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Clinical Review

Basal cell carcinoma

BMJ 2003; 327 doi: (Published 02 October 2003) Cite this as: BMJ 2003;327:794
  1. C S M Wong, specialist registrar in dermatology1,
  2. R C Strange, professor in clinical biochemistry2,
  3. J T Lear (, consultant dermatologist1
  1. 1 Dermatology Centre, University of Manchester, Hope Hospital, Salford, Manchester M6 8HD
  2. 2 Keele University Medical School, North Staffordshire Hospital, Stoke-on-Trent, Staffordshire
  1. Correspondence to: J T Lear

    The authors of this review aim to provide a comprehensive overview of basal cell carcinoma, concentrating in particular on incidence, risk factors, molecular genetics, clinical features, and treatment


    Basal cell carcinoma is the most common malignancy in white people.1 Its incidence is increasing worldwide by up to 10% a year. Although mortality is low as basal cell carcinoma rarely metastasises, this malignancy causes considerable morbidity and places a huge burden on healthcare services worldwide. Furthermore, people who have this condition are at high risk of developing further basal cell carcinoma and other malignancies. This review aims to present a concise and comprehensive overview of this important condition, concentrating on recent advances in our understanding of its epidemiology, clinical features, molecular genetics, and treatment.

    Sources and selection criteria

    This review is based on information obtained from a recent Medline search with basal cell carcinoma, rodent ulcer, and non-melanoma skin cancer as key words. We also used our extensive knowledge of the literature on basal cell carcinoma. We attached greater importance to more recent studies.


    The incidence of basal cell carcinoma shows marked geographical variation. The age standardised incidence of basal cell carcinoma in south Wales was estimated at 114.2 per 100 000 population in 1998.2 The overall age and sex standardised annual incidence in Minnesota, USA, was reported at 146 per 100 000. In Australia, the incidence is much higher at 726 per 100 000.3 These figures are likely to be underestimates, as basal cell carcinoma tends to be under-reported to the cancer registries.

    In white populations in North America, the incidence has increased at more than 10% a year, leading to a lifetime risk of 30% of developing a basal cell carcinoma.4 With an ever increasing elderly population, the disease is likely to become more of a problem in the …

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