One of the first steps in determining your treatment plan is establishing the stage of your cancer. Because basal cell carcinoma (BCC) has a low risk of spread but does tend to recur, it has a unique staging system (see SCIENCE SIDEBAR). It is based primarily on risk features and whether the BCC is difficult to treat.
Smaller BCC with no high-risk features
Localized tumors that have one or more high-risk features
BCC that is localized and difficult to treat or that has spread (metastasized). Approximately 1%-10% of BCCs are considered advanced. Locally Advanced BCCs are often:
BCCs are likely to be difficult to treat in certain populations as well, such as:
Advanced disease can also be used to describe BCCs that metastasize (spread). This is only a small proportion—an estimated less than 0.55% (or one in 200) BCCs metastasize. For additional discussion, see below.
Regional disease (N classification) is characterized by cancer that has spread to nearby lymph nodes. As shown in the graphics, lymph nodes are small, seed-shaped structures that contain clusters of immune cells. Their function is to filter the lymphatic fluid, which helps to clear waste material from the tissues and deliver white blood cells to fight infections. Lymph nodes are found throughout the body, notably in the neck, armpit, and groin. Cancer cells often spread from the primary tumor to the nearest lymph node before traveling to other parts of the body.
How is regional disease diagnosed?
If the lymph node feels swollen or if lymph nodes are identified by imaging, then the doctor will take a sample from the lymph node for testing by
The M (metastasis, distant) classification addresses what other site(s) the cancer has spread to in the body—beyond the closest lymph nodes in a process known as distant metastasis.
How is metastatic BCC diagnosed? Typically, the spread of BCC is determined by imaging studies such as computed tomography (CT) or positron emission tomography/computed tomography (PET-CT). Metastasis is a relatively rare occurrence.
Here are some questions you can ask your healthcare provider about your pathology report.
Talking With Your Doctor About Your Biopsy Results
|Which subtype of BCC do I have?|
|Can I please have a copy of the pathology report?|
|What is the next step?|