Basal cell carcinoma

Last reviewed: 4 Jun 2022
Last updated: 26 May 2022

Summary

Definition

History and exam

Key diagnostic factors

  • papules with associated telangiectasias
  • plaques, nodules, and tumors with rolled borders
  • small crusts and nonhealing wounds
  • nonhealing scabs
  • pearly papules and/or plaques
More key diagnostic factors

Other diagnostic factors

  • metastases associated with large or neglected BCC
  • local destruction with advanced lesion
Other diagnostic factors

Risk factors

  • Ultraviolet (UV) radiation
  • sun exposure
  • x-ray exposure
  • arsenic exposure
  • aberrant hedgehog signaling pathway
  • xeroderma pigmentosum
  • nevoid basal cell carcinoma (Gorlin-Goltz) syndrome
  • history of non-melanona skin cancer
  • childhood cancer survivors
  • transplant patients
More risk factors

Diagnostic investigations

1st investigations to order

  • biopsy for dermatohistopathology
More 1st investigations to order

Emerging tests

  • in vivo multiphoton microscopy

Treatment algorithm

INITIAL

nevoid basal cell carcinoma (Gorlin-Goltz) syndrome

ACUTE

low-risk subtype in noncosmetically challenging location

low-risk subtype in cosmetically challenging location

high-risk subtype

ONGOING

positive margins on initial procedure

complicated BCC recurrences and/or site not accessible to surgical and topical therapies

advanced disease

Contributors

Authors

Robert A. Schwartz, MD, MPH, FAAD, FRCP (Edin)
Robert A. Schwartz

Professor & Head

Dermatology

Rutgers University New Jersey Medical School

Newark

NJ

Honorary Professor

China Medical University

Shenyang

China

Honorary Professor

Sree Balaji Medical College

Bharath University

Chennai

India

Disclosures

RAS declares that he has no competing interests. RAS is an author of a number of references cited in this topic.

Acknowledgements

Professor Robert A. Schwartz would like to gratefully acknowledge Dr James R. DeBloom and Dr Drazen Jukic, the previous contributors to this topic.

Disclosures

JRD and DJ declare that they have no competing interests.

Peer reviewers

Richard Bull, BMBCh

Consultant Dermatologist

Homerton University Hospital NHS Foundation Trust

London

UK

Disclosures

RB declares that he has no competing interests.

David Cassarino, MD, PhD

Assistant Professor

Department of Pathology and Laboratory Medicine

University of California

Los Angeles

CA

Disclosures

DC declares that he has no competing interests.

  • Basal cell carcinoma images
  • Differentials

    • Microcystic adnexal carcinoma
    • Trichoepithelioma/trichoblastoma
    • Merkel cell carcinoma
    More Differentials
  • Guidelines

    • NCCN clinical practice guidelines in oncology: basal cell skin cancer
    • Guidelines for the management of basal cell carcinoma
    More Guidelines
  • Patient leaflets

    Staying safe in the sun

    Basal cell carcinoma

    More Patient leaflets
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer