Basal Cell Carcinoma (Rodent Ulcer or BCC) Explained

What is a Basal Cell Carcinoma?

This is a minor form of skin cancer.

It just sits and spreads slowly on the skin and very rarely spreads to other parts of the body.  If left untreated, however, it will carry on growing in the skin and spread into the tissues under the skin and can therefore become a problem.

Large, untreated BCCs often turn into ulcers, bleed and can get infected.  If they are near a place such as the eye, ear or nose, BCCs can cause a lot of damage, so it is always best to catch them early and treat them while they are still small.

How did I get a BCC?

Most cases are linked to chronic sun exposure over many years.  So they tend to be found on parts of the body which have been exposed to the most sun, namely the face and neck, the back in men who work with their tops off and the lower legs in women.

Those who have fair skin that burns easily, have spent extensive periods of time abroad, or who work outside or pursue many outdoor hobbies, with little in the way of sun protection, are the most at risk.

What does a BCC look like?

There are different types of BCCs.

• Superficial types – these can look like flat, red, scaly patches.
• Nodular types – these are pale pink or red shiny nodules.
• Morphoeic types – these tend to look like scars.
• ‘Rodent ulcer’ types – these are where the BCC turns into an open ulcer, scabs up and then the scab falls off and the BCC becomes an ulcer again.

What are the treatments for BCCs?

There are several:

• Creams – eg Efudix or Imiquimod.
  These are only really suitable for the superficial, minor forms of BCC, after a biopsy has confirmed the position.  Both treatments make the area treated red and sore, so you should expect this.

• Surgery– this can involve:
  • Curettage and cautery – the BCC is scraped away under a local anaesthetic and the base is cauterized (ie burnt).  The process is repeated several times (within the treatment) to ensure it is cleared.
  • Excision – the BCC is cut out under a local anaesthetic and the wound is repaired with stitches.
  • Plastic surgery – for larger BCCs needing flaps or grafts.
  • Moh’s micrographic surgery – this is a specialized form of skin surgery, where the BCC is removed under a local anaesthetic and the skin specimen is examined under a microscope at the time.
    If the BCC is still present at the edges, the process is repeated, until the skin cancer is gone.
    Thist is only performed at a few specialist centres and is reserved for those types of BCCs where the edges cannot be seen clearly, or on difficult areas on the face, where preserving the skin tissue is more of an issue.

•  Radiotherapy – this is reserved for cases where the patient would not tolerate a surgical procedure.  It requires several trips over several weeks, but can be very effective.

What happens afterwards?

Once a BCC has been successfully treated, the outlook is excellent. Usually the BCC usually should not recur.

However, sometimes they can grow back, so it is important that you check your skin regularly for similar growths or lesions, as you are at higher risk of developing another one in the future.

It is also important to use safe protection from the sun.

In some cases and depending on your individual case history, you may need to be seen regularly by your consultant dermatologist.