Facial basal cell carcinoma

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e5342 (Published 21 August 2012)
Cite this as: BMJ 2012;345:e5342

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  1. Julia M Baxter, specialty registrar in ophthalmology,
  2. Anand N Patel, specialty registrar in dermatology,
  3. Sandeep Varma, consultant dermatologist and dermatological surgeon
  1. 1Nottingham University Hospitals NHS Trust, Queen’s Medical Centre, Nottingham NG7 2UH, UK
  1. Correspondence to: S Varma sandeep.varma{at}nuh.nhs.uk
  • Accepted 1 August 2012

Summary points

  • Basal cell carcinoma (BCC) is a the most common human cancer and its incidence is increasing

  • Most BCCs occur on the head and neck and are easily recognised and treated

  • With timely recognition and treatment the outlook is usually excellent

  • Many different treatment options are available

  • Difficult to treat areas require specialist intervention

  • The cost to the NHS of treating BCC and other non-melanoma skin cancers is high

Basal cell carcinoma (BCC) is a locally invasive cancer of epidermal basaloid cells. It is the most common cancer in humans,1 and its incidence will soon surpass that of all other cancers.2 Skin cancers are categorised into two groups—melanomas and non-melanoma skin cancers. Of the non-melanoma skin cancers, 75-80% are BCCs3 4 5 and up to 85% of these are on the head and neck.4 5 6 7 8 9 10 11 12 13 14 15 16 The remainder are predominately squamous cell carcinomas. Delay in presentation is associated with increased tumour growth.17 Timely recognition is important because early identification can limit the extent of facial tissue involvement and subsequent resection, thereby resulting in a better cosmetic and functional reconstruction. Evidence suggests that denial is the main reason for delay in presentation with non-melanoma skin cancer.17

This review focuses on the diagnosis, investigation, and management of BCC of the head and neck.

Sources and selection criteria

We searched PubMed using keywords “basal cell carcinoma”, “facial basal cell carcinoma”, “facial non-melanoma skin cancer”, “head and neck basal cell carcinoma”, and “head and neck non-melanoma skin cancer”. We targeted more recent studies and review articles. We also consulted National Institute for Health and Clinical Excellence guidelines and other national guidance.

Who gets BCC?

The incidence of BCC varies geographically (table) and is increasing worldwide.10 11 12 13 14 15 18 19 20 21 …

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