Doctor-led patient guide to basal cell carcinoma (BCC) by Dr Christopher Irwin at The Skin Doctor, Melbourne. BCC is the most common skin cancer (~80% of all skin cancers). It is slow-growing, almost never metastasises, and is highly curable. Subtype (superficial vs invasive) guides treatment.
- BCC is the most common skin cancer worldwide — about 8 in 10 of all skin cancers.
- BCC almost never metastasises — it is locally invasive only and very rarely life-threatening.
- Subtype (superficial vs invasive — nodular, infiltrative, morpheaform) determines treatment.
- Cure rates with surgical excision (3–5 mm margin) are 95–98% for primary BCCs.
- Superficial BCC has non-surgical options including topical imiquimod/Aldara and laser-assisted photodynamic therapy.
- Routine CT/PET scans and blood tests are not needed because BCC almost never spreads.
- About 50% of people who have had one BCC will develop another non-melanoma skin cancer within 5 years.
- Care provided across two Melbourne clinics — Ivanhoe and Diamond Creek.
Basal Cell Carcinoma(BCC)
Basal cell carcinoma (BCC) is the most common skin cancer — about 8 in 10 of all skin cancers are BCC. It arises from the basal cells at the bottom of the epidermis. BCC is usually slow-growing and very rarely spreads to other parts of the body. It is highly curable and almost never life-threatening, but it does need treatment to prevent local tissue damage. We divide BCC into superficial and more invasive subtypes (nodular, infiltrative or morpheaform), which guides choice of treatment.
By Dr Christopher Irwin, MBChB, FRACGP, MMed (Skin Cancer), FACAM, MSCCA
Last reviewed 2026-06-06 · Editorial policy
Quick definition
Basal cell carcinoma (BCC) is the most common skin cancer worldwide — about 8 in 10 of all skin cancers. It arises from basal cells at the base of the epidermis. BCC is slow-growing and almost never metastasises, but untreated it can grow wider and deeper and damage local tissue, especially on the face. BCC is highly curable — cure rates are 95–98% with surgical excision. Subtype (superficial vs invasive — nodular, infiltrative, morpheaform) determines the best treatment.
Basal cell carcinoma (BCC) is the most common type of skin cancer. The reassuring part: most BCCs are slow-growing and very treatable when diagnosed early. The important part: untreated BCCs can continue to expand and may become more difficult to treat — especially on the face.
This page explains BCC in plain English and links you to the two main BCC pathways we manage.
Explore each type
Superficial BCC (sBCC)
Often flatter and more amenable to non-surgical options in selected cases — including topical imiquimod, Aldara, and laser-assisted photodynamic therapy.
Learn more →Invasive BCC (Nodular, Infiltrative)
Deeper subtypes that usually require surgical excision with a 3–5 mm margin under local anaesthetic — or carefully selected alternatives.
Learn more →What does BCC look like?
BCC can be subtle. Common patterns include:
- A pearly or shiny bump — sometimes with small surface blood vessels (telangiectasia)
- A non-healing sore that crusts, bleeds, then partly settles… and repeats
- A pink scaly patch that doesn’t go away
- A scar-like, firm area — often pale, smooth, or slightly indented
- A spot that is slowly enlarging over months
BCCs commonly occur on sun-exposed areas: face, ears, scalp, neck, shoulders, and upper chest/back — but they can occur anywhere.
If you have a spot that’s been present for weeks to months and isn’t behaving like a simple pimple, eczema, or a healing scratch, it’s worth checking.
Is BCC dangerous?
BCCs rarely spread to other organs. However, they can:
- Grow wider and deeper over time
- Damage nearby structures — especially on the nose, eyelids, lips, and ears
- Become more complex to remove and reconstruct if delayed
- Recur if not adequately treated
So BCC is usually not dangerous in the “metastatic” sense — but it can be locally destructive if ignored.
How BCC is diagnosed
A good assessment usually includes:
- Clinical examination
- Dermoscopy — magnified assessment of lesion patterns
- Biopsy when needed to confirm subtype and guide treatment
If you’re not sure whether you need a full skin check or a focused assessment, choose based on your situation:
- 1–3 spots you’re worried about → Book a targeted spot check
- Many lesions, lots of sun damage, or a history of skin cancer → Book a full skin check
Treatment overview
BCC treatment is tailored to:
- Subtype (superficial vs invasive)
- Location (face vs trunk/limbs)
- Size and margins
- Previous treatments (new vs recurrent)
- Your preferences around downtime and scarring
Common options include surgery and — for selected superficial BCC — non-surgical alternatives such as topical treatments or in-clinic therapies. The full set of options, indications and trade-offs is summarised in the Treatment options section below.
If you’ve been told you have a “BCC” but you’re unsure what subtype it is, we can explain your pathology report clearly and map out options.
Symptoms
- A pearly or shiny bump, sometimes with small surface blood vessels (telangiectasia)
- A non-healing sore that crusts, bleeds, partly settles — and repeats
- A pink scaly patch that doesn't go away
- A scar-like, firm area — often pale, smooth, or slightly indented
- A spot that is slowly enlarging over months
- Most common on sun-exposed skin (face, ears, scalp, neck, shoulders, upper chest/back) but can occur anywhere
Causes & contributors
- Cumulative ultraviolet (UV) exposure from sunlight and solariums
- Fair skin, light eyes, easy burning
- Older age (although younger patients with significant sun damage are common in Australia)
- Personal or family history of skin cancer
- Immunosuppression (eg. transplant recipients)
- Exposure to arsenic, radiation or chronic injury (less common)
Diagnosis
Diagnosis is usually made by a doctor on clinical examination and dermatoscopy and confirmed on histology after biopsy or excision. The pathology report names the subtype (superficial, nodular, infiltrative, morpheaform, micronodular or mixed). The subtype matters because it guides treatment choice — superficial BCC has many non-surgical options, while more invasive subtypes are usually best treated surgically.
Treatment options
Surgical excision
First-line treatment for most invasive BCCs. The tumour is removed with a margin (typically 3-5 mm) of normal skin under local anaesthetic. Cure rates are 95-98% for primary BCCs.
Topical immunotherapy (imiquimod / Aldara)
A prescription cream applied for around six weeks. Stimulates the immune system to attack the cancer. Suitable for selected superficial BCCs.
Laser-assisted Photodynamic Therapy (LA-PDT)
A laser ablates the lesion, a sensitising cream is applied, then a special light activates the cream and destroys remaining cancerous cells. Effective with minimal downtime and good cosmetic outcomes. We use this regularly for superficial BCC, and as an off-label option in selected nodular BCC.
Curettage and electrodessication
Scrape the lesion under local anaesthetic and cauterise the base. Useful for small superficial or low-risk nodular BCC. Leaves a round, pale scar.
Radiation therapy
Reserved for tumours where surgery is not feasible (eg. eyelid lesions, frail patients) or as adjunctive treatment in advanced cases.
When to see a doctor
See a doctor if you have a pearly bump, scaly patch, white scar-like area or non-healing crust on sun-exposed skin — particularly on the face, ears, scalp or neck. Most BCCs grow slowly, so prompt assessment lets us choose a smaller, simpler treatment.
Frequently asked questions
-
Can BCC go away on its own?
No. It may crust, bleed, or look better temporarily, but BCC typically persists and slowly enlarges without treatment. Definitive treatment is required. -
Is BCC always caused by sun?
Sun exposure is the major driver, but not the only factor. Skin type (fair skin, light eyes, easy burning), cumulative UV exposure, genetics, and immune function (eg. transplant recipients) all contribute. -
Does BCC spread to other organs?
It is very uncommon. BCCs essentially never metastasise. The main risk is local growth — they can become wider, deeper, damage nearby structures (especially on the nose, eyelids, lips, ears) and increase the complexity of treatment if ignored. -
What happens if I ignore a BCC for a year?
Many BCCs will get larger and can extend deeper. On the face, this can mean a bigger procedure and more complex reconstruction. Untreated BCCs can also recur in scar tissue and erode bone or cartilage in advanced cases. -
Should I book a spot check or a full skin check?
Spot check (up to 3 lesions) is ideal if you have one to three specific spots you're worried about. Full skin check is best for many lesions, lots of sun damage, a history of skin cancer, or reassurance. -
Will I need surgery, or can my BCC be treated with cream or laser?
It depends on the subtype. Superficial BCC has many non-surgical options (topical imiquimod/Aldara, laser-assisted PDT, curettage). More invasive subtypes (nodular, infiltrative, morpheaform) are usually best treated by surgical excision, with a 3–5 mm margin under local anaesthetic. -
If I have had one BCC, how likely am I to get another skin cancer?
About 50% of people who have had one non-melanoma skin cancer will develop another within 5 years. This is why regular skin checks and lifelong sun protection matter — not because the original is likely to come back, but because new ones can appear elsewhere.
References
- Clinical practice guidelines for keratinocyte cancer. Cancer Council Australia. (NHMRC-approved 2019.)
- Guidelines of care for the management of basal cell carcinoma. J Am Acad Dermatol. 2018. (American Academy of Dermatology.)DOI: 10.1016/j.jaad.2017.10.006
- Epidemiology of basal cell carcinoma — a scholarly review. Br J Dermatol. 2017.DOI: 10.1111/bjd.15321
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Medically reviewed by Dr Christopher Irwin, MBChB, FRACGP, MMed (Skin Cancer), FACAM, MSCCA · Last reviewed 2026-06-06 · Editorial policy