What is advanced BCC?

BCC is the most common type of skin cancer worldwide, representing up to 80% of NMSC.1

BCC often manifests as an enlarging, nonhealing lesion that may sometimes cause pruritus and tends to grow slowly.2,3

UV exposure is a major risk factor for developing BCC.4

Based on an analysis of BCC incidence, this cancer appears frequently on the head and neck.5


While most patients with early-stage BCC are effectively treated with complete surgical excision and/or radiation, a small percentage of patients progress to advanced BCC.2,3,6


of the >2 million new cases of BCC progress to advanced disease each year in the United States—and some of these cases are not amenable to surgery or radiation.6

Advanced BCC includes both locally advanced as well as metastatic disease. While the definition of locally advanced BCC may vary, it generally includes large, deep, aggressive, or recurrent tumors and/or those for which surgery or radiation are inappropriate. Metastatic BCC is more uncommon, but it can arise with greater frequency in large, untreated, or aggressive primary tumors or with recurrent tumors.3

Locally advanced BCC7

Although no formal, widely accepted definition exists, locally advanced BCC is generally classified as3:

  • Large lesions that penetrate deep into the skin or surrounding tissue, causing local tissue destruction
  • Cases for which further surgery or radiation is considered inappropriate or ineffective (eg, would be substantially disfiguring, may cause significant morbidity, loss of function)

Metastatic BCC7

  • Locally advanced BCC comprises ~95% of all advanced BCC cases while metastatic BCC represents ~5%8

Metastatic BCC is defined as disease with distant lymph node or organ (eg, bone, liver, lung) involvement3,9,10:

  • While lymphatic infiltration accounts for ≈70% of cases, hematologic spread or subcutaneous spread can occur as well

Although no formal, widely accepted definition exists, locally advanced BCC is generally classified as3:

  • Large lesions that penetrate deep into the skin or surrounding tissue, causing local tissue destruction
  • Cases for which further surgery or radiation is considered inappropriate or ineffective (eg, would be substantially disfiguring, may cause significant morbidity, loss of function)

Metastatic BCC is defined as disease with distant lymph node or organ (eg, bone, liver, lung) involvement3,9,10:

  • While lymphatic infiltration accounts for ≈70% of cases, hematologic spread or subcutaneous spread can occur as well

References: 1. Kansara S, Bell D, Weber R. Surgical management of non melanoma skin cancer of the head and neck. Oral Oncol. 2020;100:1-7. 2. Cameron MC, Lee E, Hibler BP, et al. Basal cell carcinoma: epidemiology; pathophysiology; clinical and histological subtypes; and disease associations. J Am Acad Dermatol. 2021;80(2):303-317. 3. Migden MR, Chang ALS, Dirix L, Stratigos AJ, Lear JT. Emerging trends in the treatment of advanced basal cell carcinoma. Cancer Treat Rev. 2018;64:1-10. https://www.cancertreatmentreviews.com/action/showPdf?pii=S0305-7372%2817%2930211-6. Accessed September 10, 2020. 4. Marzuka AG, Book SE. Basal cell carcinoma: pathogenesis, epidemiology, clinical features, diagnosis, histopathology, and management. Yale J Biol Med. 2015;88(2):167-179. 5. Richmond-Sinclair NM, Pandeya N, Ware RS, et al. Incidence of basal cell carcinoma multiplicity and detailed anatomic distribution: longitudinal study of an Australian population. J Invest Dermatol. 2009;129(2):323-328. 6. Asgari MM, Moffet HH, Ray GT, Quesenberry CP. Trends in basal cell carcinoma incidence and identification of high-risk subgroups, 1998-2012. JAMA Dermatol. 2015;151(9):976-981. 7. Skin cancer treatment (PDQ®)—health professional version. National Cancer Institute website. https://www.cancer.gov/types/skin/hp/skin-treatment-pdq. Updated June 26, 2020. Accessed September 17, 2020. 8. Mohan SV, Chang AL. Advanced Basal Cell Carcinoma: Epidemiology and Therapeutic Innovations. Curr Dermatol Rep. 2014;3(1):40-45. 9. Puig S, Berrocal A. Management of high-risk and advanced basal cell carcinoma. Clin Transl Oncol. 2015;17(7):497-503. 10. McCusker M, Basset-Seguin N, Dummer R, et al. Metastatic basal cell carcinoma: prognosis dependent on anatomic site and spread of disease. Eur J Cancer. 2014;50(4):774-783.