The most common skin cancer in humans grows slowly and almost never spreads — but it destroys tissue locally. Here is how to recognise it.
Basal cell carcinoma is the most common malignant tumour in humans, accounting for about three quarters of all skin cancers. It is also the one most often ignored, because it grows slowly and does not hurt.
How to recognise it
- A small sore that will not heal, bleeds from time to time and crusts over, then opens up again
- A shiny, pearly lump with fine blood vessels on its surface
- A flat reddish patch that does not respond to creams
- A whitish, waxy area that looks like a scar, although there has been no injury
- A lesion with a raised edge and a sunken, bleeding centre
The most typical scenario is the first: a small sore that the person puts down to shaving or a scratch heals halfway, then opens up again — and this goes on for months.
Where it appears
Mainly on the areas that have had the most sun over a lifetime — the nose, cheeks, forehead, ears, eyelids, the scalp where hair is thinning, the neck and the décolletage.
About one in ten cases occurs around the eyes, which makes treatment more delicate: there, reconstruction has to restore not only appearance but also the eyelid's ability to close and protect the eye.
Risk factors
- Cumulative sun exposure over a lifetime, not just last summer
- Sunburn in childhood
- Fair skin, light-coloured eyes, freckles
- Sunbeds
- Outdoor work
- A weakened immune system
- A previous skin cancer
Why treatment should not be put off
Basal cell carcinoma almost never spreads to distant parts of the body. That is precisely why it is underestimated.
Its danger lies elsewhere: it grows locally and destroys whatever it meets — skin, cartilage, bone. A tumour on the nose left for five years no longer needs a small excision but a reconstruction. A tumour next to the eye can involve structures whose repair requires several stages of surgery.
The difference between a five-millimetre and a two-centimetre defect is the difference between a single scar and several operations.
How it is treated
When the diagnosis is uncertain, dermoscopy comes first, followed by a biopsy if needed — treatment never starts from an assumption. The main treatment is surgical excision with clear margins, that is, with a rim of healthy tissue (skin) around the tumour. The tissue is always sent for histological examination, which also confirms whether the margins are clear.
Small defects are closed directly. Larger ones are reconstructed with a local flap or a skin graft chosen to match the colour and thickness of the surrounding skin.
For tumours in critical sites — the eyelid, nose or ear — excision and reconstruction are sometimes carried out in two stages, so that histology can confirm clear margins first. This is not a delay but the safer approach. For selected high-risk sites and for recurrences, the treatment of choice is Mohs surgery — staged excision with microscopic margin control during the operation itself. It is not available everywhere, and whether it is an option is discussed case by case.
After treatment
Follow-up continues for years. Anyone who has had one skin cancer has a higher risk of developing another — this, and not any doubt about the first operation, is the main reason for regular check-ups.
And the cheapest measure, which is entirely up to you: sun protection all year round, no sunbeds, and checking your own skin regularly.
Have a question about this topic?
Consultations take place at Solica Medical Centre and Grupchevi Plus Medical Centre in Varna. Book online or send an enquiry — you will receive a reply within 24 hours.