Basal cell carcinoma or BCC

Photo of man with nasal tip basal cell carcinoma
BCC can stand for a lot of things, but in this case it stands for Basal Cell Carcinoma, a common, locally invasive, keratinocyte cancer, also known as a nonmelanoma cancer (source). 

"Basal cell carcinoma begins in the basal cells — a type of cell within the skin that produces new skin cells as old ones die off" (Mayo Clinic).

"Basal-cell cancer grows slowly and can damage the tissue around it, but it is unlikely to spread to distant areas or result in death" (Wikipedia).

"It is rare that a BCC will spread to other parts of the body. If left untreated, however, it may cause damage to local structures as it continues to grow" (Medbell).

Basal cell carcinomas "often grow very slowly and rarely spread to other parts of the body. Despite this, however, they can cause extensive damage to surrounding structures, e.g. bones and tissues beneath the skin. To prevent this, it is vital to seek treatment as early as possible" (Medbell).

About this BCC web page
 
I am building this page because in recent years I have developed several BCCs, including a very noticeable one that first appeared on my nose in 2022. Due to its location, this is referred to as a nasal tip carcinoma. You can probably see it in the photo above.

Sadly, at the start of 2024, this BCC is still there, slowly getting bigger and badder than it was when it was first diagnosed in 2022. That means I have been going out in public for over a year and a half with my nose often looking something like it does in the photo above. 

To be clear, I'm not overly bothered by the aesthetics of this condition. To most people I am an old man and old men are almsot expected to look imperfect. And it's not like I'm trying to pick up a new partner, although I am sometimes concerned that a bloody scab on the end of my nose is distracting people from the things I am trying to communicate (like make a point in a face-to-face or video meeting).

I say my nose "often" looks like the photo above because this carcinoma sometimes appears to go away, as in the photo to the left, taken in April 2023. The end of my nose is covered by a shiny film of skin instead of a bloody scab. 

Sadly, this "remission" does not last. The area can randomly start bleeding, or I may accidentally catch my nose on a towel or piece of clothing, triggering a repeat of the blood-scab-film process repeats.

(Note: I take anticoagulant medication because of my atrial fibrillation, so when my blood gets out of my body it does tend to flow faster and congeal slower than average, so your BCC mileage may vary, so to speak). 

Out, damned BCC! out, I say!

So, if I first spotted this is anomaly in 2022, why is it still here? Why has it not been removed? The simple answer is this:

there is a drastic shortage of dermatology care available via England's National Health Service.* 

Apparently, there are only 746 dermatologists in all of England, a nation that has a population of over 55 million (source). Even if there were 1,000 dermatologists, that is one per 55,000 people. All of which means there are long waiting times if you want to get anything dermatological done via the National Health Service. For example: 

"A random check on NHS hospitals across England brought an average figure of 43 weeks [waiting time], for a dermatology appointment and commencing treatment. The NHS Constitution states that for routine conditions, treatment should commence within 18 weeks" (source).

In my case, it was 30 weeks from my doctor's referral, marked urgent, to getting the biopsy done. It is now been 44 weeks since the biopsy was done and I have not yet been scheduled for surgery. That's a total of 74 weeks.

I suppose you have to bear in mind that, of those 746 dermatologists, only a small percentage are qualified to perform the type of surgery and other treatments used to remove a BCC. As a result, those particular dermatologists are often tempted to offer their services outside the NHS and charge a substantial fee for doing so. In other words, I could have paid someone to remove this thing back in 2022.

Why not pay privately to remove a BCC?

As I see it, there are two main reasons.

1. We've already paid for it. Most forms of healthcare offered by the NHS are provided at no charge to the patient and funded out of revenue raised by various taxes (income tax, employment tax, and VAT — a form of sales tax currently at 20%).

2. Paying privately undermines the principles and finances of the NHS. If I pay a dermatologist to remove this BCC, that delays treatment for someone who cannot afford to pay. 

A complicating factor, at least in my experience, here in England, is the difficulty of finding out the current cost of removing a nasal tip basal cell carcinoma and covering up the would with a flap of skin from somewhere else on your body. 

One of the commonly used BCC removal procedures used is called Mohs micrographic surgery (MMS). This is often followed by a bilobed flap to protect the affected area (note: that link leads to an article that has photos, but only if you scroll down — be aware that if you google bilobed flap some of the results will be quite graphic).

Clearly, these procedures require highly specialized skills and equipment. My best guess if that the price for Mohs surgery on my BCC and repairing with a flap would be between £4,500 and £5,500 ($5,700 and $7,000). That is based on what BCC patients have reported in online forums

Depending on your financial circumstances you might consider that price to be anything from unaffordable to small change. But to put this in context, median disposable household income in the UK in 2022 was £32,300 (ONS). So a £5,000 medical bill is roughly one sixth of what a median household has available to spend on everything they need for a year (disposable income is basically take home pay, before rent, mortgage, heat, food, etc.).

All of which brings us back to the question: how urgently is treatment needed? 

The answer will vary according to the exact nature of the BCC. There are multiple types of BCC, the main four being: superficial, nodular, pigmented, and infiltrative. You can read about them on this page which contains possibly upsetting images

In terms of urgency, note what is said of the infiltrative type of BCC: "can be more aggressive and locally destructive than other types of BCC. They can invade more deeply and widely than their appearance suggests. For this reason, it is important to treat them early" (Source). Unfortunately, according to the dermatologists who have investigated my nasal tip carcinoma, mine is infiltrative.

Here's another quote about infiltrative BCC, from a website that has a lot of gruesome pics: "This cancer can grow both extremely wide and deep, causing it to destroy skin, deeper tissue, and can even damage bone" (US dermatology website).

The BCC Dilemma: Why bother?

As a medical issue, basal cell carcinoma can be confusing. I say this because, if you're just learning about BCC, it can be hard to know how serious it is or how concerned you should be if you have, or think you may have, a BCC on your body. 

I was going to say "it's hard to get you head around BCC," but because many BCCs are on the head, I was worried that might come across as inappropriate humour. That said, on a personal level, I have found humour helps me live with this thing on the end of my nose without getting too stressed or angry (I went through a phase of naming it, like Basil the Basal Cell, so I could introduce people to it.)

But seriously, the dilemma I see from from the patient perspective is this: doctors tend to tell you your BCC is not a big health threat but it should be removed. Depending on the nature of your BCC it could be growing and may be doing damage if not removed, but you get the feeling from medical staff that it's not so serious that we need to rush into anything. All of that is hard to get your head around if the context is not going to happen any time soon unless you've got a lot of money

Then you come across this statistic: there were 918 deaths a year from non-melanoma skin cancer on average in the UK from 2018-2019 (Cancer Research UK). The same source reckons 75% of non-melanoma skin cancer is BCC. Avoiding becoming one of the 918 is probably a high priority for most people — it certainly is for me.

BCC fact: Hugh Jackman has one on his nose.

Actor Hugh Jackman using social media to spread awareness of basal cell carcinoma

The Australian actor known for his portrayal of Wolverine in the X-Men film series, has been admirably open about his BCC experience. Jackman has leveraged his popularity to spread awareness of BCCs and what you can do to reduce your risk of developing them.

"Jackman is strongly committed to raising awareness by using social media to discuss his skin cancer history. In his [Instagram] post, he explains: "I know you’ve heard me talk about my basal cell carcinomas. I’m going to keep taking about them. And if it reminds even one person to put on sunscreen, then I’m happy."" — Skin Cancer Foundation

According to the Skin Cancer Foundation, the best way to avoid skin cancers like BCCs is: "a complete sun protection strategy – sunscreen, a hat, sunglasses, or simply seeking shade wherever you can. Ninety percent of nonmelanoma skin cancers like BCC are associated with the sun’s UV rays. This means that, with the right behaviors, they’re also generally preventable.""

What's next?

I will update this page when/if I do manage to get treatment. Also, if I find new information that I feel might help others faced with BCCs.

Useful sources

Listing of information sources, some of which have images of cancers and surgery. I cannot vouch for all of these sites being impartial or entirely accurate. Note that I am not medically qualified person, apart from Emergency First Aid training. 

Cancer Research UK (the main sourcer cited by NHS England).


Dermatology support site in New Zealand

Skin Cancer Foundation

Skin information website

US dermatology website

Note:

* In my opinion, the drastic shortage of dermatology care available via England's National Health Service stems from the Conservative Party "leading" the country since 2010. Many key members and supporters of the Conservative Party want to privatize all health services in order to generate profits.