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Basal Cell Carcinoma

Checked: 23-02-2022 by Rob Adams Next Review: 23-02-2023

Overview

Basal cell carcinoma (BCC) is the commonest from of skin cancer accounting for almost 80% of all skin cancers (1).

While BCCs very rarely metastasize, they can cause significant morbidity by local tissue invasion and destruction, particularly on the head and neck (1) - see red flags below.

CKS has a useful guide to symptoms suggestive of skin cancer and when to refer (2)

(1) Basal Cell Carcinoma - an overview - PCDS

(2) Symptoms suggestive of skin cancer - Clinical Knowledge Summaries

Red Flags

Please consider Skin - 2WW referral in the following circumstances (taken from 2WW form):

Refer patients to rule out suspected basal cell carcinoma if there is particular concern that a delay may have a significant impact on treatment outcomes.

i.e.If the lesion is on the head and neck AND one of more of the following:

there is rapid growth
the lesion is on or near the eye, nose,lip or ear
has a diameter of >2cm
is incompletely excised or recurrent

Please use the routine referral process to rule out suspected basal cell carcinoma for patients who do not meet the particular concern criteria (see below).

Referral

If there is no indication for 2WW referral then patients can be referred routinely. Alternatively, if there is diagnostic uncertainty, Dermatology Advice and Guidance can be used with good quality photos (and dermoscopy pictures if possible) attached.

The following services are available to patients in BNSSG via eRS and patients will be offered a choice of provider unless a preference is stated in the referral:

NBT dermatology (BCC service Southmead)
UHBW dermatology (Dermatology BRI)
Somerset Surgical Services (General Plastic Surgery Weston) - wait times for this service may be better than the services above.

Please include photos of the lesion you are concerned about as this can help services to prioritise patients appropriately and can help to reduce waiting times for patients.

See guide to taking good quality clinical images below:

Patients or referrers should be advised to view this video to help ensure good quality images are returned. A written guide is also available How to Photograph your skin from home (also available on the ICB website for sending link to patients: https://bnssg.icb.nhs.uk/library/how-photograph-your-skin-home/

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.