Hi,

Staging isn't usually done for Basal Cell, it's only done for skin tumours that are invasive (grow below the skin) such as melanoma and some squamous cell cases. It will only be done for a BCC that is very large - usually because it's been left untreated for years, spread on the skin and has then begun to grow below the skin. 

The size of the lesion does not equate to the depth of it & therefore you can't guess at the possible stage by it's size on the skin. The staging you refer to is usually for melanoma, not BCC.

Have you been diagnosed with a BCC or are you currently awaiting a dermatology appointment? 

BCC is very rarely invasive and is successfully treated, either by a chemo cream or surgical removal. Members of my family have had 4 BCC removed over the years (3 on the face and one on the back) and they've been successfully treated.

Angie (Stage 3 melanoma patient since 2009)

Hi Angie,

Thank you for your reply. When I had a look online, the staging I’ve mentioned is for BCC, it’s just that - as you’ve said - staging is rarely done for BCC.

I suppose what’s confusing me is if staging is only done if the BCC is very large, but you can’t guess at the stage by the size on the skin because it doesn’t equate to the depth, how do they know it’s large in the first place in order to know whether it needs to be staged? (Does that make sense?)

To answer your question, I’m currently awaiting dermatology appt for possible BCC.

Thanks,

Cara

It's when it's very large because it's been left for years before medical help is sought. BCC is very slow to grow and spread on the skin. To reach a size where it's in danger of growing downwards, it has to have been visible for years. If you haven't had the lesion for long you have nothing to worry about when it comes to becoming invasive. If your lesion has been growing larger over a few years, there is a small possibility of it growing below the skin. But again, the diameter of the lesion doesn't equate to the depth. It's the same with melanoma, a very small mole can grow very deep into the layers of skin. It's not until it's all been removed that they can see the depth and stage it. I hope that helps explain it better? 

Hi Angie,

Thank you - that does help explain things better. I’m still a little bit confused because there seems to be a contradiction here - you’ve said that ‘to reach a size where it’s in danger of growing downwards, it would have had to be growing for years’, but also ‘the diameter of the lesion doesn’t equate to the depth’. Those two statements seem to contradict each other. Is there something I’m misunderstanding?

I realised yesterday that mine has been visible for 2 years and I just never noticed it because the first year it was so tiny (just like a freckle), so I am concerned about the length of time it’s been left. When I noticed it a year in I sought advice from a doctor and was told it was a granuloma and nothing to worry about, but it seems that was probably a misdiagnosis. It’s only 3mm wide, but seems to be maybe 1.5mm thick (though it’s hard to measure), and my understanding is 2mm is considered advanced. I also accidentally removed the whole thing twice and it’s still grown to that height afterwards, so I’m scared it will have grown even more below the surface, where it will have been undisturbed.

To try and explain the confusion - a BCC has to have been growing & spreading on the skin for several years for it to then start growing vertically below the skin.

However, the diameter of the BCC on the skin doesn't mean it's grown by the same depth below the skin ie. a BCC with a diameter of 5mm on the skin will not have necessarily grown vertically 5mm below the skin - it could be anything from 0.1mm deep to 10mm deep. The horizontal and vertical sizes don't correspond. If they did, a dermatologist would be able to look at a BCC of 5mm diameter and confidently predict that it's depth is also 5mm. Only a removal & biopsy can ascertain  the depth.

When talking about the depth of the lesion that's started to grow below the surface (because it's been left years without being treated), the depth is taken from the skin downwards - it doesn't include the depth of the lesion above the skin. So, in explanation, if your lesion has started growing below the skin & it is 1.5mm thick on top of the skin, only the depth below the skin's surface is used for Staging purposes. 1.5mm above the skin and 2mm below the skin aren't added together to make 3.5mm - it will be staged as a 2mm BCC. The only time when the growth above the skin is calculated into the staging of skin cancer is if it's a nodular melanoma which is very aggressive and has a bad prognosis.