what tests will I have?

If you think you may have a BCC, you will need to see your GP. Your GP may ask you questions about your symptoms and your lifestyle, including your history of sun exposure. She or he may check your medical history to see what illnesses you have had in the past. Your GP may want to look at other areas of your skin.

If your GP decides the condition is suspicious, you will be referred to see a dermatologist (specialist skin doctor) at the hospital. There are cancer referral guidelines to help GPs decide who needs to see a specialist, and how quickly.

At hospital
At hospital you will be seen in the appropriate specialist department. This may be a dermatology, plastic surgery, clinical oncology, or other appropriate (e.g. eye) clinic, supervised by a consultant.

The area of your skin with the sore or lump will be examined. As some patients have more than one BCC, other areas of skin may also be examined.

Your consent
Before any doctor, nurse or therapist examines or treats you, they must seek your consent.

Biopsy
A biopsy is way of getting a sample of cells or body tissue to be looked at under a microscope. This is rarely required for BCC because it has a distinctive look. You may need a biopsy if there is doubt about the diagnosis.

There are various ways of taking a skin biopsy. First, a local anaesthetic is injected to numb the area of the operation:

• shave biopsy
  You will have a little of the top layer of the affected area of skin shaved off with surgical knife. Sometimes no local anaesthetic is needed.
  
  
• punch biopsy
  A disposable biopsy tool called a punch is used. It looks like a biscuit cutter, but is smaller and sharper. After swabbing the area with antiseptic, a local anaesthetic is injected. The tool is pressed and turned to cut down into the skin to remove the lump in a plug of tissue. The wound will be closed with a stitch if needed.
  
  
• excision biopsy
  In this procedure the area around the spot is swabbed with antiseptic and injected with a local anaesthetic. An oval cut is made with a scalpel and the whole of the abnormal area, plus a margin of healthy cells around it, are removed. The wound is stitched up. Small areas take about 10-15 minutes to do. The stitches will have to be taken out in about a week, or later, depending on the site of the excision.
  
  
• incision biopsy
  This procedure is similar to excision biopsy, except that only a portion of the suspect area is cut out for examination.

• curettage and cautery
  In this procedure the abnormal cells are scraped off with a spoon-shaped instrument with a sharp edge (a curette). The raw area this leaves is heat-sealed (cautery), sometimes more than once. This leaves a scab that heals in the same way as a graze. This may treat the area as well as providing a biopsy, but it is not suitable for some types of BCC or some areas of the body.

Whatever method is used, the removed tissue is sent to a laboratory to be examined under a microscope for cancer cells.

For more general information, see our page on biopsy.

The results should be given to you a few weeks later. This may be by letter, or you may be asked to attend the hospital or your GP’s surgery. A treatment plan will be discussed with you.

Sometimes a biopsy can completely remove the tumour, and no further treatment will be needed. However, if there is any doubt that cancer cells remain, you will need to have more surgery, or other treatment such as radiotherapy, to make sure that all the cancerous cells are removed.

Remember that BCC is a relatively harmless tumour, provided it is treated early and adequately. The vast majority of patients will be cured by their first treatment, and the risk of it spreading to other sites in the body is extremely small.

However, a cancer diagnosis can be shocking. You may want emotional and practical support and advice for yourself and your family. You will find more information in the following sections What will life be like after treatment? and Where can I get more information?