Basal Cell Carcinoma Skin Cancer: An Overview

Patient's Guide to Basal Cell Skin Cancer Types, Symptoms, and Treatment

Sunburnt adult male applies sun lotion to face on beach, while lying on beach towel.
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Basal cell carcinoma is the most common form of cancer worldwide, accounting for about 80% of all cases of skin cancer. If you or a loved one has just been diagnosed with basal cell carcinoma, this overview will help you understand the disease and make more informed treatment choices.


Upwards of one million people are diagnosed with basal cell carcinoma (BCC) each year in the United States.

It was once found mostly in middle-aged or older people but is now being seen more and more at younger ages. The incidence of BCC is rising and is now called an "epidemic" by some experts.

Risk Factors

Caucasians, especially those with blue eyes, a fair complexion, and red, blond, or light brown hair (Celtic ancestry), have the highest risk of BCC. BCC is possible but uncommon in African-Americans, Asians, and Hispanics. Compared with Caucasians, African-Americans have a decreased risk of BCC on sun-exposed areas, but the same incidence of BCC on covered skin. There are many other risk factors as well.


Excessive exposure to ultraviolet light from the sun or tanning salons causes 80% of BCC cases. However, BCC is less correlated to sun exposure than, for example, squamous cell carcinoma, and can occur in areas that aren't exposed to the sun at all, such as the scalp. People living in states closer to the equator (such as Florida), or with a history of sunburns during childhood, can see BCC lesions form in their 20s.

More typically, the incubation period lasts for 10 to 20 years.


A basal cell lesion is often described by doctors as a pearly papule — "pearly" meaning that it has a slight shine, unlike benign (non-cancerous) lesions that are brown and scaly, and "papule" meaning that it's elevated above the surface of the skin.

Dilated blood vessels can overlie it in a scenario called telangiectasia. These basal cell skin cancer pictures show that BCC lesions can take on a variety of appearances, so a biopsy is the only way to make a definitive diagnosis.


Nodular: About 60% of BCCs are nodular. They start out as flat, well-defined lesions, then often become small bumps, which eventually collapse in the middle, leaving a raised ring on the border. Most nodular BCCs are on the face and can be disfiguring if not treated promptly.

Pigmented: Pigmented BCCs are similar to the nodular type, but they can contain brown or black spots, which can confuse them with certain types of melanoma.

Fibrosing or Sclerotic: These BCCs are usually found on the face and look similar to scars. They are usually firm, ill-defined at the border, flat or slightly depressed, yellowish in color, and the surface tends to be smooth and shiny.

Superficial: This type comprises about 15% of BCCs. They spread outward from a red, well-defined, scaly patch, most commonly found on the trunk and limbs.

They are easily confused with psoriasis or eczema.

Fibroepithelioma of Pinkus: This is a rare type of BCC. It tends to be a smooth, elevated, small nodule found on the back, extremities, groin, or sole of the foot. As those are not sun-exposed areas, this disease is probably not sun-related.


A skin biopsy is the removal of skin tissue for examination under a microscope for the purposes of diagnosis. The exact type of biopsy depends on how deep the lesion has penetrated the skin:

  • Shave biopsy uses a thin surgical blade to shave off the top layers of skin. This is the most common method for diagnosing BCC.
  • Punch biopsy uses a round, cookie-cutter-like tool. It is used to take a deeper skin sample.


Treatment depends on the type, extent, and location of the lesion. Although BCC doesn't typically spread to distant organs (metastasize), the lesions can eventually cause disfigurement and should be removed as soon as possible. The treatment required to remove them is much simpler and less likely to cause significant scarring when they are small. Common methods to treat BCC include:

  • Curettage and electrodesiccation
  • Surgical excision (removal)
  • Mohs surgery (also known as "micrographic surgery"), especially if the lesion is on the face, is recurrent, has a diameter of greater than 2 cm, or is the sclerotic type
  • Topical creams such as imiquimod are FDA-approved for the treatment of superficial BCCs not on the face, although studies have shown it can be effective against nodular BCC as well
  • more details on treatment options

If basal cell carcinoma is left untreated, the lesions can grow to be many inches across and eventually ulcerate (break through the skin) or damage the surrounding tissue or bone. (There have been cases reported of people losing an eye, nose, or ear due to untreated BCC.) Especially if they occur on the face, BCCs should be removed quickly to prevent disfigurement due to either the lesion itself or the surgery. Unfortunately, regardless of how fast a lesion is removed, a person with a history of BCC has about a 40% greater likelihood of developing a second BCC than someone with no history.

Basal cell carcinoma is the most common — but also one of the most curable — of all cancers. Please see your physician promptly if you find any unusual lesions during your regular skin self-exams.


"What is Basal Cell Carcinoma?" Medical College of South Carolina. 4 September 2008.

"Detailed Guide: Skin Cancer - Basal and Squamous Cell" American Cancer Society. 5 November 2008.

"Basal and Squamous Cell Skin Cancers" National Comprehensive Cancer Network. 5 November 2008.

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