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BCC’s – Basal Cell Cancers

Basal cell cancers or BCCs are the most common form of skin cancer in Australia – one in three Queenslanders will have a BCC before the age of 60. Due to the high UV index in Brisbane, BCCs are more common here than in Sydney or Melbourne. BCCs can present as red scaly patches, or non-healing lumps and bumps. BCCs can be treated with either surgery or with a special non-surgical treatment called photodynamic therapy (PDT). Skin cancer doctors only recommend PDT for the treatment of superficial or thin cancers.

Important facts on BCCs

  • BCCs are the most common skin cancer in Queensland
  • They are also referred to as rodent ulcers
  • BCCs can present as red persistent patches or non-healing areas on the skin
  • Basal cell cancers can be treated by surgery, photodynamic therapy, creams, or radiotherapy
  • If treated correctly, BCCs have cure rates approaching 99.5%
  • BCCs unlike melanomas or squamous cell cancers are not life threatening
  • Thin BCCs on cosmetically sensitive areas such as the face and chest are best treated with PDT
  • Suitable BCCs on the legs can also be treated with PDT

What are the risk factors For BCCs?

bcc risksIndividuals with fair skin, blonde or red hair and blue or green eyes are most at risk for developing BCCs.

Factors that increase your risk for BCC include frequent sun exposure / tanning bed use and repeated sunburns.


What does a basal cell cancer look like?

basal cell cancers

 BCC occur most often on areas of the body that are frequently exposed to the sun such as the face, head/scalp, neck and hands.They often grow slowly over time and range in size from millimeters to 1-2 centimeters in diameter and have varied appearances. Frequently BCCs present as a pinkish nodule with a crater like indentation in the center.


Other features of BCCs can include the following:

  • An open sore that may bleed, ooze or itch often with crusting that fails to heal within expected time.
  • A shiny, pearly appearing or translucent nodule that is usually pink, reddish, or white however can appear tan, black, or brown particularly in those with dark hair.

How are basal cell cancers diagnosed?

bcc follow upFollowing clinical examination, lesions suspected to be BCCs should be biopsied.

What treatment options are there for BCCs?

pdt for bccsDoctors at My Skin Clinics will treat all cases of BCC.  Treatment options often depend on the type, size, location, and number of tumors. Possible treatments include:


Non-Surgical Options:



Freezing the tumor with liquid nitrogen can be used for treat small superficial BCCs. A permanent white scarcan result from this treatment.Cure rates are lower than those seen with surgical treatments–approximately 85-90%.


Photodynamic Therapy (PDT)

A chemical cream is applied to the skin several hours prior toexposing the treated skinto light in order to activate the chemical.  This is ideal for smaller more superficial BCCs.


Topical Chemical Treatments

Imiquimod cream (Aldara) is used mostly for small superficial BCCs and induces a localised inflammatory response.  The skin is generally treated once a day for 5 days per week, for a total of 6-12 weeks.


5-Fluorouracil cream (Efudex)can be used for very superficial small BCCs usually requiring 12 weeks of application twice a day.



Involves the use of x-rays and generally requires several treatments per week for a few weeks for complete removal. Radiation may be most appropriate for the elderly or for tumors that are difficult to manage surgically. Cure rates are around 90%, however this treatment can result in long-term cosmetic problems and involves radiation risks.

surgery for bccsSurgical Options:

Use of local anesthesia is required before surgical treatments.

Curettage and Electrodessication

The BCC is scraped off using a curette (a sharp, ring-shaped instrument). Curettage is often followed by the use of an electro-cautery needle to remove residual tumor and control bleeding.  Although cure rates are similar to those of surgical excision this treatment may not be as useful for aggressive BCCs or when the BCC is in a high-risk or difficult site. Healing is usually complete within several weeks.


Surgical Excision

For larger BCCs a scalpel may be used to remove both the BCC as well as a surrounding border of normal skin as a safety margin. The skin is then closed with stitches, and the excised tissue is sent to a pathology lab for examination to confirm that all cancer cells have been removed. This method produces cure rates around 90%.

For large BCCs or those on specific areas of the body skin grafts may be necessary.


Mohs surgery. This is a procedure performed by a specialized skin doctor (dermatologist or Mohs surgeon). The cancerous cells are removed layer by layer. This technique is used frequently for tumors on delicate areas such as eyelids, temples and ears. This treatment has a high cure rate.

How does PDT or photodynamic therapy fit in with BCC management?

pdt for basal cell cancers

PDT is a highly effective method of treating superficial BCCs on virtually any area, including the face, scalp, hands and chest. It is a minimally invasive treatment that leaves little to no scarring with a relatively rapid recovery. The treatment makes use of photosensitizing agents such as Aminolevulinic acid hydrochloride (ALA) cream that is applied topically and becomes concentrated within cancer cells over 3-6 hours.  When activated by light, the photosensitizing agents selectively destroy cancer cells, leaving normal cells largely unaffected.The resultant reaction usually appears much like sunburn and usually heals within 4-8 weeks with good cosmetic results.  Cure rates are variable ranging from 70 to 90%.


Benefits of PDT include shorter treatment time compared with Imiquimod (Aldara) or Flurouracil (Efudex) creams.


Read more about Photodynamic Therapy

How do I know what treatment is best for my BCC?

3281ECF700000578-3507084-image-a-3_1458781007937No single treatment method is ideal for all BCCs. Factors influencing treatment include the lesion’s size, site, and histologic type, as well as your age and functional status.


Superficial and nodular BCCs respond especially well to non-surgical treatments whereas larger lesions may require surgical excision.  PDT can be used where multiple BCCs are present.

What are the best tips for managing Basal Cell Cancers?

bcc curesBCCshave an excellent prognosis and can almost always be cured. These tumors rarelyspread to other areas of the body (metastasize).

So what happens after treatment and what follow up will I need?

skin check-brisbaneDespite most BCCs being cured by treatment, recurrence is always a possibility.  Furthermore, those individuals affected by BCCs have an increased risk of developing other forms of skin cancer such as melanoma.  For these reasons it is recommended the following steps are undertaken to manage your risks:


  • Ensure regular follow up appointments with your dermatologist or a My Skin Clinics doctor
  • If you notice any new lesion that is bleeding or growing, always consult your dermatologist
  • Ensure you protect your skin from the sun
  • Perform regular skin checks. Your doctor can showyou how to do this.



Why does Brisbane have such a high incidence of Basal Cell Cancer?

bcc treatments-brisbane 1Australia has the highest rate of skin cancer in the world with an estimated 296,000 cases of Basal cell carcinoma (BCC) diagnosed in 2008. Accordingly, as one of Australia’s larger cities, Brisbane has a high incidence of BCC largely attributed to the high UV index.

Prevention of BCCs


  • Avoid the sun between 10:00 a.m. and 4:00 pm
  • Use a sunscreen with a sun protection factor of 30 or greater applied at least 30 minutes before sun exposure
  • Reapply sunscreen every 2 to 4 hours whilst outside, after swimming, and after excessive sweating.
  • Always wear protective hats, clothing, and sunglasses with ultraviolet protection.

Avoid indoor tanning.