Basal Cell Carcinoma
By Clarissa Portocarrero
Reviewed by Dr. Peter Bittar
What is Basal Cell Carcinoma?
Basal cell carcinoma (BCC) is the most common type of skin cancer. It is a cancer that starts in keratinocytes which are found in the outermost layer of your skin. BCCs usually grow slowly and rarely spread to other parts of the body, but they can damage surrounding tissues if not treated.
Who is at Risk of BCC?
Basal cell carcinoma is most often caused by prolonged exposure to ultraviolet (UV) radiation from the sun or tanning beds. Risk factors include:
● Fair skin, especially those also with light hair and light eyes
● Frequent or severe sunburns, particularly during childhood
● Older age (though rates are rising in younger people)
● History of tanning bed use
● Weakened immune system
● Male sex (men are slightly more affected than women)
● Certain genetic conditions (e.g. Gorlin syndrome)
● A history of other types of skin cancer (e.g. melanoma)
BCC is most common in White populations and typically appears on sun-exposed areas such as the face, scalp, neck, and arms.
What Does It Look Like?
Basal cell carcinoma can vary widely in appearance, which is why it’s important not to rely on just one image or description. However, the most common presentations include:
● A pink pearly or waxy bump, often with visible blood vessels
● A flat, scaly patch that may look like a scar
● A sore or bleeding spot that doesn’t heal or keeps coming back
● A pink growth with a raised, rolled edge and a central indentation
These often develop on sun-exposed areas like the face, ears, neck, scalp, shoulders, and back
If you notice a persistent spot or any skin changes that concern you, see a board-certified dermatologist. They are trained to recognize subtle variations in skin cancer and can help ensure you get the right diagnosis and care.
Images of Basal Cell Carcinomas
Images sourced from DermNet New Zealand and Te Whatu Ora – Health New Zealand
https://dermnetnz.org/topics/basal-cell-carcinoma
Is BCC Dangerous?
BCC is rarely life-threatening, but if left untreated, it can:
● Grow deeper into the skin
● Damage nearby tissue or bone
● Become disfiguring
In very rare cases, BCC can spread (metastasize) to other parts of the body.
How Is It Diagnosed?
Your dermatologist will examine the area and may perform a skin biopsy by removing a small piece of the lesion. The sample is then analyzed in a lab, where specialists look at the cells under a microscope to determine if it is cancerous.
How is it treated?
Treatment depends on the size, type, and location of the tumor, as well as your health and preferences. Common options include:
For Low-Risk BCCs:
● Surgical Excision: The cancer is cut out with a safety margin of normal skin, often with excellent cure rates
● Curettage and electrodesiccation (C&E): The tumor is scraped off and the area is treated with an electric needle
● Topical medications (e.g., imiquimod or 5-fluorouracil)
● Cryotherapy: Freezing the lesion
● Photodynamic therapy (PDT)
For High-Risk or Difficult Cases:
● Mohs micrographic surgery: A precise surgery where the cancer is removed one layer at a time and examined until no cancer remains. Ideal for cosmetically sensitive areas like the face.
● Radiation therapy: Used when surgery isn't an option
What if BCC Comes Back or Can’t Be Removed?
If BCC has spread or can’t be treated with local therapies, systemic treatments may be needed:
● Hedgehog pathway inhibitors (like vismodegib or sonidegib) target the cancer’s growth signals
● Immunotherapy (e.g., cemiplimab) may be used in select cases, especially if hedgehog inhibitors fail
● Chemotherapy is rarely needed, but may be considered for advanced cases
Can It Be Prevented?
Yes! You can reduce your risk of developing BCC by:
● Wearing sunscreen (SPF 30 or higher) every day (and reapplying it!)
● Avoiding tanning beds
● Wearing protective clothing, hats, and sunglasses
● Seeking shade between 10 a.m. and 4 p.m.
● Getting regular skin checks, especially if you’ve had skin cancer before
What’s the Outlook?
Most BCCs are cured with proper treatment. However, people who’ve had one BCC are at higher risk of developing more. Lifelong skin monitoring is essential.
When to See a Doctor
See a dermatologist if you notice:
● A new spot that looks unusual or changes over time
● A sore that doesn’t heal
● A bump that bleeds or crusts
Basal cell carcinoma is the most common type of skin cancer and is highly treatable. Most cases are easily managed, especially when found early. Keep an eye on your skin, take sun protection seriously, and talk to your doctor about any new or changing spots.
References
Wu PA. Basal cell carcinoma: Epidemiology, pathogenesis, clinical features, and diagnosis. UpToDate. Stern RS, Robinson JK (section editors). Corona R (deputy editor). Updated May 13, 2025. Accessed June 13, 2025. https://www.uptodate.com/contents/basal-cell-carcinoma-epidemiology-pathogenesis-clinical-features-and-diagnosis
Aasi SZ. Treatment and prognosis of basal cell carcinoma at low risk of recurrence. UpToDate. Stern RS, Robinson JK (section editors). Corona R (deputy editor). Updated May 7, 2025. Accessed June 13, 2025. https://www.uptodate.com/contents/treatment-and-prognosis-of-basal-cell-carcinoma-at-low-risk-of-recurrence
Aasi SZ, Hong AM, Stern RS, Robinson JK. Treatment of basal cell carcinomas at high risk for recurrence. UpToDate. Corona R (deputy editor). Updated May 7, 2024. Accessed June 13, 2025. https://www.uptodate.com/contents/treatment-of-basal-cell-carcinomas-at-high-risk-for-recurrence
Martins RG. Systemic treatment of advanced basal cell and cutaneous squamous cell carcinomas. UpToDate. Robinson JK, Brockstein BE (section editors). Yushak M (deputy editor). Updated April 24, 2025. Accessed June 13, 2025. https://www.uptodate.com/contents/systemic-treatment-of-advanced-basal-cell-and-cutaneous-squamous-cell-carcinomas
Barankin B, Lam JMC. Nevoid basal cell carcinoma syndrome (Gorlin syndrome). UpToDate. Stern RS, Robinson JK (section editors). Corona R (deputy editor). Updated April 30, 2025. Accessed June 13, 2025. https://www.uptodate.com/contents/nevoid-basal-cell-carcinoma-syndrome-gorlin-syndrome