Synopsis
Recognise nodular, superficial, morphoeic and pigmented basal-cell carcinoma, stratify anatomical and histological risk, refer appropriately and explain why apparently slow growth can still cause major local destruction.
- Nodular BCC is a pearly or translucent papule with arborising vessels, rolled edge and possible central ulceration.
- Superficial BCC is a thin pink-red, brown or subtly pigmented scaly plaque, often on trunk, and can resemble eczema.
- Morphoeic BCC appears scar-like, firm, pale or yellow-white and poorly defined; its subclinical extension makes it high risk.
- Pigmented BCC occurs in every skin tone and can mimic melanoma; refer diagnostic uncertainty without destructive treatment.
- Most low-risk BCCs are referred routinely, but NICE advises urgent referral when delay could materially affect outcome because of site or size.
- Surgical excision is standard for many tumours; Mohs surgery is considered where tissue conservation and complete margin control matter.
- Topical imiquimod, topical 5-fluorouracil, curettage, cryotherapy or photodynamic therapy suit selected low-risk superficial lesions after diagnosis.
- Metastasis is rare, but local invasion can be severe; new pain, numbness, weakness or fixation is not compatible with casual routine follow-up.
Key red flags
Rapid change, deep fixation, cranial-nerve symptoms, recurrent tumour, ill-defined morphoeic plaque, large neglected ulcer or periocular, nasal, lip or ear disease threatens critical structures and requires urgent specialist assessment.
An indurated ivory or yellow-white poorly defined plaque can extend well beyond what is visible.
New pain, paraesthesia, numbness or weakness near a tumour suggests nerve invasion and requires urgent escalation.
Investigation priorities
Identify arborising vessels, shiny white structures, ulceration, leaf-like areas and blue-grey nests.
Management branches
A well-defined primary lesion is away from high-risk sites and lacks aggressive features.
- Document site, size, border and dermoscopy and refer through the local routine BCC pathway when clinically appropriate.
- Use standard excision with histology for many lesions or a selected non-surgical option for confirmed superficial low-risk disease.
- Review pathology, healing and recurrence advice and support ultraviolet protection and whole-skin awareness.