Basal Cell Carcinoma (BCC)

Condition

High risk basal cell carcinomas (BCCs) should go directly to secondary care, ideally on a fast track pathway. These include:

• Patients 24 years old or younger
• Immunocompromised
• Genetically predisposed (e.g. Gorlin’s Syndroms)
• Recurrent or incompletely treated BCC
• Lesions on the nose and lips, including nasofacial sulci and nasolabial folds, or around the eyes (periorbital) or ears
• Lesions:
  • > 2cm in diameter below the clavicle; or
  • > 1cm above the clavicle
  • unless they are a superficial BCC that can be managed non-surgically
• Flat lesions, hard thickened skin (appearance of a morphoeic BCC)
• Poorly defined margins
• Lesion located over important anatomical structures where primary surgical closure may be difficult of where excision may lead to a poor cosmetic result
• Histological subtypes: morphoeic, micronodular, inflitrative, and basosquamous

Low risk BCCs are suitable for Community Dermatology Services:

• Age > 24 years
• No immunosuppression or genetic syndrome
• Below the clavicle and < 20mm diameter
• Above the clavicle and < 10mm and on the chin, cheeks, forehead, temples, neck, or side of the face
• Not recurrent or persistent
• Not morphoeic, infiltrating, or basosquamous
• Not over an important anatomical structure
• Primary closure not difficult
• Not an area with potentially poor cosmetic results
• Not a highly visible anatomical site with cosmetic risk

Last updated: