BCC = basal cell carcinoma.

I read on {4}:

Certain clinical and pathological features of BCC are associated with an elevated risk for recurrence after treatment. Recurrent BCC may reappear months to years after initial treatment, leading to local tissue destruction, morbidity, increased risk for metastasis, and the need for retreatment (picture 1A-B). (see "Treatment and prognosis of basal cell carcinoma", section on 'Local recurrence' and "Treatment and prognosis of basal cell carcinoma", section on 'Metastasis')

The following characteristics have been proposed as factors associated with increased risk for tumor recurrence {1-3}:

  • Location and size
  • Greater than or equal to 6 mm in diameter in high-risk areas (eg, central face, nose, lips, eyelids, eyebrows, periorbital skin, chin, mandible, ears, preauricular and postauricular areas, temples, hands, feet)
  • Over 10 mm in diameter in other areas of the head and neck
  • Over 20 mm in diameter in all other areas (excluding hands and feet)

Why are some areas of the face more likely to have BCC recurrences than others?

The 2010 paper {3} illustrates the areas of the face with high BCC recurrence in this image (grey = higher BCC recurrence):

enter image description here

From {3}:

Clinical Risk Factors

Several clinical risk factors apply to both basal and squamous cell cancers (see pages 840 and 848). These risk factors include tumor location and size, the status of tumor borders, whether the tumor is primary or recurrent, certain settings of immunosuppression, and tumors developing in previously irradiated sites.

Location and Size

The panel elected to group together 2 separate risk factors: location and size. The science of dividing these factors into low- and high-risk categories is somewhat arbitrary because, to a certain extent, both factors, especially size, involve a continuous spectrum of risk.

For many years, location has been known to be a risk factor for NMSC recurrence and metastasis.{5,6} Stated in general terms, both basal and squamous cell cancers that develop in the head and neck area are more likely to recur than carcinomas developing on the trunk and extremities. Squamous cell carcinomas that develop on the genitalia, mucosal surfaces, and ear are also at greater risk of metastasizing. The concept of a so-called high-risk “mask area of the face” dates back to at least 1983 (Figure 1).24,25 Size has also been shown to be a risk factor for NMSC recurrence.26–28 Various different divisions have been used; probably the most common has been “greater than (or less than) 2 cm in diameter.”

I don't have access to studies {5,6} (I can't even find their abstracts).


  • {1} Batra RS, Kelley LC. Predictors of extensive subclinical spread in nonmelanoma skin cancer treated with Mohs micrographic surgery. Arch Dermatol 2002; 138:1043.
  • {2} Walling HW, Fosko SW, Geraminejad PA, et al. Aggressive basal cell carcinoma: presentation, pathogenesis, and management. Cancer Metastasis Rev 2004; 23:389.
  • {3} Miller SJ, Alam M, Andersen J, et al. Basal cell and squamous cell skin cancers. J Natl Compr Canc Netw 2010; 8:836. DOI.
  • {4} Treatment of basal cell carcinomas at high risk for recurrence. Sumaira Z Aasi, MD; Timothy K Chartier, MD. (mirror). Note: this link is slightly more up-to-date but it is pay-walled.
  • {5} Boeta-Angeles L, Bennett RG. Features associated with recurrence (basal cell carcinoma). In: Miller SJ, Maloney ME, eds. Cutaneous Oncology: Pathophysiology, Diagnosis, and Management. Malden: Blackwell Science; 1998:646–656.
  • {6} Haas AF. Features associated with metastasis (squamous cell carcinoma). In: Miller SJ, Maloney ME, eds. Cutaneous Oncology: Pathophysiology, Diagnosis, and Management. Malden: Blackwell Science; 1998:500–505.


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