# Basal cell carcinoma

Source: https://onco.cc/cancers/basal-cell-carcinoma/  
OnCo record `basal-cell-carcinoma` (Cancer). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Basal cell carcinoma is a skin cancer and the most common cancer of all, caused by sun exposure and almost never life-threatening. Nearly all are removed surgically; the rare advanced cases are treated with drugs that block the hedgehog signalling pathway, and with immunotherapy if those fail.

## Summary

Basal cell carcinoma arises from hedgehog-pathway activation in nearly every case, through loss of PTCH1 (~70%) or activating SMO mutations (~10-20%); germline PTCH1 loss causes Gorlin (basal cell nevus) syndrome. Subtypes range from indolent nodular and superficial to infiltrative, morphoeic and basosquamous tumours with higher recurrence risk.

Treatment is surgical (excision, Mohs for high-risk sites), with curettage, topical imiquimod or 5-fluorouracil, photodynamic therapy and radiotherapy as alternatives for low-risk or inoperable lesions. Vismodegib (ERIVANCE, 2012) and sonidegib (BOLT, 2015) are oral SMO inhibitors for locally advanced or metastatic BCC with ~45-60% response; their class toxicities (muscle spasms, dysgeusia, alopecia, weight loss) cause many to stop, and resistance arises through SMO mutations. Cemiplimab (2021) is approved after hedgehog-inhibitor failure or intolerance. Nicotinamide and sun protection reduce new BCCs in high-risk patients.

## Fields

- Kind: Cancer
- Last checked: 2026-09-25
- Also known as: BCC; Basal Cell Carcinoma of the Skin; Basal cell skin cancer; Rodent ulcer; Basalioma; Keratinocyte carcinoma, basal cell type; BCC of the skin
- Tags: gap-fill; skin
- Group: skin
- Burden: The most common human cancer: several million cases per year in the US alone; metastasis is exceptionally rare (<0.1%), but locally advanced disease can be destructive.
- Subtypes: Nodular (most common); Superficial; Infiltrative / morphoeic (high-risk); Basosquamous; Gorlin syndrome (germline PTCH1/SUFU); Low-risk growth patterns: nodular (the commonest), superficial, and fibroepithelial (of Pinkus) (RCPath G123, following WHO); High-risk growth patterns, reported together in the UK as infiltrative basal cell carcinoma: infiltrating, sclerosing or morphoeic, and micronodular (nodules under 0.15 mm across); Basosquamous carcinoma, a basal cell carcinoma with a moderately or severely atypical or malignant squamous component, treated as high risk; Composite basal cell carcinoma, meaning a tumour containing low-risk and high-risk patterns at once, which is usual; the risk is read from the highest-risk pattern present; Gorlin syndrome (naevoid basal cell carcinoma syndrome), in which germline loss of PTCH1 or SUFU causes many tumours from a young age; Locally advanced and metastatic basal cell carcinoma, which is a treatment setting rather than a type and has its own page
- Biomarkers: Histologic subtype and high-risk location (H-zone of face); PTCH1 / SMO / SUFU alterations (research; SMO mutations predict hedgehog-inhibitor resistance); Perineural invasion; Germline PTCH1 (Gorlin); Growth pattern, low or high risk, which is the single most consequential line on the report (RCPath G123); Squamous differentiation, reported when moderate or severe, because basosquamous tumours recur and metastasise more often; Level of invasion and thickness: beyond subcutaneous fat, or more than 6 mm, are high-risk features and upstage to pT3; Perineural invasion, which is collected for nodular but not for superficial tumours because superficial tumours cannot show it; Margins: involved at 0 mm, or clear but under 1 mm, both count as high risk; PTCH1, SMO and SUFU alterations, which are the biology rather than a routine test; germline PTCH1 or SUFU indicates Gorlin syndrome

## Sections of this record

The page is a hub with ten sections in reading order; large sections have their own page. The same plan as JSON: https://onco.cc/api/v1/cancers/basal-cell-carcinoma/sections.json

- Overview (on the hub): The TL;DR, the family this cancer belongs to, the organ, who gets it and what the state of the art is. https://onco.cc/cancers/basal-cell-carcinoma/#overview [1 subtype, 4 state-of-the-art points]
- Types and stages (on the hub): Anatomy, the subtypes and how they differ, how it is staged, and where advanced disease spreads. https://onco.cc/cancers/basal-cell-carcinoma/#what-it-is [12 subtypes, 6 staging notes]
- Symptoms and diagnosis (on the hub): How this cancer shows itself, how the diagnosis is confirmed, and the biomarkers clinicians test for. https://onco.cc/cancers/basal-cell-carcinoma/#finding-it [5 symptoms, 10 biomarkers, 1 prevalence rows]
- Treatment (on the hub): The standard of care by setting, the medicines, surgery and radiotherapy named in it, and the regimens behind them. https://onco.cc/cancers/basal-cell-carcinoma/#treating-it [11 settings, 6 decisions with options]
- Trials and papers (on the hub): Trials recruiting now, the landmark trials, the trials held by this cancer's subtypes, the key papers and what they mean, the latest literature, and the milestones year by year. https://onco.cc/cancers/basal-cell-carcinoma/#evidence [23 trials, 1 key paper, 10 milestones]
- Biology and targets (on the hub): The molecular landscape: the targets and how often each appears, the pathways, the mechanics stages and the preclinical models. https://onco.cc/cancers/basal-cell-carcinoma/#science [33 targets, 2 pathways]
- Countries and centres (own page): Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes. https://onco.cc/cancers/basal-cell-carcinoma/where-you-are/ [8 centres, 2 centres in the subtypes, 10 UK centres]
- Decisions and support (on the hub): The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask. https://onco.cc/cancers/basal-cell-carcinoma/#living-with-it [12 questions, 6 red cards, 1 decision aid]
- Pipeline and open problems (own page): Everything in development, the medicines held by this cancer's subtypes, the open problems and what is being done about them, the roadmaps, and what changed on this record. https://onco.cc/cancers/basal-cell-carcinoma/coming/ [8 medicines, 1 medicine in the subtypes, 23 trials, 10 open problems]
- Data (own page): Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked. https://onco.cc/cancers/basal-cell-carcinoma/data/ [139 connected records, 9 notes]

## Standard of care

- Low-risk: Standard excision with 4 mm margin, curettage and electrodesiccation, or topical imiquimod / 5-FU / photodynamic therapy for superficial lesions. ([Fluorouracil (5-FU)](https://onco.cc/drugs/fluorouracil/))
- High-risk or recurrent: Mohs micrographic surgery or excision with complete margin assessment; radiotherapy if surgery not feasible. ([IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/))
- Locally advanced or metastatic: Vismodegib or sonidegib; cemiplimab after hedgehog-inhibitor failure or intolerance; multidisciplinary review for surgery/radiotherapy after response. ([Vismodegib](https://onco.cc/drugs/vismodegib/), [Sonidegib](https://onco.cc/drugs/sonidegib/), [Cemiplimab](https://onco.cc/drugs/cemiplimab/))
- Choosing between surgery, curettage, freezing, a cream and photodynamic therapy: For a superficial or low-risk nodular basal cell carcinoma this is a real choice and not a formality, so here are the numbers instead of the phrase several options are available. Surgery has the highest cure rate: the Cochrane review of 52 randomised trials and 6,690 participants concluded that surgical interventions have the lowest recurrence rates. In the UK SINS trial, 501 people with primary nodular or superficial disease at low-risk sites were randomised between imiquimod cream (once daily, six weeks for superficial and twelve for nodular) and excision with a 4 mm margin: treatment succeeded in 83.6 percent against 98.4 percent at three years and 82.5 percent against 97.7 percent at five, and most cream failures happened in the first year. Among the non-surgical options, a Dutch trial of 601 people with superficial disease gives the ranking at five years: imiquimod 80.5 percent tumour-free, fluorouracil cream 70.0 percent, photodynamic therapy 62.7 percent. Curettage and cautery, scraping the lesion away and sealing the surface with heat, usually repeated two or three times in one sitting, is a surgical option for low-risk disease; the BAD notes that unlike an excision it leaves no margins for a pathologist to check but is generally considered effective for a low-risk basal cell carcinoma. Cryotherapy is offered for superficial lesions and the BAD says it generates a wound that usually heals with a scar. Now the other side, because cure rate is not the only axis. Creams take weeks of a visibly inflamed, itching, weeping face (in SINS, itching in 211 of the imiquimod group against 129 of the surgery group); photodynamic therapy causes moderate to severe pain and burning during the treatment itself; and the cosmetic result of the non-surgical options is better, not worse. The Cochrane review found observers rated the outcome good or excellent in 60.6 percent after imiquimod against 35.6 percent after excision, and after photodynamic therapy against excision 87.1 percent against 46.6 percent, while patients rated imiquimod and surgery the same. So: surgery is one appointment and the highest cure rate and a scar; a cream is six to twelve weeks of a sore face, a one-in-six chance of failure, and usually a better-looking result. Both are defensible. Not treating at all is a third option the BAD names for a slow-growing lesion on a non-critical site or where someone could not tolerate treatment. ([Wide local excision](https://onco.cc/terms/wide-local-excision/), [Curettage and cautery](https://onco.cc/terms/curettage-and-cautery/), [Mohs surgery](https://onco.cc/terms/mohs-surgery/), [Imiquimod](https://onco.cc/drugs/imiquimod/), [Fluorouracil (5-FU)](https://onco.cc/drugs/fluorouracil/), [Methyl aminolevulinate](https://onco.cc/drugs/methyl-aminolevulinate/), [Aminolevulinic acid (topical, for photodynamic therapy)](https://onco.cc/drugs/aminolevulinic-acid/), [Cryoablation](https://onco.cc/terms/cryoablation/), [Photodynamic therapy lasers and light sources](https://onco.cc/technologies/photodynamic-therapy-lasers/), [Curative intent vs palliative intent](https://onco.cc/terms/curative-intent/), [Multidisciplinary tumour boards](https://onco.cc/technologies/multidisciplinary-tumour-board/))
- Will it come back, and will I get another one: Two different questions get muddled here and they have different answers. Will this one come back: usually not, and the risk depends on what it was and how it was treated. In the Dutch randomised trial of high-risk facial basal cell carcinoma, ten-year recurrence was 4.4 percent after Mohs and 12.2 percent after standard excision for primary tumours, and 3.9 against 13.5 percent for recurrent ones; the same trial found that 56 percent of the recurrences of primary tumours appeared more than five years after treatment, which is why a clear five years is reassuring but is not the end of the story for a high-risk lesion on the face. Will I get another one: probably, and sooner than you would guess. In a meta-analysis of 17 studies, the three-year cumulative risk of a further basal cell carcinoma after a first was 44 percent, at least ten times the rate of first tumours in a comparable population, while the risk of a squamous cell carcinoma after a basal cell carcinoma was 6 percent. Those are cohort figures rather than a prediction for you, and they are about new cancers on damaged skin rather than this one returning. What follow-up is offered follows from that, and it is lighter than most people expect. The BAD says not everyone needs it, that people are usually discharged if the recurrence risk is low and they are not at high risk of future skin cancers, and that it is considered for advanced disease, a high risk of recurrence, or a high risk of multiple cancers such as people with weakened immune systems or genetic syndromes. Cancer Research UK says an early basal cell carcinoma may mean a single follow-up appointment and then none. Being discharged is not being dropped: it is a transfer of the surveillance to you, and both the BAD and Cancer Research UK are explicit about what you are then meant to do. The BAD puts a frequency on it, once a month, with someone else looking at the places you cannot see; Cancer Research UK asks you to know what your skin normally looks like and does not name an interval. Both say to go to the GP for any mark that is growing, changing, bleeding or not healing, including a change where this one was treated. ([The next skin cancer: second primaries after a keratinocyte cancer](https://onco.cc/terms/second-primary-skin-cancer/), [Sun protection after a skin cancer diagnosis](https://onco.cc/terms/sun-protection-after-skin-cancer/), [Mohs surgery](https://onco.cc/terms/mohs-surgery/), [Wide local excision](https://onco.cc/terms/wide-local-excision/), [Survivorship care and late-effects surveillance](https://onco.cc/technologies/survivorship-care-plan/), [Late effects and survivorship toxicity](https://onco.cc/terms/late-effects/), [Field cancerisation](https://onco.cc/pathways/field-cancerisation/))
- Choosing between an operation and a cream for a superficial tumour: This is a real choice and the numbers for it exist. In 601 Dutch patients with superficial basal cell carcinoma, five-year tumour-free survival was 80.5 per cent with imiquimod cream, 70.0 per cent with fluorouracil cream and 62.7 per cent with methyl aminolevulinate photodynamic therapy; imiquimod beat photodynamic therapy with a hazard ratio for failure of 0.48 and fluorouracil with 0.65. Against surgery all of them lose: SINS randomised 501 people in the United Kingdom and found clinical success at five years of 82.5 per cent with imiquimod against 97.7 per cent with excision, a relative risk of 0.84 whose confidence interval fell below the non-inferiority margin, so imiquimod is inferior rather than unproven. Cryotherapy matched photodynamic therapy on five-year recurrence, 20 against 22 per cent, and lost badly on appearance, 16 against 60 per cent excellent. Failures come early in every one of these trials, so a lesion still clear at a year is likely to stay clear. ([Creams, light and cold for basal cell carcinoma](https://onco.cc/terms/topical-and-destructive-treatment-bcc/), [Photodynamic therapy against imiquimod against fluorouracil for superficial basal cell carcinoma](https://onco.cc/trials/mal-pdt-imiquimod-fluorouracil-superficial-bcc/), [SINS (surgical excision against imiquimod cream for basal cell carcinoma)](https://onco.cc/trials/sins-trial/), [Photodynamic therapy against cryotherapy for superficial basal cell carcinoma](https://onco.cc/trials/mal-pdt-versus-cryotherapy-superficial-bcc/), [Imiquimod](https://onco.cc/drugs/imiquimod/), [Fluorouracil (5-FU)](https://onco.cc/drugs/fluorouracil/))
- The same choice for a nodular tumour, where it goes worse: The creams and the light are licensed for the thin superficial form, and stretching them to the thicker nodular form has been tested twice with the same answer. Methyl aminolevulinate photodynamic therapy against excision gave five-year recurrence of 14 against 4 per cent and a sustained complete response of 76 against 96 per cent, with an excellent or good cosmetic outcome in 87 against 54 per cent. Scraping the tumour off first and then applying imiquimod, tested in the SCIN trial, gave freedom from treatment failure at five years of 77.8 against 98.2 per cent, a relative risk of failure of 15.93. Both are defensible for someone who cannot or will not have facial surgery, and neither is equivalent to it. ([Photodynamic therapy against surgery for nodular basal cell carcinoma](https://onco.cc/trials/mal-pdt-versus-surgery-nodular-bcc/), [SCIN (curettage then imiquimod against excision for nodular basal cell carcinoma)](https://onco.cc/trials/scin-trial/), [Creams, light and cold for basal cell carcinoma](https://onco.cc/terms/topical-and-destructive-treatment-bcc/), [Curettage and cautery](https://onco.cc/terms/curettage-and-cautery/))
- Shrinking a tumour before the operation: For a large facial basal cell carcinoma where the operation would cost an eyelid or a nostril, a hedgehog inhibitor can be given first. VISMONEO gave vismodegib for a mean of 6.0 months to 55 patients with a mean lesion size of 47.3 mm and downstaged the planned surgery in 44 of them (80 per cent, 67 to 90), with 27 complete responses of which 25 were proved on biopsy. The part usually left out belongs in the conversation: at three years 16 of those 44 patients had a known recurrence, 36 per cent. The drug changes the operation, it does not replace it. ([VISMONEO (vismodegib before surgery for locally advanced basal cell carcinoma)](https://onco.cc/trials/vismoneo/), [Vismodegib](https://onco.cc/drugs/vismodegib/), [Why people stop taking hedgehog inhibitors](https://onco.cc/terms/hedgehog-inhibitor-tolerability/), [Mohs surgery](https://onco.cc/terms/mohs-surgery/))
- Living with a hedgehog inhibitor: Vismodegib and sonidegib work and most people stop taking them. STEVIE gave vismodegib to 1,215 patients in ordinary practice: response was 68.5 per cent in locally advanced disease, 98 per cent had a treatment-emergent adverse event, 23.8 per cent had a serious one, and the median treatment duration was 8.6 months, with only 12 per cent still taking it at the analysis. The characteristic events are muscle spasms, loss of taste, hair loss and weight loss, none dangerous and all wearing. Most of them resolve within a year of stopping. Intermittent dosing, neoadjuvant courses and topical delivery are the three attempts to get round it. ([STEVIE (vismodegib in ordinary practice)](https://onco.cc/trials/stevie/), [Why people stop taking hedgehog inhibitors](https://onco.cc/terms/hedgehog-inhibitor-tolerability/), [Vismodegib](https://onco.cc/drugs/vismodegib/), [Sonidegib](https://onco.cc/drugs/sonidegib/), [Hedgehog pathway inhibitors](https://onco.cc/technologies/hedgehog-inhibitors/))
- After a hedgehog inhibitor has failed or cannot be tolerated: Cemiplimab, a PD-1 antibody. In 84 patients with locally advanced disease who had progressed on, could not tolerate, or had no better than stable disease after nine months of a hedgehog inhibitor, objective response by independent central review was 31 per cent (21 to 42) with five complete responses; grade 3 or 4 treatment-emergent adverse events occurred in 48 per cent and serious events in 35 per cent. It was approved in February 2021 on that single-arm evidence and there is no randomised comparison. That basal cell carcinoma responds to checkpoint blockade at all is not obvious for a tumour that almost never spreads, and is explained by its very high ultraviolet mutational burden. ([Cemiplimab in basal cell carcinoma after a hedgehog inhibitor](https://onco.cc/trials/cemiplimab-advanced-bcc/), [Cemiplimab](https://onco.cc/drugs/cemiplimab/), [Immune checkpoint inhibitors](https://onco.cc/technologies/checkpoint-inhibitor/), [Tumour mutational burden (TMB)](https://onco.cc/terms/tmb/), [Immune-related adverse events (irAEs)](https://onco.cc/terms/irae/))
- What is available in England: Less than the approvals suggest. NICE technology appraisal TA489 recommendation 1.1 does not recommend vismodegib within its marketing authorisation for metastatic basal cell carcinoma or for locally advanced disease unsuitable for surgery or radiotherapy: the committee found the comparison with best supportive care not good enough for decision-making and the cost per quality-adjusted life year much higher than 30,000 pounds. Recommendation 1.2 allows anyone already on it to continue. There is no NICE appraisal of sonidegib, and none of cemiplimab in basal cell carcinoma. The commonest cancer in human beings has one NICE technology appraisal and it is a refusal. ([Vismodegib](https://onco.cc/drugs/vismodegib/), [Sonidegib](https://onco.cc/drugs/sonidegib/), [Cemiplimab](https://onco.cc/drugs/cemiplimab/), [Why people stop taking hedgehog inhibitors](https://onco.cc/terms/hedgehog-inhibitor-tolerability/))

## State of the art

- Hedgehog inhibitors are among the few targeted drugs whose rationale came straight from a developmental-biology pathway and a hereditary syndrome (Gorlin).
- Cemiplimab gives a second line after hedgehog-inhibitor failure.
- Neoadjuvant vismodegib can shrink tumours to make surgery less destructive (VISMONEO).
- Chemoprevention (nicotinamide) reduces new keratinocyte cancers in high-risk patients.

## Open problems

- Hedgehog-inhibitor tolerability leads most patients to stop within a year.
- Resistance via SMO mutations has no approved next-in-class agent.
- Huge volume: dermatology and Mohs capacity, and cost of treating millions of low-risk lesions.
- Nobody knows how many there are. The registration rule recorded only the first basal cell carcinoma per person for two decades, the annual method that replaced it finds 67 percent more, and that method still misses about 14 tumours per 100 patients. Dermatology and Mohs capacity is commissioned against the smaller number.
- Risk stratification depends on a pattern that is often mixed and not always reproducible. Most tumours are composite, there is no evidence about what proportion of a high-risk pattern is biologically significant, and the joint Royal College of Pathologists and British Association of Dermatologists audit found risk status among the most frequently omitted core items in skin cancer reports.
- Superficial basal cell carcinoma has no agreed definition and may not be invasive at all. The UK dataset records that there is no consensus on whether it is in situ or invasive, no consensus on its exact definition, and that studies quote various thicknesses, all under 1 mm; that is why the dataset deliberately avoids the phrase invasive basal cell carcinoma in its own title.
- The volume is the problem. Millions of low-risk lesions have to be treated to prevent the small number of destructive ones, and the whole cost of that falls on a disease that is left out of the national cancer statistics.
- The first drug ever approved for the commonest cancer in human beings is not recommended by NICE for it, and neither sonidegib nor cemiplimab in this disease has been appraised at all.
- Hedgehog inhibitors are stopped by most people who start them, with a median treatment duration of 8.6 months in the largest study, and neither intermittent dosing nor topical delivery has yet produced a licensed alternative.
- Acquired smoothened mutations restore hedgehog signalling downstream of the drug and there is no approved next-in-class agent; the working answer is to change pathway entirely and use a PD-1 antibody.

## Notes

- Basal cell carcinoma, the choice and what follows it: This is orientation from public patient pages, guidelines and the trials themselves, not advice for your case: your own team's instructions and the number they gave you come first, and no figure on this page is a prediction about you. The two rows above quote the randomised evidence rather than summarising it, because the choice between an operation and a cream is routinely presented as a matter of preference when the trials show a 15 percentage point difference in five-year success and an opposite difference in how the result looks.
- The decision aid at /tools/bcc-low-risk-treatment/ walks the same evidence a question at a time. It gives no score and makes no prediction, because none of the sources it quotes gives one.
- What this page does not carry: hedgehog inhibitors, cemiplimab and the management of locally advanced or metastatic disease, which belong to the locally advanced and metastatic basal cell carcinoma record; and everything about the face, Mohs as a day, the sun, the mind and immunosuppression, which is true of squamous cell carcinoma too and is written once on the skin cancer family page.
- Every number on this page rests on a counting rule. Basal cell carcinoma is the cancer the registries handle worst, because people get several and the rules were written for cancers people get once. UK registration long recorded only the first one in a lifetime; counting one per person per year instead found 67 percent more over 2013 to 2022 in England, and validation suggests that even the annual count misses about 14 tumours per 100 patients. Scotland still collects only the first occurrence per person, in its own words because they are so common. The Office for National Statistics excludes the whole group from the national cancer total because it is greatly under-registered. Read every incidence figure here as a floor (see `keratinocyte-cancer-counting`).
- The commonest cancer there is, and the one most often left out of the list. Basal cell carcinoma is about 75 in every 100 non-melanoma skin cancers (Cancer Research UK). In England in 2019 the registered rate was 282.36 per 100,000 person-years; on the annual counting method it was 295 per 100,000 in 2022, and rates stabilised after 2015 rather than continuing to rise. Across the UK the annual-method estimate is 184,280 basal cell carcinomas a year for 2016 to 2018. About one person in five in England will develop at least one keratinocyte cancer in their lifetime.
- Why the growth pattern is the most important word on the report. It decides the operation, the margin, who performs it and where. Nodular and superficial tumours have edges that can be seen; infiltrating, sclerosing and micronodular tumours grow as strands and specks that extend further than they look, which is why they recur after an excision that appeared complete and why they are the tumours Mohs surgery exists for. The UK dataset combines those three under one term because there is no clinical value in separating them, and reads the risk from the worst pattern present whatever its percentage.
- Why so few people with this cancer are ever given a stage, and why that is not an oversight. A stage exists to say how far a cancer has travelled and to predict what it will do. A cancer that metastasises in well under one in a thousand cases has almost nothing for a stage to predict, so what gets recorded instead is a binary, low risk or high risk, that predicts local recurrence. Britain does have a staging system for it, which is more than the American manual offers outside the head and neck, and it is used for registration and for the rare destructive tumour rather than for the ordinary one.
- This is not the same thing as a rodent ulcer being harmless. The old name comes from what a neglected basal cell carcinoma does: it erodes. Because it sits most often on the face, and because it grows slowly enough to be ignored for years, the harm it causes is the loss of a nose, an eyelid or an ear rather than a metastasis. That is the reason a small tumour in a difficult place is treated more aggressively than a larger one on the trunk, and the reason the locally advanced page exists.
- Who is at risk, and the gap in what is known. Incidence in England is about 26 to 27 times higher in the White ethnic group than in the Asian or Black groups, and ethnicity was unknown for 19.2 percent of registered basal cell carcinomas, the highest proportion of any skin tumour studied (Ahmed 2026). People of every skin tone can get skin cancer, and the near-absence of data on darker skin is itself a finding rather than a reassurance.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Basal-cell_carcinoma
- NCCN Guidelines: Basal Cell Skin Cancer: https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1416
- ERIVANCE (NEJM 2012): https://doi.org/10.1056/NEJMoa1113713
- NCI PDQ: skin cancer: https://www.cancer.gov/types/skin/patient/skin-treatment-pdq
- Thomson et al., interventions for basal cell carcinoma of the skin: Cochrane review of 52 randomised trials and 6,690 participants (2020): https://doi.org/10.1002/14651858.CD003412.pub3
- Bath-Hextall et al., surgical excision versus imiquimod 5% cream for nodular and superficial basal-cell carcinoma, SINS (Lancet Oncology 2014): https://doi.org/10.1016/S1470-2045(13)70530-8
- Williams et al., surgery versus 5% imiquimod for nodular and superficial basal cell carcinoma, 5-year results of the SINS randomised controlled trial (J Invest Dermatol 2017): https://doi.org/10.1016/j.jid.2016.10.019
- Arits et al., photodynamic therapy versus topical imiquimod versus topical fluorouracil for superficial basal-cell carcinoma, randomised trial of 601 patients (Lancet Oncology 2013): https://doi.org/10.1016/S1470-2045(13)70143-8
- Jansen et al., five-year results of a randomised controlled trial comparing photodynamic therapy, topical imiquimod and topical 5-fluorouracil in superficial basal cell carcinoma (J Invest Dermatol 2018): https://doi.org/10.1016/j.jid.2017.09.033
- van Loo et al., surgical excision versus Mohs micrographic surgery for basal cell carcinoma of the face: randomised clinical trial with 10-year follow-up (Eur J Cancer 2014): https://doi.org/10.1016/j.ejca.2014.08.018
- Marcil and Stern, risk of developing a subsequent non-melanoma skin cancer in patients with a history of non-melanoma skin cancer: review and meta-analysis (Arch Dermatol 2000): https://doi.org/10.1001/archderm.136.12.1524
- British Association of Dermatologists: basal cell carcinoma, patient information leaflet (updated July 2025): https://www.skinhealthinfo.org.uk/condition/basal-cell-carcinoma/
- British Association of Dermatologists and British Society for Dermatological Surgery: Mohs micrographic surgery, patient information leaflet (updated June 2025): https://www.skinhealthinfo.org.uk/condition/mohs-micrographic-surgery/
- Cancer Research UK: types of surgery for non-melanoma skin cancer: https://www.cancerresearchuk.org/about-cancer/skin-cancer/treatment/surgery/treatment-surgery-types
- Cancer Research UK: follow-up after non-melanoma skin cancer treatment: https://www.cancerresearchuk.org/about-cancer/skin-cancer/treatment/follow-up-appointments
- Cancer Research UK: photodynamic therapy for non-melanoma skin cancer: https://www.cancerresearchuk.org/about-cancer/skin-cancer/treatment/photodynamic-therapy
- Cancer Research UK: chemotherapy cream for non-melanoma skin cancer: https://www.cancerresearchuk.org/about-cancer/skin-cancer/treatment/chemotherapy-cream
- NHS: treatment for non-melanoma skin cancer: https://www.nhs.uk/conditions/non-melanoma-skin-cancer/treatment/
- Royal College of Pathologists G123: dataset for histopathological reporting of primary cutaneous basal cell carcinoma, version 4, February 2019 (Slater and Barrett): https://www.rcpath.org/resourceLibrary/g123-dataset-basal.html
- Cancer Research UK: basal cell carcinoma: https://www.cancerresearchuk.org/about-cancer/skin-cancer/types/basal-cell-carcinoma
- Nasr et al., British Journal of Dermatology 2021;185(5):899 to 920: British Association of Dermatologists guidelines for the management of adults with basal cell carcinoma 2021: https://doi.org/10.1111/bjd.20524
- Royal College of Pathologists appendix A, version 3, 6 November 2025: UICC TNM 9 pathological staging of primary cutaneous carcinoma (basal cell), combining the UICC chapters for skin carcinoma of the head and neck and carcinoma of the skin: https://www.rcpath.org/resourceLibrary/basal-cell-tnm9.html
- Cancer Research UK: non-melanoma skin cancer incidence statistics (UK): https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/non-melanoma-skin-cancer/incidence
- Mistry, Levell, Karponis, Wakkee, Whiteman, Proby and Venables, British Journal of Dermatology 2026: trends in keratinocyte cancers in England 2013 to 2022, basal cell carcinoma incidence, cutaneous squamous cell carcinoma incidence and non-melanoma skin cancer mortality: https://doi.org/10.1093/bjd/ljag315
- Kwiatkowska et al., Skin Health and Disease 2021;1(4):e61: an updated report on the incidence and epidemiological trends of keratinocyte cancers in the United Kingdom 2013 to 2018: https://doi.org/10.1002/ski2.61
- Venables et al., British Journal of Dermatology 2019;181(3):474 to 482: epidemiology of basal and cutaneous squamous cell carcinoma in the UK 2013 to 2015, a cohort study (the paper that introduced the first-per-person-per-annum count): https://doi.org/10.1111/bjd.17873
- Ahmed et al., British Journal of Dermatology 2026;194:273 to 282: ethnicity and the epidemiology of skin cancer incidence, a national retrospective population-based study in England, 2013 to 2020: https://doi.org/10.1093/bjd/ljaf352
- NHS: non-melanoma skin cancer, symptoms: https://www.nhs.uk/conditions/non-melanoma-skin-cancer/symptoms/

## Connected records

- cancers: [Bowen's disease (squamous cell carcinoma in situ)](https://onco.cc/cancers/bowens-disease/), [Cutaneous squamous cell carcinoma](https://onco.cc/cancers/cutaneous-scc/), [Locally advanced and metastatic basal cell carcinoma](https://onco.cc/cancers/locally-advanced-bcc/), [Melanoma](https://onco.cc/cancers/melanoma/), [Merkel cell carcinoma](https://onco.cc/cancers/merkel-cell-carcinoma/), [SHH-activated medulloblastoma](https://onco.cc/cancers/medulloblastoma-shh/), [Skin cancer (all types)](https://onco.cc/cancers/skin-cancer/)
- technologies: [Black salve and other escharotic pastes](https://onco.cc/technologies/black-salve-escharotics/), [Chemoprevention & risk-reducing surgery](https://onco.cc/technologies/chemoprevention/), [Confocal microscopy and optical coherence tomography for skin (VivaScope, VivoSight, deepLive)](https://onco.cc/technologies/confocal-oct-skin-imaging/), [Dermoscopy, total-body photography & AI skin analysis](https://onco.cc/technologies/dermoscopy-ai/), [Electrochemotherapy devices (Cliniporator)](https://onco.cc/technologies/electrochemotherapy-devices/), [Electron beam therapy systems (linac electrons, total skin electron units, mobile electron IORT)](https://onco.cc/technologies/electron-beam-therapy-systems/), [Facial reconstruction and facial prostheses: ears, orbits and noses](https://onco.cc/technologies/rejuv-recon-facial-prosthetics/), [Hedgehog pathway inhibitors](https://onco.cc/technologies/hedgehog-inhibitors/), [Immune checkpoint inhibitors](https://onco.cc/technologies/checkpoint-inhibitor/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [Multidisciplinary tumour boards](https://onco.cc/technologies/multidisciplinary-tumour-board/), [Photodynamic therapy lasers and light sources](https://onco.cc/technologies/photodynamic-therapy-lasers/), [Psycho-oncology and distress screening](https://onco.cc/technologies/psycho-oncology/), [Skin cancer screening (visual skin examination)](https://onco.cc/technologies/skin-cancer-screening/), [Small-molecule kinase inhibitors](https://onco.cc/technologies/kinase-inhibitors/), [Superficial and orthovoltage radiotherapy for skin cancer](https://onco.cc/technologies/superficial-radiotherapy/), [Survivorship care and late-effects surveillance](https://onco.cc/technologies/survivorship-care-plan/)
- targets: [ARHGAP35](https://onco.cc/targets/arhgap35/), [ARHGEF10L](https://onco.cc/targets/arhgef10l/), [BACH2](https://onco.cc/targets/bach2/), [BNC2](https://onco.cc/targets/bnc2/), [CCDC6](https://onco.cc/targets/ccdc6/), [CPEB3](https://onco.cc/targets/cpeb3/), [CPVL](https://onco.cc/targets/cpvl/), [CTSS](https://onco.cc/targets/ctss/), [CYP1B1](https://onco.cc/targets/cyp1b1/), [KNL1](https://onco.cc/targets/knl1/), [KRT5](https://onco.cc/targets/krt5/), [LATS1](https://onco.cc/targets/lats1/), [LPP](https://onco.cc/targets/lpp/), [MC1R](https://onco.cc/targets/mc1r/), [MSN](https://onco.cc/targets/msn/), [NACA](https://onco.cc/targets/naca/), [OCA2](https://onco.cc/targets/oca2/), [PABPC1](https://onco.cc/targets/pabpc1/), [PD-1](https://onco.cc/targets/pd1/), [PPM1D](https://onco.cc/targets/ppm1d/), [PPP6C](https://onco.cc/targets/ppp6c/), [PTCH1 (Patched 1)](https://onco.cc/targets/ptch1/), [PTPN14](https://onco.cc/targets/ptpn14/), [RASA1](https://onco.cc/targets/rasa1/), [RNASET2](https://onco.cc/targets/rnaset2/), [SLC45A2](https://onco.cc/targets/slc45a2/), [Smoothened (hedgehog pathway)](https://onco.cc/targets/smoothened/), [TGM3](https://onco.cc/targets/tgm3/), [TNS3](https://onco.cc/targets/tns3/), [Toll-like receptor 7 (TLR7)](https://onco.cc/targets/tlr7/), [TYR](https://onco.cc/targets/tyr/), [XPA](https://onco.cc/targets/xpa/), [ZBTB10](https://onco.cc/targets/zbtb10/)
- drugs: [Aminolevulinic acid (topical, for photodynamic therapy)](https://onco.cc/drugs/aminolevulinic-acid/), [Cemiplimab](https://onco.cc/drugs/cemiplimab/), [Fluorouracil (5-FU)](https://onco.cc/drugs/fluorouracil/), [Imiquimod](https://onco.cc/drugs/imiquimod/), [Methyl aminolevulinate](https://onco.cc/drugs/methyl-aminolevulinate/), [Nicotinamide](https://onco.cc/drugs/nicotinamide/), [Sonidegib](https://onco.cc/drugs/sonidegib/), [Vismodegib](https://onco.cc/drugs/vismodegib/)
- companies: [Caliber Imaging and Diagnostics](https://onco.cc/companies/caliber-imaging-diagnostics/), [DAMAE Medical](https://onco.cc/companies/damae-medical/), [Galderma](https://onco.cc/companies/galderma/), [Michelson Diagnostics](https://onco.cc/companies/michelson-diagnostics/), [Philogen S.p.A.](https://onco.cc/companies/philogen-s-p-a/), [Regeneron](https://onco.cc/companies/regeneron/), [Roche / Genentech](https://onco.cc/companies/roche-genentech/), [Sanofi](https://onco.cc/companies/sanofi/)
- pathways: [Basal cell carcinoma (KEGG map)](https://onco.cc/pathways/basal-cell-carcinoma-signalling/), [Field cancerisation](https://onco.cc/pathways/field-cancerisation/)
- terms: [Actinic keratosis (solar keratosis): sun damage, not cancer](https://onco.cc/terms/actinic-keratosis/), [Cancer stem cell theory and phenotypic plasticity](https://onco.cc/terms/cancer-stem-cell-theory/), [Creams, light and cold for basal cell carcinoma](https://onco.cc/terms/topical-and-destructive-treatment-bcc/), [Cryoablation](https://onco.cc/terms/cryoablation/), [Curative intent vs palliative intent](https://onco.cc/terms/curative-intent/), [Curettage and cautery](https://onco.cc/terms/curettage-and-cautery/), [How skin carcinoma is staged in Britain: UICC TNM, and why it is not the American system](https://onco.cc/terms/tnm-skin-carcinoma/), [Immune-related adverse events (irAEs)](https://onco.cc/terms/irae/), [Inherited syndromes that cause skin cancer: Gorlin syndrome and xeroderma pigmentosum](https://onco.cc/terms/inherited-skin-cancer-syndromes/), [Keratinocyte cancer (and why 'non-melanoma skin cancer' is being retired)](https://onco.cc/terms/keratinocyte-cancer/), [Late effects and survivorship toxicity](https://onco.cc/terms/late-effects/), [Mohs surgery](https://onco.cc/terms/mohs-surgery/), [Perineural invasion (PNI)](https://onco.cc/terms/perineural-invasion/), [Radiotherapy for skin cancer](https://onco.cc/terms/radiotherapy-for-skin-cancer/), [Resection margins (R0 / R1 / R2)](https://onco.cc/terms/resection-margins/), [Skin cancer after an organ transplant](https://onco.cc/terms/skin-cancer-after-organ-transplant/), [Skin cancer after cancer treatment](https://onco.cc/terms/second-primary-skin-cancer-after-cancer-treatment/), [Skin grafts and flaps after skin cancer surgery](https://onco.cc/terms/skin-graft-and-flap-reconstruction/), [Sun protection after a skin cancer diagnosis](https://onco.cc/terms/sun-protection-after-skin-cancer/), [The growth pattern on a basal cell carcinoma report: nodular, superficial, infiltrative, basosquamous](https://onco.cc/terms/bcc-growth-pattern/), [The margin in skin cancer surgery](https://onco.cc/terms/surgical-margins-keratinocyte-cancer/), [The next skin cancer: second primaries after a keratinocyte cancer](https://onco.cc/terms/second-primary-skin-cancer/), [The scar on the face after skin cancer surgery](https://onco.cc/terms/facial-scar-after-skin-cancer/), [Tumour mutational burden (TMB)](https://onco.cc/terms/tmb/), [What makes a skin cancer high risk: the UK feature lists](https://onco.cc/terms/skin-cancer-high-risk-features/), [Why nobody knows how many skin cancers there are: the counting rule behind every figure](https://onco.cc/terms/keratinocyte-cancer-counting/), [Why people stop taking hedgehog inhibitors](https://onco.cc/terms/hedgehog-inhibitor-tolerability/), [Wide local excision](https://onco.cc/terms/wide-local-excision/)
- trials: [BOLT](https://onco.cc/trials/bolt/), [Cemiplimab in basal cell carcinoma after a hedgehog inhibitor](https://onco.cc/trials/cemiplimab-advanced-bcc/), [Clinical Trial to Evaluate BO-112 in Patients With Basal Cell Carcinoma (BCC)](https://onco.cc/trials/nct06422936/), [Efficacy and Safety of Patidegib Gel 2% for Preventing Basal Cell Carcinomas on the Face of Adults With Gorlin Syndrome](https://onco.cc/trials/nct06050122/), [ERIVANCE BCC](https://onco.cc/trials/erivance/), [Flash Radiotherapy for Skin Cancer](https://onco.cc/trials/nct07455331/), [IMPACT (cemiplimab in advanced basal cell carcinoma)](https://onco.cc/trials/impact-bcc/), [L19IL2 or L19TNF or L19IL2/TNF in Patients With Basal Cell Carcinoma (BCC)](https://onco.cc/trials/nct07227350/), [L19IL2/TNF in Patients With Basal Cell Carcinoma](https://onco.cc/trials/nct07227870/), [Mohs surgery against ordinary excision for facial basal cell carcinoma (Maastricht trial)](https://onco.cc/trials/mohs-versus-excision-facial-bcc/), [Patidegib gel in Gorlin syndrome (phase 2A)](https://onco.cc/trials/patidegib-gel-gorlin-phase-2/), [Photodynamic therapy against cryotherapy for superficial basal cell carcinoma](https://onco.cc/trials/mal-pdt-versus-cryotherapy-superficial-bcc/), [Photodynamic therapy against imiquimod against fluorouracil for superficial basal cell carcinoma](https://onco.cc/trials/mal-pdt-imiquimod-fluorouracil-superficial-bcc/), [Photodynamic therapy against surgery for nodular basal cell carcinoma](https://onco.cc/trials/mal-pdt-versus-surgery-nodular-bcc/), [Placebo Microneedles in Healthy Volunteers (Part I) and Efficacy/Safety of Doxorubicin Microneedles in Basal Cell Cancer Subjects (Part II)](https://onco.cc/trials/nct04928222/), [Safety and Efficacy Study for the Treatment of Non-Aggressive Basal Cell Carcinoma With Photodynamic Therapy](https://onco.cc/trials/nct02144077/), [SCIN (curettage then imiquimod against excision for nodular basal cell carcinoma)](https://onco.cc/trials/scin-trial/), [SINS (surgical excision against imiquimod cream for basal cell carcinoma)](https://onco.cc/trials/sins-trial/), [STEVIE (vismodegib in ordinary practice)](https://onco.cc/trials/stevie/), [Study to Investigate the Efficacy and Safety of RP1 in Adult Patients With Organ Transplants and Advanced Skin Malignancies](https://onco.cc/trials/nct04349436/), [Surgery against radiotherapy for basal cell carcinoma of the face](https://onco.cc/trials/avril-surgery-versus-radiotherapy-bcc/), [To Assess the Safety and Efficacy of SP-002 with Vismodegib for the Treatment of Locally Advanced Basal Cell Carcinoma](https://onco.cc/trials/nct06344052/), [VISMONEO (vismodegib before surgery for locally advanced basal cell carcinoma)](https://onco.cc/trials/vismoneo/)
- institutions: [British Association of Dermatologists](https://onco.cc/institutions/british-association-of-dermatologists/), [Guy's and St Thomas' NHS Foundation Trust / King's Health Partners Cancer Centre](https://onco.cc/institutions/guys-st-thomas/), [Leeds Cancer Centre, St James's University Hospital](https://onco.cc/institutions/leeds-cancer-centre/), [National and Kapodistrian University of Athens, School of Medicine](https://onco.cc/institutions/nkua-athens/), [Newcastle Cancer Centre / Northern Centre for Cancer Care](https://onco.cc/institutions/newcastle-cancer-centre/), [Nottingham University Hospitals Cancer Centre (City Hospital)](https://onco.cc/institutions/nottingham-cancer-centre/), [Skcin (the Karen Clifford Skin Cancer Charity)](https://onco.cc/institutions/skcin/), [University of Arizona Cancer Center](https://onco.cc/institutions/arizona-cancer-center/)
- people: [Hywel Williams](https://onco.cc/people/hywel-williams/), [Nick Levell](https://onco.cc/people/nick-levell/), [Susana Puig](https://onco.cc/people/susana-puig/)
- key papers: [Esteva 2017: a deep neural network classifies skin cancer at dermatologist level](https://onco.cc/key-papers/paper-esteva-skin-cancer-deep-learning-nature-2017/)

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JSON: https://onco.cc/api/v1/entities/basal-cell-carcinoma.json