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Ask Dr. Ben: Is Basal Cell Carcinoma Fatal?

By , On , In Skin Cancer Physician

If you are concerned that it Basal Cell Carcinoma is fatal, the short answer is no. The risk of death from this type of cancer is extremely low. However, it has the potential to cause significant disfigurement and that can have a serious impact on your life.

The prognosis for most patients with primary BCC is excellent. These lesions are typically slow growing and metastatic disease is a very rare event. Estimates of the rate of metastasis for BCC was estimated to be 0.1% or even lower. The mortality rate for BCC is approximately 0.05% However, it is not something that you want to ignore and leave untreated.

Basal Cell Carcinoma (BCC) is still a cancer and is locally invasive, aggressive and can cause considerable disfigurement by locally destroying skin, cartilage and even bone. Untreated advanced lesions typically ulcerate, creating wound care problems. Therefore, treatment of BCC is definitely indicated.

Having a Basal Cell Carcinoma also puts you at risk of repeatedly developing Basal Cell Carcinomas. Approximately 15% of patients with one BCC subsequently develop another primary BCC within one year. 35% develop a new BCC within 5 years. This risk increases to approximately 34% within one year and 75% within 5 years for patients with more than one previous BCC.

Patients who develop a BCC are also at increased risk of developing both Squamous Cell Carcinoma and Melanoma. Their risk of developing Melanoma is more than 3 times higher than the general population.

There is also a risk of recurrence of Basal Cell Carcinoma. Recurrence may appear months to years after initial treatment, leading to local tissue destruction, morbidity, increased risk for metastasis, and the need for re-treatment.

Four image collage with examples of the varying appearance of basal cell carcinoma.
Basal Cell Carcinoma often presents as a pinkish or red, raised bumps.

Factors that increase the risk for recurrence include:

  • lesions in sites of prior radiation
  • lesions in high-risk areas of the face
  • lesions on the hands and feet
  • recurrent lesions
  • large lesions – more than 10mm in diameter
  • lesions with aggressive pathologic features
  • lesions in immunocompromised patients
  • lesions where there was tumour growth in or around nerves

There has also been a study reporting an overall twofold increased risk of second malignancies (including lung, colon, and breast cancer) in people with either confirmed cutaneous Squamous Cell Carcinoma or Basal Cell Carcinoma.

Although this study suggests an increased risk of other cancers, routine evaluation for systemic malignancy is not indicated in healthy individuals who are diagnosed with Basal Cell Carcinoma.

As mentioned previously, metastatic BCC is luckily very rare and usually occurs in association with deeply invasive or very large lesions.Common sites for metastasis include the regional lymph nodes, lungs, bones, skin and liver.

Metastatic disease unfortunately has a very poor prognosis, with a median survival of 10 months after diagnosis of metastatic disease.

In summary, Basal Cell carcinoma is the least serious of all the types of skin cancer. It is extremely unlikely to be deadly and it is almost always possible to get completely cured of BCC. However, it is not harmless, and it should not be taken lightly. After all, it is still a cancer.

Want to learn more about how you can prevent skin cancer? Read our blog on Vitamin B3.