Spring is here, and that means increased sun exposure! Here in the UK we get very excited when the sun comes out, as it's so very rare, but before we shed our jeans and jumpers for skirts and flip flops, I'd like to help by hopefully, saving a few people from developing skin cancer. I’m going to go in gently here by first discussing the ‘least’ life-threatening form of skin cancer - Basal Cell Carcinoma.  (BCC) is the most common form of skin cancer—and the most common cancer overall—affecting millions of people worldwide each year. While rarely life-threatening, this slow-growing cancer deserves serious attention due to its potential to cause significant local damage if left untreated. This comprehensive guide covers everything you need to know about basal cell carcinoma, from risk factors and prevention to detection and treatment options.

 

What is Basal Cell Carcinoma?

Basal cell carcinoma begins in the basal cells—a type of cell within the skin that produces new skin cells as old ones die off. Located in the lowest layer of the epidermis (the outer layer of skin), these cells can become cancerous due to DNA damage, primarily from ultraviolet (UV) radiation exposure.

Unlike more aggressive skin cancers such as squamous cell carcinoma and melanoma, BCC rarely spreads (metastasizes) to distant parts of the body. However, if left untreated, it can grow deep into the skin and even into surrounding tissues, including bone, causing significant damage and disfigurement. Not ideal!

 

How to Spot Basal Cell Carcinoma

Like many cancers, early detection is crucial for successful treatment. BCC can appear in various forms, but common signs include changes in moles, marks or areas of skin:

 

The ABCDE Rule for Skin Changes

While the ABCDE rule is typically associated with melanoma, it can help identify suspicious skin changes that warrant medical attention. The below guide is a good start when looking at a ‘mole,’ but something important to note is that BCC may not necessarily look like a mole to begin with. More on that shortly.

 

Mole or mark checks:

• Asymmetry: One half doesn't match the other half
• Border irregularity: Edges are ragged, notched, or blurred
• Color variation: Multiple colours within the same growth
• Diameter: Larger than 6mm (about the size of a pencil eraser), though BCCs can be smaller
• Evolving: Changes in size, shape, colour, or new symptoms like itching or bleeding

Specific BCC Warning Signs

So as mentioned above and as you can see from the images, basal cell carcinoma can present in many different ways, and the lesion doesn't have to start within a mole:

• A pearly or waxy bump, often with visible blood vessels (telangiectasias)
• A flat, flesh-coloured or brown scar-like lesion
• A bleeding or scabbing sore that heals and returns (this is common)
• A pink growth with a slightly elevated, rolled border and a crusted indentation in the center
• A shiny bump that might be pink, red, white, tan, black, or brown
• An itchy area of skin, that seems to go away, only to keep returning

Any skin abnormality that persists, grows, bleeds easily, or doesn't heal properly warrants medical attention.

 

Risk Factors for Basal Cell Carcinoma

Understanding your risk factors can help you take appropriate preventive measures. The last thing I want to do is scare you (or ruin your fun for that matter), but the higher your risk factors, the more aware you need to be.

 

Sun Exposure

UV radiation from the sun is the primary cause of BCC. Those with a history of the following are at increased risk.

• Frequent sunburns, especially in childhood (that's all of us!)
• Prolonged sun exposure over years
• Regular tanning bed use (please don’t tell me any of you still use these!)
• Living in sunny or high-altitude climates

Skin Type

People with fair skin characteristics have heightened vulnerability, including:

• Fair or light-colored skin that burns easily
• Blue, green, or grey eyes
• Blonde or red hair
• Freckles or many moles

However, people of all skin tones can develop BCC.

 

Age and Gender

BCC risk increases with age, with most cases diagnosed in people over 50. Men have historically had higher rates than women, though this gap is narrowing as lifestyle patterns change.

 

Hereditary Factors

While BCC isn't directly inherited in most cases, certain genetic factors influence risk:

• Family history: Having close relatives with skin cancer increases your risk, suggesting shared genetic susceptibility factors.
• Genetic syndromes: Rare conditions like Gorlin syndrome (nevoid basal cell carcinoma syndrome) and xeroderma pigmentosum dramatically increase BCC risk.
• Inherited skin types: Fair skin characteristics that increase sun sensitivity often run in families.

Most cases of BCC result from a combination of genetic predisposition and environmental exposure rather than a single inherited gene.

 

Medical Factors

There are also certain medical conditions and treatments that can increase risk:

• Immunosuppressive medications (used after organ transplants)
• Radiation therapy
• Long-term exposure to arsenic (sadly this can still be an issue for people working in certain industries such as electronics and glass manufacturing as well as mining and copper smelting. It can also be present in contaminated drinking water in some countries)
• Certain inflammatory skin conditions 

Personal History

If you've had one BCC, then unfortunately you have a significantly higher chance of developing another within five years – so if this is you, ensure to do your skin checks regularly.

 

How Basal Cell Carcinoma Develops and Progresses

BCC develops through a multi-stage process:

1. Initiation: UV radiation damages DNA in basal cells, particularly the tumor suppressor gene called PTCH1. If you need another reason to stay away from retinol, which can increase the skin’s sensitivity to UV radiation by 20-30%, and up to a week ‘after’ application, then this is it!
2. Promotion: Additional UV exposure and other factors promote the growth of abnormal cells.
3. Progression: The damaged cells multiply uncontrollably, forming a tumor.

Initial growth is typically slow—a BCC might take months or years to become noticeable. Most BCCs grow locally and rarely metastasize. However, without treatment, they continue to enlarge and can eventually invade surrounding tissues. Trust me, I’ve had one on the back of my neck, and what I thought was a weird patch of eczema, needed 10 stitches to close!

 

Consequences of Untreated BCC

If left untreated, BCC can cause:

• Local tissue destruction
• Disfigurement, especially on the face
• Invasion of nearby structures, including nerves, cartilage, and bone
• Impairment of vital functions if near the eyes, ears, nose, or mouth
• Rarely, metastasis to lymph nodes or distant organs (occurs in less than 0.1% of cases but is more likely with large, long-standing tumours)

Prevention Strategies

Many cases of BCC can be prevented with proper sun protection and skin care:

 

Sun Protection

• Apply broad-spectrum, water-resistant sunscreen with SPF 30+ daily, even on cloudy days. If on holiday, or in sunnier climates, ramp this up to SPF50.
• Reapply sunscreen every two hours, or after swimming or sweating. I know hardly anyone does this, but please do, it makes a huge difference.
• Seek shade, especially between 10 AM and 4 PM
• Wear protective clothing, including wide-brimmed hats, long sleeves, and UV-blocking sunglasses. This is especially important if you want to avoid skin cancer on your scalp. Hair can make it very difficult to spot, and the consequences of going under the knife, far outweigh the hassle of wearing a hat!
• Consider UV-protective clothing with a high UPF (ultraviolet protection factor) rating

Avoid Artificial UV Sources

• Never use tanning beds or sunlamps
• Be cautious with nail-curing UV lamps, using protective gloves or sunscreen. If you can, go to salons that use LED rather than UV.

Regular Skin Checks

• Perform monthly self-examinations to note any changes. A good way to do this yourself at home is to ask a partner or family member to draw around any suspect moles or skin areas, and to take close-up photographs of them. Most of us have iPhones now and their zoom capabilities are more than adequate for this task. Repeat this exercise the following month and compare the photos for any signs of change. If something doesn’t look right, go to your GP, show them the affected area, AND the photographs.
• If you can, see a dermatologist for annual professional skin examinations, especially if you have risk factors. They can perform digital mole mapping which is incredibly accurate, and if anything looks suspect, they can do a biopsy.

Lifestyle Factors for Skin Health

• Maintain a balanced diet rich in antioxidants (fruits, vegetables)
• Stay hydrated
• Avoid smoking, which damages skin cells
• Limit alcohol consumption
• Get adequate sleep to support skin repair

The NHS Two-Week Rule for Dermatology Referrals

In the UK, the National Health Service (NHS) has implemented a "Two-Week Wait" rule for suspected cancer referrals, including skin cancers. This initiative aims to ensure that patients with suspected cancer see a specialist within two weeks of GP referral.

 

When the Two-Week Rule Applies

Your GP should refer you under this pathway if they suspect your skin lesion might be cancerous, based on:

• Appearance consistent with skin cancer
• Recent changes to an existing mole or lesion
• New, rapidly growing lesions
• Lesions that bleed without trauma, don't heal, or cause pain

What to Expect

• Your GP will complete an urgent referral form
• You should receive an appointment within two weeks
• At the specialist appointment, a dermatologist will examine the concerning area and may perform a biopsy
• The clinic may use dermoscopy (specialised skin microscopy) to examine the lesion in detail

Important Notes

If you are referred, please don’t panic, as the two-week pathway does not guarantee a cancer diagnosis, and many referred lesions turn out to be benign. If your symptoms worsen while waiting for your appointment, contact your GP again.

 

Treatment Options for Basal Cell Carcinoma

Treatment choice depends on the tumour's size, location, type, and your overall health. Common options include:

 

Surgical Treatments

• Excisional surgery: The tumor and a margin of healthy skin are removed; the sample is examined to ensure complete removal.
• Mohs surgery: Tissue is removed layer by layer and examined during the procedure until no cancer cells remain. This technique spares the most healthy tissue and is ideal for cosmetically sensitive areas.
• Curettage and electrodessication: The tumor is scraped away, and the base is treated with an electric needle to destroy remaining cancer cells. This is repeated several times during the same session.

Non-Surgical Options

• Cryotherapy: Freezing the tumor with liquid nitrogen.
• Photodynamic therapy: Application of a light-sensitive medication followed by exposure to a specific wavelength of light.
• Topical treatments: Medications like imiquimod or 5-fluorouracil (5-FU) applied directly to the skin for several weeks.
• Radiation therapy: Primarily used for older patients or when surgery isn't possible.
• Oral medications: For advanced or multiple BCCs, targeted drugs like vismodegib or sonidegib may be prescribed.

Living with Increased Risk

If you've had basal cell carcinoma you're at a higher risk for developing additional skin cancers, so try and integrate these practices into your lifestyle for preventative measures:

• Rigorous sun protection
• Regular dermatology check-ups (typically every 6-12 months)
• Prompt investigation of new skin changes
• Possible prophylactic treatments for high-risk individuals

Remember that early detection typically leads to simpler treatment and better outcomes, so don’t feel like you’re putting anyone out by seeking advice from your doctor. It’s what they’re there for!

 

So, sadly for all those sun worshipping iguanas out there, the days of cooking your skin on a sun-lounger are over!! Find a quality Vitamin D3 supplement to ensure your hormones work efficiently, and a good natural fake-tan. Nobody will know the difference, and you’ll stay healthier, for longer!

 

Until next time….

 

(Photographs courtesy of The American Cancer Society and The Skin Cancer Foundation)