BCC is the most common cancer in the world, with incidence exceeding that of all other cancers combined.

BCC represents approximately 80% of all cases of non-melanoma skin cancer (NMSC), and predominantly affects the Caucasian and older population. BCC originates in the basal layer of the epidermis, with studies so far suggesting origins primarily being from stem cells. (Peterson SC, et al. Cell stem cell 16.4 (2015): 400-412;  Sehgal VN, et al. Skinmed 12.3 (2014): 176-81)

BCC can develop anywhere, though it is most commonly found in sun exposed areas. It is possible to have more than one BCC. It is rare but possible for BCC to spread, or metastasize – it is estimated that ~1% of BCCs can be classified as advanced BCC. (Mohan SV & Chang ALS. Curr Derm Rep 2014;3:40–5)

Advanced BCC (aBCC)

Advanced BCC encompasses a heterogeneous assortment of cases, including metastatic BCC as well as locally advanced BCC (for which no formal definition exists but which generally includes large, deep, aggressive, or recurrent tumors).

Most BCCs can be effectively treated with standard surgical excision, Mohs micrographic surgery, curettage and electrodessication, radiotherapy, and/or superficial field therapies (including 5-fluorouracil, imiquimod, and photodynamic therapy); however, a minority of patients develop advanced BCC.

Locally advanced BCC (laBCC)

In general, this classification often includes large, aggressive, or recurrent tumors or those with deeper penetration into the underlying skin and surrounding tissues.

LaBCC may be broadly categorized as cases for which (further) surgery is considered inappropriate (i.e., would be substantially disfiguring, may cause significant morbidity, loss of function), and radiation is considered inappropriate as a single modality or second-line treatment.

Metastatic BCC (mBCC)

Metastatic BCC is defined as primary cutaneous basal cell carcinoma that has spread to local or distant lymph nodes or to distant organs or tissues.

Migden, et al. Cancer Treatment Reviews 64 (2018) 1–10; 2. Mohan SV & Chang ALS. Current dermatology reports 3.1 (2014): 40-45

BCC can be classified into indolent or aggressive subtypes:

Indolent subtypes

Nodular and superficial are the most common indolent subtypes of BCC. Nodular BCC, the most common histological subtype of BCC, predominates on the head, especially the cheeks, nasolabial folds, forehead, and eyelids. Superficial BCC, the second most common histological subtype, is frequently found on the trunk and extremities.

Aggressive subtypes

]such as morpheaform, micronodular, infiltrative, and mixed histologies that are estimated to comprise 5–15% of BCC. They show the deeper invasion of tissues and a higher rate of recurrence. Frequently found on the head and neck.


Marzuka AG & Book SE. The Yale journal of biology and medicine 88.2 (2015): 167-179.

Treatment Pathway

Recent clinical guidelines recommend the use of Hedgehog Pathway Inhibitors (HPIs) in aBCC patients when neither surgery nor radiotherapy are an option. There is no approved treatment option or guideline-recommended therapy for aBCC patients who have progressed on HPI therapy or are intolerant to HPIs.

Real-world data indicate that the majority of aBCC patients who progress on or are intolerant to HPIs are managed with surgery or radiotherapy (36%-65%). Other treatment options include HPIs, itraconazole, chemotherapy, or inclusion in clinical trials of immuno-oncology drugs (IOs).

For more information please click below to watch our September 2020 webinar titled Basal Cell Carcinoma: What Patients Need to Know


Basal Cell Carcinoma:   What Patients Need to Know

September 29, 2020

Dr. Max Sauder, Onco-dermatologist at Princess Margaret Cancer Centre, reviews the latest news, clinical data and other updates as they relate to the treatment of cutaneous basal cell carcinoma (BCC), a common and sometimes metastatic skin cancer.  Dr. Sauder provides an update on skin cancer statistics in Canada, the science behind primary and metastatic BCC diagnosis and treatment, and shares his key insights into what the landscape of metastatic BCC immuno-oncology treatment looks like for the near future in Canada.

Educational Video Series: What is Basal Cell Carcinoma (BCC)

Sept 13, 2016

Understanding the basics around basal cell carcinoma (BCC)


Additional Resources

New! NCCN® Guidelines for Patients booklet on Basal Cell Carcinoma (BCC, or Basal Cell Skin Cancer):

Coming Soon! SYSF Patient Resource and BCC awareness campaign to be released in Autumn 2021

NOTE: The information on the Save Your Skin website is not intended to replace the medical advice of a doctor or healthcare provider. While we make every effort to ensure that the information on our site is as current as possible, please note that information and statistics are subject to change as new research and studies are published.


Making awareness and education available is crucial. Since 2006, the Foundation has worked to raise awareness of melanoma and non-melanoma skin cancers focusing on education, prevention and the need for improved patient care.