Basal Cell Carcinoma (BCC) – Consultant Skin Cancer Diagnosis & Treatment in London

What Is Basal Cell Carcinoma?

Basal cell carcinoma (BCC) is a skin cancer that arises from basal cells in the outer layer of the skin (epidermis). Unlike melanoma, BCC almost never spreads to distant organs. Its challenge is local destruction: the tumour grows slowly but steadily and can erode skin, cartilage and bone if ignored. Because most BCCs sit on sun-exposed sites—nose, cheeks, eyelids, ears, scalp, neck and shoulders—timely diagnosis protects both function and appearance.

There are several growth patterns. Knowing which type you have helps us choose the most effective, tissue-sparing treatment.

Common Clinical Types

Nodular BCC

The classic “pearly” bump with fine surface vessels (telangiectasia). It may ulcerate in the centre and bleed after minor trauma (“rodent ulcer”). Typically on the face, particularly the nose.

Superficial BCC

Appears as a thin, pink or red scaly patch or plaque with a subtle, slightly rolled edge; often on trunk and shoulders. Multiple lesions can occur. These respond well to certain non-surgical options when appropriately selected.

Infiltrative / Morphoeic (Sclerosing) BCC

Looks like a scar-like, ivory or firm patch with poorly defined edges. It can send microscopic strands beyond what is visible, so margin-controlled surgery is often preferred.

Micronodular BCC

Made of tiny nodules that can extend more widely under the surface than expected. Because edges are harder to judge, it is treated as higher risk for recurrence with simple curettage.

Pigmented BCC

Contains brown, blue, or black pigment. More common in medium to deep skin tones and can be mistaken for a mole or melanoma; dermoscopy helps us tell them apart.

Basosquamous Carcinoma

A rarer variant with features of both BCC and squamous cell carcinoma; managed more aggressively and usually with surgical excision and close follow-up.

Who Is at Risk of Basal Cell Carcinoma?

• Sun exposure: lifelong ultraviolet (UV) exposure is the main driver. Outdoor work or hobbies, and sun holidays without protection, add up over time.
• Skin type: fair or freckle-prone skin, light eyes or hair. BCC still occurs in every skin tone, but may present as pigmented lesions in darker skin.
• Sunbeds: artificial UV is a significant risk.
• Age and sex: risk rises with age; historically more common in men due to outdoor exposure, though patterns are levelling with lifestyle.
• Immunosuppression: medicines after organ transplant or for autoimmune disease increase risk.
• Radiation/arsenic scarring: previous radiotherapy fields or chronic arsenic exposure (rare) predispose to BCC.
• Genetic syndromes: e.g., Gorlin syndrome (basal cell naevus syndrome) causes multiple BCCs at a young age.

Signs to Watch For

• A pearly, translucent bump with fine red vessels that bleeds or crusts and doesn’t heal.
• A scaly pink patch that slowly enlarges over months, sometimes with a thin rolled border.
• A scar-like, firm area that seems to broaden with time (especially on the mid-face).
• A brown/black lesion that is shiny with a slight raised edge (pigmented BCC).

Any new, changing or non-healing skin lesion should be assessed—especially on the face, ears or scalp.

Diagnosis at Skinhorizon

We begin with a focused history (onset, growth, bleeding, prior treatment, sun exposure) and a careful examination with dermoscopy (a magnified, polarised light tool). Dermoscopy shows predictable structures—arborising vessels, shiny white lines, leaf-like areas—that help differentiate BCC from mimics.

When the appearance is unequivocal and the lesion is suitable for straightforward treatment, we may proceed directly to excision. In other cases we perform a biopsy (usually a small, local anaesthetic sample) to confirm the subtype before planning management. For suspected high-risk subtypes (infiltrative/morphoeic, micronodular) or lesions in critical sites, we discuss tissue-sparing options and, where appropriate, referral for Mohs micrographic surgery (margin-controlled excision performed in stages with immediate microscopic assessment).

Treatment Options

The best treatment depends on size, site, subtype, your general health and your preference. We explain benefits, expected cure rates, likely scars and downtime so you can decide confidently.

Surgical Excision

Standard treatment for many BCCs. Under local anaesthetic, the tumour is removed with a cuff of normal skin and the wound is closed with fine stitches. Cure rates are high when appropriate margins are taken. We plan incisions along natural lines to minimise scarring. Pathology confirms that margins are clear.

Mohs Micrographic Surgery (Referral When Indicated)

For high-risk sites (nose, eyelids, lips, ears), recurrent tumours or aggressive histology, Mohs offers the highest cure rates while sparing healthy tissue. Tissue is checked immediately under the microscope and additional layers are removed only where tumour remains. If your BCC meets criteria, we will discuss referral pathways and subsequent reconstruction options.

Curettage & Cautery (C&C)

Scraping the tumour then sealing the bed with heat. Suitable for selected small, low-risk lesions on non-critical sites (e.g., upper trunk). Healing is by a flat, paler patch rather than a line scar. Not recommended for infiltrative or poorly defined BCCs.

Cryotherapy

Freezing can be used in limited circumstances for small, superficial lesions but requires expertise to balance clearance with cosmetic outcome. Post-treatment lightening of the skin can occur.

Topical Treatments (for Superficial BCC)

Imiquimod 5% cream (immune-stimulating) or 5-fluorouracil (5-FU) (chemotherapeutic) can clear appropriately selected superficial BCCs. Courses last several weeks and cause predictable redness and crusting as the lesion responds. We select patients and sites carefully and provide clear, step-by-step guidance.

Photodynamic Therapy (PDT)

A light-activated treatment after applying a photosensitising cream to the tumour. Effective for superficial BCC with good cosmetic outcomes. You’ll need to protect the area from bright light for a short period afterwards.

Radiotherapy

Useful when surgery is not appropriate or as an adjunct for complex cases. It achieves good control but may have longer-term skin changes; we weigh pros and cons carefully.

Systemic Options

For rare advanced or multiple tumours where surgery/radiotherapy aren’t suitable, oral medicines that block the hedgehog signalling pathway can shrink BCCs. These require specialist oversight and specific safety monitoring.

Cosmetic Outcome & Scars

Any treatment leaves a mark. Our aim is a neat, durable result that blends with surrounding skin. For excision, scar placement follows relaxed skin tension lines; stitches are fine and timed by site. For non-surgical treatments, we set expectations about temporary redness and crusting. We provide scar care advice (sun protection, wound care, silicone options where helpful) and schedule review to ensure healing stays on course.

Recurrence & Follow-Up

Most BCCs are cured with appropriate first-line treatment. A small proportion recur, usually in the first few years. You are also at risk of developing new BCCs in the future, especially if you have ongoing sun exposure or other risk factors. We agree a follow-up schedule proportionate to your risk and provide a simple self-check routine so you can spot changes early.

Skin of Colour

BCC occurs in all skin tones. It may be pigmented and mistaken for a benign mole in medium to deep skin. Because redness is less obvious, we emphasise texture change, a shiny surface, rolled borders, and the history of a “sore that won’t heal”. Dermoscopy is particularly helpful for accurate diagnosis and to avoid unnecessary large excisions.

When to Seek Prompt Assessment

• A new lesion that bleeds or crusts and does not heal within 6–8 weeks.
• A slowly enlarging shiny bump, scaly patch or scar-like area—especially on the face, scalp or ears.
• A previously treated site that becomes tender, shiny or starts to break down again.

These features are typical of BCC and deserve timely review. Earlier treatment means smaller procedures and better cosmetic outcomes.

Prevention & Everyday Protection

• Sun-smart habits: shade between 11am and 3pm, hats, UV-protective clothing.
• Daily sunscreen: broad-spectrum SPF 30+ on exposed skin; reapply with outdoor activity.
• Avoid sunbeds: artificial UV adds risk without benefit.
• Skin checks: once a month, look for non-healing sores or new shiny lesions; ask a partner to check your back and scalp.

Why Choose Skinhorizon?

We provide high-quality advanced dermatology with consultant oversight. Our BCC care is meticulous: rapid dermoscopic assessment, proportionate biopsy, and a treatment plan matched to subtype and site to maximise cure while minimising scarring. Where margin-controlled surgery is indicated, we will discuss referral options and coordinate reconstruction planning. You’ll receive clear aftercare, safety-net advice and straightforward follow-up.

Your First Visit — What to Expect

1. Assessment: history, dermoscopic examination, clinical photography where helpful.
2. Diagnosis: immediate plan for biopsy or treatment based on clinical confidence and tumour features.
3. Treatment discussion: excision versus non-surgical options; cure rates, scarring, downtime and aftercare.
4. Procedure (if suitable): local anaesthetic treatment with fine sutures, or scheduling/referral for the most appropriate technique.
5. Follow-up: pathology review, wound care support and a sensible skin-check schedule.