The clinical types of BCC
There are different types of BCC requiring different treatments. The broad category of BCC may be established clinically prior to excision. However, the pathology report is required to identify any concerning features and to confirm the BCC subtype.
Let’s describe the two main types of BCC:
- Nodular BCC that is raised, shiny, may be pigmented & usually occurs on the face. Nodular BCC needs to be cut out.
- Superficial BCC that is flat, pink, & usually occurs on the trunk or limbs. This may be treated with skin cancer cream.
Now let’s look at all the main types of BCC in more detail.
Superficial BCC accounts for around 30% of Basal Cell Carcinoma. The condition tends to occur in a younger age group than those affected by other BCC types. UV light is a little less important in the development of superficial BCC than nodular BCC.
Superficial BCC appears as a pink or red flat lesion with well defined borders. On stretching the skin, there may be a slightly raised edge though this is a subtle sign. When you know what to look for, the edge may be slightly pearly in appearance. The lesion itself may be slightly shiny and/or scaly. These signs are not very specific, and a superficial BCC may look similar to an IEC (Bowens disease). A dermatoscope will certainly help distinguish the two.
Superficial BCC may be treated non-surgically. The most common non-surgical treatment is with Imiquimod (®Aldara) cream.
Nodular BCC is the most common type of BCC, accounting for around 60% of all Basal Cell Carcinoma. UV light is the key risk factor. This type of BCC is found most commonly on the face, head and neck.
A nodular BCC is a raised lesion. Like all BCC, stretching the skin around it may make the pearly colour more obvious. The colour of the lesion itself is pink or red. There may be a central ulcer (the so-called “rodent ulcer”) or a central crust. Look for fine blood vessels coursing over the top of it in the shape of a branch (“Arborising Vessels” – much better seen with a dermatoscope). The lesion tends to bleed with minor trauma and may be a little itchy.
A Pigmented BCC is simply that … a BCC with some brown or black areas within it. Typically, a pigmented BCC is not completely pigmented and will have some pink or red area and/or pearly border like a non-pigmented one. They may be reasonably flat or raised like a nodular BCC. The important point about this uncommon type of BCC is that it may look like a melanoma.
Morphoeic Basal Cell Carcinoma accounts for 5 to 10% of BCC. The lesion is hard to spot because doesn’t look like a normal BCC! It is scar-like (hence the term morphoea). Typically, it feels hard or firm with an ivory colour, and the borders are poorly defined. When pink, it may have fine blood vessels and be easier to spot.
A morphoeic BCC tends to spread and has a higher recurrence rate – and so is harder to treat than other types.