Basal Cell Carcinoma

What is a Basal Cell Carcinoma (BCC)??

BCC is the most common type of non-melanoma skin cancer. It usually appears as a pearly or waxy bump, flat lesion, or ulcer that doesn’t heal — most commonly on sun-exposed areas such as the face, scalp, or neck.

BCCs grow slowly and rarely spread, but can become locally invasive if left untreated.

When Should I Seek Treatment?

If you have a lesion that is growing, bleeding, crusting, or changing shape

Any non-healing sore or persistent scab on sun-exposed skin

If referred by your GP or dermatologist following skin assessment or biopsy

What is the NHS Criteria for this procedure?

Basal cell carcinoma: *NO prior approval needed*

You can refer both low risk (below clavicle) and High Risk bcc to Deeping Surgical

Criteria for Low Risk BCC: *NO prior approval needed*

The BCC is singular, primary, nodular BCCs, <1cm and below the clavicle.

The patient is not:
- Aged 24 years or younger (that is, a child or young adult)
- Immunosuppressed or has Gorlin syndrome
The lesion:
- Is located below the clavicle (that is, not on the head or neck)
- Is 1 cm clinical diameter or less with clearly defined margins
- Is not a recurrent BCC following incomplete excision
- Is not a persistent BCC that has been incompletely excised according to histology
- Is not morphoeic, infiltrative or basosquamous in appearance and is not located:
  - Over important underlying anatomical structures (for example, major vessels or nerves)
  - In an area where primary surgical closure may be difficult (for example, digits or front of shin)
  - In an area where difficult excision may lead to a poor cosmetic result
  - At another highly visible anatomical site (for example, anterior chest
    
    or shoulders) where a good cosmetic result is important to the patient

Criteria for High Risk BCC *NO prior approval needed*

High risk BCC lesions will only be seen at Deeping Surgical where the patient meets any of the following criteria:

The patient is aged 24 years and older
Trunk and Limbs (excluding hands, ankles, feet, genitals, and pre-tibia area) – Is

more than 1cm but not larger than 2.5cm clinical diameter
Ears, nose, periorbital, jawline, perioral and chin – Is up to 1cm clinical diameter
Cheeks, forehead, scalp and neck – Is up to 1cm clinical diameter
Clearly or unclearly defined borders/margins
Primary and Recurrent lesion
Immunosuppressed, or have Gorlin Syndrome or on the site of prior Radiotherapy
Adjacent to major nerves / vessels to be considered

Can It Be Treated Without Surgery?

No, surgical excision is the most effective treatment for most BCCs. Other options (e.g. creams, cryotherapy, or radiotherapy) may be used for superficial or inoperable cases, but excision offers the highest cure rate.

What Happens During Surgery?

Performed under local anaesthetic, a margin of healthy skin around the tumour is removed to ensure complete clearance. The wound is closed with sutures and sent for histology (microscopic analysis).

What to Expect Before and After Surgery

Consultation and discussion of scar placement and closure options

Procedure takes 30–60 minutes

Results from histology typically available within 1–2 weeks

Stitches may be removed after 7–14 days; aftercare advice is provided

What Are the Risks?

Scarring (we use cosmetic techniques to minimise this)

Infection

Bleeding or bruising

Rare: incomplete excision (may need re-excision)

How Do I Prepare?

Patients Asking a doctor Questions _edit

Frequently Asked Questions

Q: Is it cancer?
A: BCC is a form of skin cancer but is not life-threatening and rarely spreads. Early treatment is very effective.

Q: Will it come back?
A: Once completely removed, recurrence is unlikely — though new BCCs can occur elsewhere on sun-damaged skin.