Basal Cell Carcinoma (BCC/Rodent Ulcer)

Basal Cell Carcinoma also known as BCC and ‘Rodent Ulcer’  is the most common form of skin cancer in the UK and is responsible for about 75% of all skin cancer cases. . Approximately 100,000 new cases of Basal Cell Carcinoma are diagnosed each year in the UK. There are two main categories of skin cancer: melanoma and non-melanoma skin cancer. Basal Cell Carcinoma is a non-melanoma skin cancer.

What causes Basal Cell Carcinoma?

The commonest cause of a Basal Cell Carcinoma is too much exposure to ultraviolet (UV) light from the sun or from sun beds. Basal Cell Carcinomas can occur anywhere on the body but are most common on areas that are exposed to the sun, such as the face, head, neck, and ears.
Basal Cell Carcinomas mainly affect fair skinned adults and are more common in men than women. Those with the highest risk of developing a Basal Cell Carcinoma are fair skin people who have had a lot of sun exposure. As people in the UK are living longer, alongside environmental changes,  the incidence of Basal Cell Carcinoma is increasing.

 There are several different types of Basal Cell Carcinoma, which can have an impact upon what they look like and how they are treated.

 Some of the different types of basal cell carcinoma:

• Superficial – This type may be suitable for treatment with a topical cream.
• Nodular- This is the most common type of basal cell carcinoma.
• Micronodular
• Morphoeic
• Pigmented

What are the symptoms of Basal Cell Carcinomas?

There may be no symptoms of Basal Cell Carcinoma at all , however, probably the most common symptom is of a scab that bleeds occasionally but never fully heals. Basal Cell Carcinomas frequently go through this cycle of ulcerating, temporarily healing over, but then ulcerating again. The name ‘rodent ulcer’ comes from this tendency to ulcerate.

How will my Basal Cell Carcinoma be diagnosed?

The majority of Basal Cell Carcinomas can be diagnosed from their history and appearance by a skin expert.  Dermatologists and Plastic Surgeons are two types of specialist doctor that frequently diagnose and treat Basal Cell Carcinomas. During an examination by a skin expert, your lesion will be closely examined under magnification and the specialist will look for features that help to make the diagnosis. If there is any doubt about the diagnosis, the dermatologist or plastic surgeon may recommend a biopsy is taken. During a biopsy a small section of skin is removed under a local anaesthetic and sent to the lab for analysis. The results from this analysis should be able to conclusively diagnose the skin lesion. Once the diagnosis is made, the specialist will be able to advise you on the best treatment.

How will my Basal Cell Carcinoma be treated?

The majority of Basal Cell Carcinomas are treated by surgical removal. The vast majority of Basal Cell Carcinoma removal is carried out under a local anaesthetic and as an out-patient. During a local anaesthetic procedure, the area is skin is made numb through an injection of local anaesthetic into the skin next to and around the area to be removed. Once the area is insensate, the basal cell carcinoma is removed and the defect that is created from doing so is then repaired.

Depending upon the size  and location of the basal cell carcinoma, this repair may be simple, or require reconstruction through plastic surgery techniques (see below)

There are two main methods of surgical removal that are influenced by the type of Basal Cell Carcinoma and where it is on the body. These differing techniques are called:

1)     Surgical excision with pre-determined margins and

2)     Mohs surgery.

Before the treatment happens, the specialist will discuss these options with, along with the advantages and disadvantages of each. In general terms, Mohs surgery is usually reserved for specific circumstances and most Basal Cell Carcinomas are removed through surgical excision with pre-determined margins.

Will I need a skin graft?

When a Basal Cell Carcinoma is removed it is important to make sure that it is completely removed so that the risk of it returning is reduced. Since they tend to have ‘roots’ that spread beneath the surface of the skin, a wider margin of skin needs to be taken away, beyond what looks abnormal from the surface. For this reason, it may be necessary to undertake some form of reconstruction involving plastic surgery. Typically, this will either be a skin graft or a local rearrangement of skin in the adjacent area (a local flap reconstruction).

The below images (left to right) show the area to be removed along with the planned local flap to be utilised:

Can Basal Cell Carcinomas be cured?

Basal Cell Carcinomas are generally readily treated and cured through surgical removal. As with all forms of skin cancer, treatment is more successful, the sooner the problem is identified. Basal Cell Carcinomas very rarely spread to other parts of the body which makes them a much easier form of skin cancer to treat.