metastatic potential. For that reason, You will often hear the claim, even from doctors that deal with carcinomas, that it’s not dangerous because “it can’t metastasize”. Probability of metastasis is between 0,0028% to 0.5%.. However, with skin BCCs that are not adequately treated, that last for years and slowly grow, the probability of metastasizing grows with their size, so it rises to 2% with skin BCCs greater than 3cm, 25% with skin BCCs greater than 5cm, and to 50% with skin BCCs greater than 10cm in diameter.

Is it curable?

Skin BCC is completely curable in all cases when it’s diagnosed and treated in a timely manner.

Skin BCC risk factors

Anyone can get skin BCC, but persons who are fair skinned, with red hair, that already had intense Sunburn before the age of 20 or have regularly used a sunbed to get a tan are at the greatest risk. More on other risk factors can be seen in the following table.

Risk scale Risk status
High risk factors
  • Intense sunburn before the age of 20
  • Use of sunbeds before the age of 20
  • Previous occurrence of skin BCC
  • Skin BCC in the family
Medium risk factors
  • Intense sunburn after the age of 20
  • Use of sunbeds after the age of 20
  • Long term exposition to arsenic compounds, tars, charcoal
  • PUVA (>=250) treatments for psoriasis and other skin conditions
Moderate risk factors
  • Light- reddish skin complexion
  • Red hair
Minimal risk factors
  • Children under the age of 10
  • Persons with skin phototype 5 and 6
Table: Skin BCC risk factors


Primary Prevention

Protection from all sources of excessive UV radiation presents primary prevention. The principal source of UV radiation is the Sun, and next to it are sunbeds and different UV lamps. Basic danger that UV radiation poses is damaging the skin and with it, the melanocytic cells, which can cause the development of skin BCC, but other skin lesions whether they are benign or malignant.

Table: Basic measures of protection from the Sun
Avoid Sun exposure between the hours of 10am and 4pm There’s elevated UV radiation between April and October each year in Serbia
Use shade as a natural protection Bear in mind that parasols are not always adequate protection, especially not next to large reflective surfaces like water and sand
Protect Your head with a hat or a cap The larger the rim, the better the protection
Use sleeved garment for body protection Even the lightest of clothes are usefull
Protect Sun exposed regions by SPF 15 or higher sunblock creams Sunblocks with an SPF (SPF – sun protection factor) should be applied every 2 to 3 hours, and always after swimming
Do not use sunbeds as skin preparation for vacation Tan that You get in a sunbed is not adequate Sun protection of the skin
Special measures of protection for small children Babies up to the age of 1 should not be exposed to the sun in the period between 10am and 4pm

Other measures of primary prevention entail protection of workers that are exposed to charcoal, tars or arsenic compounds daily, as well as control of PUVA therapy usage.

Secondary prevention and screening

Early detection of skin BCC is considered to be secondary prevention. Skin selfexamination and spotting the first signs of skin BCC are the forefront of secondary prevention. Permanent education of the population in conducting these measures presents, before all, a task for health and education management and public media.

BCC screening would include a wholesome examination of the skin, for all persons with high skin BCC risk factors, and due to a disproportional number of persons to be examined, it is obviously impossible to perform for now.

Early diagnostics

Digital dermoscopy provides a very reliable early diagnostic tool for skin BCC. It can be used to detect first suspicious signs that can’t be detected by eye or other forms of clinical detection.

Dermoscopic signs that point to a skin BCC are: arborisation, leaf-like regions, large blue-gray oval formations, multiple blue-gray globules and spokes on the wheel .

Blood vessels like a branched tree

Leaf-like region
Isolated region of blue-gray color

Large blue-gray oval formations
Big blue oval shapes

Multiple blue-gray globules
Small blue-gray oval shapes

Spokes on a wheel
Light brown shapes with a dark colored center

When we diagnose a skin BCC, by adequately removing it, we provide a COMPLETE RECOVERY. Other than just being able to diagnose early BCC, by digital dermoscopy we can even identify the changes that precede the development of BCC.

How is skin BCC treated?

There is a large number of different successful treatments for skin BCC. Essentially, these are surgical and non-surgical treatments.

Surgical treatments

  • Excision
  • Destruction
    • Curettage
    • Electro-surgery
    • Cryosurgery
    • Laser surgery

Non-surgical treatments

  • Immunosuppressive creams
  • Photodynamic therapy
  • Radiotherapy

Surgical removal by excision is the main way to remove skin BCC. Other techniques are used only in cases where surgical excision is unavailable for any reason. These reasons can range from heatlh to esthetic ones. Over the last few years, lasers are being used more and more in the removal of skin BCCs, but that still doesn’t exclude the use of cryosurgery and immunosuppressive creams, such as Imiquimod.

Skin BCC excision: This excision is also called a radical excision.

Skin BCC before surgery

Excision plan

Defect after the excision

Wound closure by a local flap

This kind of surgical intervention is done under local anesthesia in most cases.

When there is a need for more extensive removal, it is done under general anesthesia.

Skin BCC removal by lasers

Skin BCC before surgery

Dermoscopic finding

Result after 6 months

Dermoscopic finding of a complete tumor removal

We use 2 types of lasers for skin BCC removal: Nd Yag 1064 and a CO2 laser.

Skin BCC laser treatment is done under local anesthesia by using an anesthetic cream, and it usually takes between 2 and 3 treatments, spaced over 4 to 8 weeks.

How to live with skin BCC?

Everyone reacts differently to a skin BCC diagnosis. Reactions range in the spectrum from complete belittling of the illness, over different reactions of fear, to shock and isolation. However, luckily most of the patients realistically accept the fact that it’s a skin carcinoma which carries low risk of metastasizing, and that by adequately removing it , they are cured for life.

Stress management

In case of persisting chronic stress, look for professional help, and You are always welcome to look at our stress management advice.


After receiving the histopathological diagnosis, we recommend a detailed skin examination to be done, from head to toe, for further adequate follow ups. Unless there are any other “risky” lesions on the skin, we recommend a regular dermoscopic follow up once a year.

Skin monitoring

Regular monthly skin selfexaminations are recommended to all pesons with skin tumors, and more details on skin monitoring can be seen in the skin and mole monitoring section.


Number of cases of skin BCC is not really known. In our cancer registry for Central Serbia, all non-melanoma skin carcinomas are registered together, as “other”. Based on those numbers (and on the basis of a known fact that at least 80% of all skin carcinomas are skin BCCs), we can easily conclude that in Central Serbia alone, several thousand new cases are registered each year. (Table 1). If You consider the fact that many cases of BCCs are not properly registered, because they are treated with cryotherapy (nitrogen) and there is no histopathological confirmation, we come to a conclusion that the probable number of cases is far greater than 5000.

Skin BCC mortality is also not known. Number of deaths associated with “other” skin carcinomas, of which 80% are skin BCCs, is over a 100 a year. (Table 2.) .

Year Women Men Total
2002 1052 1259 2311
2003 1138 1316 2454
2004 1365 1408 2773
2006 1663 1731 3394
Table 1: Incidence Of Other Malignant Skin Tumors In Central Serbia
Year Women Men Total
2002 68 48 116
2003 37 49 86
2004 45 64 110
2006 45 57 102
Table 2: Mortality From Other Malignant Skin Carcinomas In Central Serbia

These indicators point to the fact that measures of primary prevention, screening and early diagnostics are of key importance for a successful fight against all skin carcinomas.

Frequently asked questions

Is skin BCC the most common carcinoma of the human population?

YES. From the total number of newly discovered carcinomas of all kinds, over 50% belongs to BCC.

What are the first signs that can be spotted with developing BCC?

A new, pinkish spot, crust or a wound that doesn’t heal.

What needs to be done when there is a suspicion to a potential BCC lesion?

Contact Your physician or go to a nearest specialized skin tumor facility.

Is BCC curable?

YES. In all cases when it’s diagnosed early enough and adequately treated.

How is BCC diagnosed?

Dermoscopically. Dermoscopy presents the most successful diagnostics.

What is the basic principle of BCC treatment?

Surgical excision. Radical or adequate removal presents the basic principle for a successful treatment.

Can BCC be successfully treated without a surgical excision?

YES. In all cases of early skin BCC, as well as in all cases when there is no indication for an excision, possible treatments are by Lasers, Nitrogen, Electrosurgery, and Immunosuppressive creams.

Is there a possibility for skin BCC prevention?

YES. These are the measures of primary prevention from getting skin UV radiation damage in persons with risk factors.