Basal cell carcinoma

Last revised by Calum Worsley on 27 May 2022

A basal cell carcinoma (BCC) is one of the commonest non-melanocytic types of skin cancer

Typically present in elderly fair-skinned patients in the 7th to 8th decades of life. There may be an increased male predilection.

Multiple basal cell carcinomas may be present in those with Gorlin-Goltz syndrome.

It is an indolent primary cutaneous neoplasm arising from the basal layer of the epidermis.

On ultrasound, small primary cutaneous basal cell carcinomas tend to usually appear as well‐defined oval hypoechoic or heterogeneous dermal structures; although the lesions can also affect deeper layers. Basal cell carcinomas can have hyper-echoic spots, which if present has been reported to be a useful sign to differentiate from other types of skin cancer. These hyperechoic spots can have a "cotton flower-like appearance" and usually does not show posterior acoustic shadowing artifact that is classically described in gross calcified structures 4.

Generally reported signal characteristics include 1:

  • T1: isointense or hyperintense (relative to muscle)
  • T2: hyperintense (relative to muscle)
  • T1 C+(Gd): enhances 

It is often locally aggressive, may invade the skin and adjacent structures, including the muscles and bones. It has a low metastatic potential (but can very rarely metastasize). It also has a high rate of recurrence. 

Surgery is the treatment of choice of primary basal cell cancers; chemotherapy (e.g. sonidegib (Odomzo) is used for metastatic cases.

ADVERTISEMENT: Supporters see fewer/no ads

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.