How is Basal Cell Carcinoma (BCC) Staged?

Unlike many types of cancers with a numerical staging system, basal cell carcinoma (BCC) follows a unique categorization based on the chance that cancer might return, also referred to as its risk for recurrence. This unique staging system puts most BCCs into one of two groups: Low Risk or High Risk.

Treatment options are then based on each category to prevent recurrence. A third category, Advanced BCC, describes tumors that require more complicated treatment procedures rather than a standard surgical removal to eradicate the disease. Advanced BCCs have spread beyond the immediate area and may require additional measures, including imaging, to determine the extent of the cancer.

Low-Risk Basal Cell Carcinoma

This type of BCC is based on a lower relative risk of recurrence. These low-risk tumors are usually located on the trunk of the body or extremities and are less than two centimeters (cm) in size. The borders of low-risk BCC have well-defined edges. Patients diagnosed with low-risk BCC are not immunosuppressed and have not experienced prior medical radiation therapy in the area. The pathology report may often describe this type of BCC as nodular or superficial.

High-Risk Basal Cell Carcinoma

High-risk BCC has a higher relative risk of recurrence or returning. All recurrent tumors are automatically labeled high-risk. If a BCC is located on the trunk or extremities, high-risk indicates that the size is greater than two cm in those specific regions. Alternatively, a high-risk BCC could be any size when it is located on the head, neck, or feet, or in the pretibial (shin) or anogenital (anus and genital) areas. In addition, the borders of high-risk BCC are poorly defined. Patients diagnosed with high-risk BCC may be immunosuppressed or have experienced prior medical radiation therapy to the area. The pathology report will often describe this type of BCC as having an aggressive growth pattern. Pathological reporting may also describe these high-risk BCCs as micronodular, infiltrative, sclerosing, or morpheaform (desmoplastic).

Advanced Basal Cell Carcinoma

Advanced BCC is less common (less than 10% of cases), represents extensive disease, such as bone involvement, perineural invasion, or deep soft tissue involvement, and requires more treatment methods to control, such as a combination of surgery, radiation, chemotherapy, and/or immunotherapy. It has spread around the area, to lymph nodes, or to a distant location in the body. Imaging techniques such as a magnetic resonance imaging (MRI) or computed tomography (CT) scan will indicate the extent of disease spread. These tumors have invasive growth, are relatively larger, and are sometimes located in hard-to-treat areas.