BCCS come in three main types:
Superficial BCC. These BCCs are the least dangerous. They grow only on the outer layers of the skin. Sometimes they do not need to be excised. Treatment with creams or curette can sometimes be an alternative for these cancers. These often look like a flat red rash. The shape is often irregular. They can be a little scaly. They are not generally raised above the skin surface.
Nodular BCC. These BCCs grow into the deeper layers of the skin. Almost invariably the treatment is surgical excision. The excised skin includes a margin of apparently normal skin to maximize the prospects of cure and minimize the risk of later local recurrence. Most of these look like pink round lumps on the skin. Some have an ulcer or crater feature to them.
Tough BCC. This is really a collection of many types of BCC. They have names such as: infiltrating, micronodular, morphoeic, desmoplastic, sclerosing and morphoeiform. These BCCs are the ones that are most notorious for growing into nearby organs or later recurring nearby. Of greatest concern, by the time a recurrence is apparent, they may have burrowed into and destroyed other structures. For this reason, tough BCCs are the hardest BCCs to treat. Sometimes on the face they are treated with margin control surgery or an alternative careful scientific approach. Their appearance varies. Some are just apparent thickenings in the skin. Colour and shape can also vary. We never treat these BCCs with creams or curette or photodynamic therapy. Surgery, often extensive, is required.
You will have noticed that not all BCCs are the same. They look different and treatments are very different for the different types. ACSCM trains doctors to respect these differences and to manage each tumour on its merits based on subtype and location.