Basal Cell Carcinoma (BCC): 12 Questions Patients Really Ask
Is BCC dangerous? Does it need removing? Will it leave a scar?
Being told you might have skin cancer can be frightening, particularly when you're not sure what happens next. Basal cell carcinoma (BCC) is the most common type of skin cancer in the UK, but it behaves very differently from more aggressive cancers.
The reassuring news is that BCC is usually slow-growing, rarely spreads to other parts of the body and can often be treated successfully. However, it shouldn't be ignored.
Here, we answer 12 of the questions patients commonly have about BCC, from recognising the symptoms to understanding surgery, recovery and the risk of recurrence.
1. Is basal cell carcinoma actually cancer, and how serious is it?
Yes, basal cell carcinoma is a form of skin cancer, but it is usually much less aggressive than melanoma.
BCC develops in cells within the outer layer of the skin. It generally grows slowly and very rarely spreads to distant parts of the body.
That doesn't mean it is harmless. Left untreated, a BCC can gradually grow into surrounding skin and deeper tissues, potentially damaging structures such as the nose, eyelids or ears.
Most BCCs are highly treatable, particularly when diagnosed and managed early. The important thing is not to panic, but not to ignore a suspicious lesion either.
2. What does basal cell carcinoma look like in its early stages?
BCC doesn't always look like a typical mole. It can resemble a spot, a patch of irritated skin or a small wound that refuses to heal.
Common appearances include:
A shiny, pearly or translucent bump
A pink, red or scaly patch
A sore that repeatedly bleeds, scabs and reopens
A slightly raised growth with rolled edges
A flat, scar-like area that feels different from the surrounding skin
A brown or darkly pigmented lesion that may resemble a mole
BCC commonly appears on sun-exposed areas, particularly the face, ears, scalp and neck, although it can develop elsewhere.
A useful rule: If a new skin lesion persists, changes, bleeds repeatedly or fails to heal, arrange a professional assessment rather than trying to diagnose it yourself.
3. Can a BCC look like an ordinary spot or pimple?
Yes. Some BCCs initially resemble a small spot, particularly if they are raised, pink or shiny.
The difference is often how the lesion behaves over time.
An ordinary spot usually improves or disappears. A BCC may remain for weeks or months, gradually enlarge, bleed after minor contact or appear to heal before breaking down again.
A persistent spot is not necessarily cancer, but it deserves examination if it isn't behaving as expected.
4. Can basal cell carcinoma go away on its own?
No. A confirmed BCC should not be expected to disappear permanently without treatment.
The surface may occasionally appear to heal, particularly if the lesion has been bleeding or scabbing. However, cancerous cells can remain beneath the surface.
Some very low-risk BCCs may be monitored in selected patients following specialist assessment, but this is a deliberate clinical decision rather than simply leaving a suspicious lesion untreated.
5. How quickly does BCC grow, and how long can you leave it?
Most BCCs grow slowly, often over months or years, but growth rates vary.
Some remain relatively small for a long time. Others grow more quickly or extend beneath the skin further than their surface appearance suggests. Location matters too. A small BCC close to the eye, nose or ear may require more careful treatment planning than a similar lesion on the trunk.
If you suspect a BCC, arrange an assessment promptly. If you already have a confirmed diagnosis, follow the timeframe recommended by your treating clinician rather than postponing treatment indefinitely.
6. Does every basal cell carcinoma need to be surgically removed?
Not always. Surgery is a common and effective treatment, but other options may be suitable for certain low-risk BCCs.
Treatment depends on the lesion's size, subtype, location, depth, previous treatment and your general health. Options can include surgical excision, prescription creams, curettage and cautery, radiotherapy or other specialist treatments.
For many BCCs, surgery is preferred because it removes the affected tissue and allows it to be examined under a microscope. A specialist can explain which approach offers the best balance of cancer clearance, healing and cosmetic outcome.
7. What happens during BCC removal surgery?
BCC excision involves removing the cancer along with an appropriate margin of surrounding tissue.
For many smaller lesions, the procedure can be performed under local anaesthetic.
The typical process is:
The area is cleaned and numbed with a local anaesthetic injection.
The surgeon carefully removes the lesion with an appropriate margin.
The wound is closed using stitches, or another reconstructive technique if required.
The removed tissue is usually sent for laboratory examination to assess the diagnosis and whether the margins are clear.
Many procedures are completed as day-case treatments, allowing patients to return home the same day.
8. Will BCC removal leave a scar, especially on my face?
Yes. Any surgical removal of skin will leave a scar, but careful planning can help make it as discreet as possible.
For patients with BCC on the face, scarring is understandably a major concern.
The final appearance depends on several factors, including the size and location of the lesion, the amount of tissue removed, skin characteristics and individual healing.
A Consultant Plastic and Reconstructive Surgeon considers not only how to remove the cancer, but also how to repair the resulting wound.
Depending on the circumstances, this may involve:
Direct closure: Bringing the wound edges together with stitches.
Local skin flap: Moving nearby skin into the area.
Skin graft: Using skin from another part of the body to cover the wound.
Scars generally change and mature over several months. Although no surgeon can promise an invisible scar, appropriate reconstructive techniques can help achieve a satisfactory functional and cosmetic result.
9. Does having BCC mean I'm more likely to develop another skin cancer?
Yes. Having had one BCC increases your likelihood of developing another BCC in the future.
This is partly because the same risk factors, particularly cumulative ultraviolet exposure, continue to affect your skin.
It doesn't mean another cancer is inevitable, but it makes ongoing skin awareness important.
Protecting your skin from excessive sunlight, avoiding sunbeds and monitoring new or changing lesions can help reduce future risks.
Your clinician can advise whether you need regular professional skin examinations.
10. Can basal cell carcinoma come back after it has been removed?
Yes, although most appropriately treated BCCs do not recur.
The likelihood of recurrence depends on the tumour's characteristics and the treatment used.
A recurrent BCC may develop at or near the original treatment site. A completely new BCC can also appear elsewhere on the skin.
If laboratory results show that the cancer has not been fully removed, further treatment or specialist monitoring may be recommended.
This is one reason why examining the removed tissue and discussing the pathology results are important parts of surgical care.
11. How long does it take to recover from BCC removal?
Many patients can resume light everyday activities within a few days, although wound healing often takes one to three weeks.
Recovery varies depending on the size and location of the wound and whether stitches, a flap or a skin graft are used.
You may experience some tenderness, swelling or bruising initially. Your surgical team will explain how to care for the wound, when any stitches should be removed and when you can return to exercise or other activities.
A scar can continue to settle for several months. Increasing redness, worsening pain, spreading swelling, pus, fever or persistent bleeding should be reported promptly to your treating team.
12. Should I see a dermatologist or a plastic surgeon for BCC?
Both dermatologists and plastic surgeons can play important roles in diagnosing and treating BCC. The most appropriate specialist depends on the lesion.
A dermatologist may assess suspicious skin lesions, perform biopsies and offer medical or surgical treatment.
A plastic surgeon may be particularly appropriate when the BCC is large, located in a cosmetically
or functionally sensitive area, or likely to require reconstruction after removal.
For certain high-risk or recurrent BCCs, specialist techniques such as Mohs micrographic surgery may be recommended, involving a clinician trained in that procedure.
The priority is choosing an appropriately qualified specialist and a treatment plan suited to the individual cancer.
Concerned About a Possible BCC?
Mr Rikki Mistry is a Consultant Plastic and Reconstructive Surgeon offering private assessment and surgical treatment for skin lesions, including basal cell carcinoma.
With experience in skin cancer excision and reconstructive surgery, he considers both the safe removal of the lesion and the functional and cosmetic aspects of wound repair.
If you have noticed a suspicious skin change, received a BCC diagnosis or would like advice about surgical removal, his team can help you arrange an appropriate consultation.
This guide provides general patient information and is not a substitute for individual medical assessment. A suspicious lesion cannot be reliably diagnosed from its appearance alone.
