Stages of Basal Cell Carcinoma

Cancer staging is a way of describing how extensive a cancer is. It is rarely necessary to stage basal cell carcinoma (BCC).1 BCC grows very slowly and almost never spreads (metastasizes) to distant parts of the body.1 BCC is usually treated and cured before it can spread.

Doctors do evaluate the risk that BCC will recur (return) after treatment. BCC is categorized as “low risk” or “high risk.” The choice of treatment depends on the risk category. Some treatments used for low-risk BCC cannot be used for high-risk BCC. The category is based on:2

  • Location
  • Size
  • Borders of the tumor
  • Medical history
  • Features of the cancer that are seen under a microscope

If it is necessary to stage BCC, the criteria for squamous cell carcinoma are used.3

Low-risk basal cell carcinoma

Low-risk BCC are generally smaller and have a well defined border.2 Primary (first) tumors are less risky than recurrent tumors. Nodular or superficial tumors are less risky. Nodular BCC is usually pearly and dome-shaped. Superficial BCC looks like a scaly pink or red plaque.

Characteristics of Low-Risk Tumors2

  • Location and size: On chest, arms, or legs: <20 mm; on cheeks, forehead, scalp, neck, and shins: <10 mm
  • Border: Well defined
  • Primary or recurrent: Primary (first tumor)
  • Patient has a weakened immune system? No
  • Tumor developed at the site of prior radiation therapy? No
  • Tumor type: Nodular or superficial
  • Tumor surrounds a nerve? No

Excision is a primary treatment for low-risk and high-risk BCC.2 Additional treatment options for low-risk BCC are curettage and electrodessication, cryotherapy, or photodynamic therapy. Fluorouracil and imiquimod are topical medications used to treat low-risk thin BCC.

High-risk basal cell carcinoma

High-risk BCC is larger.2 The borders of the tumor are harder to see. Tumors that recur once are more likely to recur again. Some people who have had radiation therapy for an unrelated condition develop BCC at the radiation site. These tumors are considered high risk. People who have a weakened immune system are more likely to have recurrent BCC. Tumors that grow aggressively, such as morpheaform BCC, are high risk. So are tumors that surround a nerve.

Characteristics of High-Risk Tumors2

  • Location and size: On chest, arms, or legs: ≥20 mm; on cheeks, forehead, scalp, neck, and shins: ≥10 mm; on central face, around the eyes, nose, lips, jaw, near the ear: Any size
  • Border: Poorly defined
  • Primary or recurrent: Recurrent
  • Patient has a weakened immune system? Yes
  • Tumor developed at the site of prior radiation therapy? Yes
  • Tumor type: Morpheaform or aggressive
  • Tumor surrounds a nerve? Yes

The first choice of treatment for high-risk BCC is Mohs surgery.2 Excision with a wider margin is an alternative. Your doctor may recommend adjuvant therapy. Adjuvant therapy is a second treatment given after the primary (main treatment). Adjuvant therapy can help reduce the risk of recurrence. Adjuvant therapy may be done with radiation therapy or targeted medication therapy.

Written by: Sarah O'Brien | Last reviewed: May 2017.
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