The risk factors for BCCs are as follows:

• People with pale skin and fair hair who burn easily in the sun.
• Previous significant sun exposure or sun-burn.
• Previous sun-bed usage.
• Previous BCCs – about a third of patients will develop a new BCC within 3 years of having a previous BCC treated.
• Long-term immunosuppression (such as chronic use of steroids).
• Radiation exposure
• Rare conditions such as Gorlin syndrome and Xeroderma Pigmentosa that result in multiple lesions.
• BCCs do not tend to run in families (unless associated with conditions such as Gorlin syndrome).
• BCCs tend to occur in more elderly individuals but can occur in people in their 20’s and 30’s.

Symptoms are variable and several different types of BCC exist. Common symptoms include:

• A raised lesion on the face that does not improve of its own accord and that occasionally may bleed or fail to heal.
• An area of red irritated or scaly skin that doesn’t improve of its own accord.
• Sometimes a BCC may have a ‘pearl’ or ‘shiny’ appearance.
• Occasionally a small ulcer may be present. Such BCCs have historically been called ‘rodent cell ulcers’ as these types of BCC gradually nibble away at the skin getting larger and larger over a period of time.

There are many different treatments available for BCCs in depending on which part of the body they occur. These include surgical excision, cryotherapy, radiotherapy and certain types of skin creams. However, BCCs around the eyes are often treated surgically. In Oxford we are able to provide a Mohs Surgery service in conjunction with a dermatologist. This is a very bespoke way of excising BCCs and preserves as much tissue as possible to allow for reconstruction with Mr Norris. Mohs surgery has a good success rate with under 2% of patients having a recurrence of the BCC within the first 5 years.