What is basal cell carcinoma?
Basal cell carcinoma (BCC) starts in the basal cells — found in the deepest layer of the epidermis, the skin's outer layer. It's by far the most common type of skin cancer in Australia, accounting for roughly two-thirds of all skin cancers diagnosed nationally.
BCC typically grows slowly, over months to years, and almost never spreads (metastasises) to other parts of the body. That makes it the least dangerous of the three main skin cancers — but it isn't harmless. Left untreated, a BCC can keep growing into the surrounding skin, and in some cases deeper into nerves, cartilage or bone, particularly around the face. This local invasion is why early diagnosis and treatment matter, even though BCC is rarely life-threatening.
There are several subtypes of BCC, including nodular (the most common), superficial, and morphoeic/infiltrative (a less common, more aggressive-growing pattern that can be harder to see the true edges of). Your doctor will identify the likely subtype on examination and confirm it with a biopsy if needed, as this affects the recommended treatment.
Causes and risk factors
BCC is overwhelmingly caused by cumulative exposure to ultraviolet (UV) radiation from the sun over a lifetime, which is a major reason Australia — with some of the highest UV levels in the world — has such a high skin cancer burden.
- Cumulative sun exposure — years of everyday UV exposure, not just sunburns, add up.
- Fair skin that burns easily and tans poorly (Fitzpatrick skin types I–II).
- Age — most common over 40, though it can occur younger.
- A history of sunburn, particularly blistering sunburns.
- Outdoor occupations such as farming, building, and landscaping — occupational UV exposure is estimated to cause tens of thousands of keratinocyte cancers in Australia each year.
- A personal history of BCC or other skin cancer, which increases the likelihood of developing further lesions.
- Immunosuppression, including from certain medications or organ transplantation.
Signs to look for
BCC can look different depending on the subtype, but some patterns are common:
- A pearly or translucent lump, sometimes with visible small blood vessels (telangiectasia) across its surface.
- A lump with a rolled, raised border and a central area that may ulcerate, crust or bleed.
- A sore that doesn't heal within about four weeks, or one that heals and then reopens.
- A flat, scaly, reddish patch that can resemble a stubborn patch of eczema (more typical of superficial BCC).
- A scar-like area with no clear history of injury (can indicate a morphoeic BCC).
⚠ See a doctor if
You notice any new, non-healing, pearly, or bleeding spot on your skin — especially on sun-exposed areas like the face, ears, neck, scalp or shoulders — that has been present for more than a few weeks. Don't wait for it to become painful; BCC is often painless in its early stages.
How we diagnose BCC
Diagnosis usually starts with a clinical examination using dermoscopy — a handheld magnification device that lets your doctor examine the structure of a lesion beneath the skin's surface, well beyond what's visible to the naked eye. If a lesion looks suspicious, we'll usually recommend a biopsy (a small sample, or occasionally the whole lesion, removed under local anaesthetic) to confirm the diagnosis and subtype under the microscope before planning treatment.
Treatment options available at our clinic
The right treatment depends on the BCC's subtype, size, depth and location. Our Accredited Skin Cancer Doctors will talk you through the options suited to your specific lesion.
Surgical excision
The lesion is cut out under local anaesthetic with a margin of healthy surrounding skin, then sent for histopathology to confirm complete removal. The most common and reliable treatment for most BCCs.
Curettage & cautery
The lesion is scraped away and the base treated with heat. Often suited to smaller, low-risk, superficial or nodular BCCs on the trunk or limbs.
Cryotherapy
Freezing treatment with liquid nitrogen, used for select superficial, low-risk lesions in appropriate locations.
Photodynamic therapy (PDT)
A light-activated topical treatment well suited to superficial BCCs, particularly where a good cosmetic result is a priority, such as on the face.
For larger, recurrent, or more complex BCCs — particularly around the nose, eyes, ears or lips — we may refer you to a plastic surgeon or Mohs surgery specialist for the best possible functional and cosmetic outcome.
With appropriate treatment, cure rates for BCC are excellent. Because having one BCC increases the chance of developing another, we recommend regular skin checks going forward — we'll advise how often based on your individual risk.
Prevention & early detection
- Follow the SunSmart five: slip on sun-protective clothing, slop on SPF 30+ (or higher) broad-spectrum sunscreen, slap on a broad-brimmed hat, seek shade, and slide on wraparound sunglasses.
- Reapply sunscreen every two hours, and more often if swimming or sweating.
- Check the daily UV index — protection is needed whenever it reaches 3 or above, which is most of the year in Queensland.
- Book a professional skin check at least annually if you're over 40, fair-skinned, or have a personal or family history of skin cancer.
Frequently asked questions
Is basal cell carcinoma dangerous?
BCC very rarely spreads to other parts of the body, so it's not usually life-threatening. Left untreated, though, it can keep growing locally and invade deeper skin, nerves and tissue, making treatment more complex and increasing the risk of scarring, especially on the face. Early treatment keeps things simple.
How is a BCC removed?
Most BCCs are removed with a straightforward excision under local anaesthetic, or with curettage and cautery for smaller, superficial lesions. Cryotherapy or PDT may suit select superficial BCCs. Your doctor will recommend the best option for your specific lesion.
Does Medicare cover BCC treatment?
Medicare rebates generally apply to the medically necessary diagnosis and treatment of skin cancer, including biopsies and excisions. Out-of-pocket costs vary by procedure — see our Fees page or ask our reception team for current details.
Will a BCC come back after treatment?
When fully removed with clear margins, most BCCs don't return. However, having had one BCC raises your risk of developing another, so we recommend ongoing annual skin checks.