Growth of BCC is a localised phenomenon in people with a competent immune system. BCCs tend to infiltrate surrounding tissues in a three-dimensional fashion through the irregular extension of finger-like outgrowths which may not be apparent clinically.3,18 If left untreated, or if inadequately treated, the BCC can cause extensive local tissue destruction, particularly on the face. Neglected cases may even infiltrate bone and deeper structures such as the brain and cause death.19 Death from BCC is extremely rare, but may occur in neglected cases and/or those with major underlying immunosuppression. The clinical course of BCC is unpredictable. A BCC can remain small for years with little tendency to grow, it may grow rapidly, or it may proceed by successive spurts of extension of tumour and partial regression.20 Histological subtype (infiltrative, micronodular or morphoeic patterns), initial diameter and male sex have been shown to be the best independent predictors of BCC invasion.21 It is unknown whether the phenotypic characteristics of people who present with clusters of BCCs or those who develop BCCs on truncal sites are also associated with increased growth once a BCC has established.

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