Basal Cell Carcinoma on the Face: Early Signs, Treatment Options, and Scars

Nose, especially the sides and bridge.

Forehead and temples.

Cheeks, particularly high points exposed to sunlight.

Eyelids and the area around the eyes.

Ears, including the rim and behind the ear.

Upper lip and chin.

A pearly or shiny bump: One classic sign is a small, raised bump that looks pearly, translucent, waxy, or shiny. It may be pink, skin-coloured, red, brown, or darker depending on skin tone. Tiny blood vessels may be visible on the surface. On the face, this can be mistaken for a harmless spot, mole, enlarged pore, or cyst. Unlike an ordinary blemish, it tends not to go away.

A sore that bleeds or crusts: A BCC may appear as a sore that bleeds easily, scabs over, seems to heal, and then breaks down again. Some people notice bleeding after washing their face, shaving, applying make-up, or drying with a towel. A repeated cycle of bleeding, crusting, and partial healing is a strong reason to arrange a skin check.

A flat, scaly patch: Some basal cell carcinomas look like a patch of eczema, dermatitis, or dry skin. It may be red, pink, pale, or slightly brown. It can feel rough or scaly and may not improve with moisturiser. This type can be particularly easy to overlook on the cheek, forehead, or temple. If a “dry patch” remains in the same place for weeks or months, it deserves attention.

A scar-like area: A less common but important form of BCC can look like a white, yellowish, waxy, or scar-like patch. The skin may appear tight, shiny, or slightly depressed. This type can grow with less obvious surface change, so it may be more extensive than it first appears. Scar-like changes on the face should be assessed, especially if there has been no injury to explain them.

A changing or irritated mole-like mark: Pigmented basal cell carcinoma can resemble a mole. It may be brown, blue-black, grey, or mixed in colour. Because it can look similar to melanoma, any new or changing pigmented facial lesion should be checked promptly. Warning signs include growth, irregular colour, bleeding, tenderness, or a border that becomes less even.

Lasts longer than four to six weeks without healing.

Bleeds, crusts, or repeatedly reopens.

Slowly grows or changes shape.

Looks shiny, pearly, waxy, or scar-like.

Has visible tiny blood vessels.

Feels tender, itchy, or irritated without a clear cause.

Appears near the eye, nose, lip, or ear.

Mohs micrographic surgery: Mohs surgery is often considered the gold standard for many facial BCCs, especially those on the nose, eyelids, lips, ears, and other high-risk areas. During Mohs surgery, the visible tumour is removed along with a thin layer of surrounding tissue. The tissue is examined immediately under a microscope. If cancer cells remain at the edge, another thin layer is removed only from the affected area. This process continues until the margins are clear. The advantage is that Mohs surgery removes as little healthy tissue as possible while achieving a high cure rate. This makes it especially useful on the face, where every millimetre matters.

Standard surgical excision: With standard excision, the tumour is cut out along with a margin of normal-looking skin. The wound is then closed with stitches. The removed tissue is sent to a laboratory to confirm whether the margins are clear. This is a common and effective treatment for many BCCs. On the face, the doctor may place the incision along natural skin lines to make the scar less noticeable. If the area is large, reconstruction may involve a skin flap or graft.

Curettage and cautery: Curettage and cautery involves scraping away the cancerous tissue with a curette and using heat to destroy remaining cells and control bleeding. This may be suitable for selected low-risk BCCs, usually in less cosmetically sensitive areas. It is less commonly preferred for high-risk facial sites because it does not allow the same precise margin assessment as Mohs surgery or excision. The resulting scar may also be round, pale, or slightly depressed.

Topical treatments: Certain superficial BCCs may be treated with prescription creams such as imiquimod or 5-fluorouracil. These medicines stimulate the immune system or destroy abnormal cells at the skin surface. Topical treatment can be useful for carefully selected superficial lesions, but it is not suitable for deeper, aggressive, or high-risk facial tumours. The treated area usually becomes red, inflamed, crusted, and sore during treatment before healing.

Photodynamic therapy: Photodynamic therapy, or PDT, uses a light-sensitive cream and a special light source to destroy abnormal cells. It may be considered for some superficial BCCs. PDT can produce good cosmetic results in selected cases, but it may not be appropriate for deeper or more aggressive tumours. It can cause temporary burning, redness, swelling, and crusting.

Radiotherapy: Radiotherapy uses targeted radiation to destroy cancer cells. It may be an option for people who cannot have surgery or for tumours in difficult locations. It can also be considered in specific cases where surgery would be complex. Radiotherapy avoids an operation, but it usually requires several sessions and can cause long-term skin changes such as thinning, colour change, visible blood vessels, or texture changes. It may not be ideal for younger patients because these changes can become more noticeable over time.

Tablets for advanced BCC: Rarely, basal cell carcinoma becomes advanced or cannot be managed with surgery or radiotherapy alone. In these cases, specialist medicines such as hedgehog pathway inhibitors may be considered. These are usually reserved for complex cases under specialist supervision.

Size of the BCC: Larger cancers usually require larger wounds and may leave larger scars.

Location: Areas such as the nose, eyelids, lips, and ears can be more complex to repair.

Treatment method: Mohs surgery and excision allow planned closure, while scraping or topical treatments may leave different surface changes.

Skin tension: Scars can widen if the wound is under tension.

Healing tendency: Some people are more prone to thick, raised, or keloid scars.

Aftercare: Sun protection and proper wound care can improve healing.

Fine-line scars, often after surgical excision or Mohs surgery.

Pale or slightly shiny patches, sometimes after curettage or topical treatment.

Indented scars, particularly if tissue has been removed from deeper layers.

Raised or thickened scars, more common in people prone to hypertrophic or keloid scarring.

Skin graft or flap scars, where nearby or transferred skin is used to repair the wound.

Wearing broad-spectrum SPF 30 or higher every day on exposed skin.

Reapplying sunscreen when outdoors for long periods.

Wearing a wide-brimmed hat and UV-protective sunglasses.

Seeking shade when the sun is strongest.

Avoiding sunbeds.

Checking your skin monthly.

Photographing suspicious marks so changes are easier to notice.