A Guide to Basal Cell Carcinoma (BCC)

Medically Reviewed By Sarika Ramachandran, MD
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Basal cell carcinoma (BCC) is skin cancer that develops on the base layer of the epidermis, the outer layer of the skin. Though it can develop anywhere on the body, BCC typically occurs on sun-exposed skin. BCC is highly treatable in the early stages because it grows slowly and usually does not spread. While the main treatment is surgical removal, doctors may also use cryotherapy or photodynamic therapy.

Read on to learn more about the causes, symptoms, treatments, and outlook for people with basal cell carcinoma.

What are the causes of basal cell carcinoma?

A man laying in the sun
Nomad studio/Stocksy United (person appearing is a model and used for illustrative purposes only)

BCC develops when cells grow out of control. This happens when the genes that control cell growth change or mutate.

Unlike some cancers, BCC has a known trigger or cause — UV light exposure. Excess UV light, which can come from the sun or artificial sources like tanning beds, causes damage to cells that results in them becoming cancerous.

A little bit of damage occurs each time the skin encounters UV light. With time, the cumulative damage builds until the body can no longer repair it. The more exposure you have, the faster the damage can occur.

Factors such as a weakened immune system, exposure to arsenic, and a family history of BCC may also play a role.

What are the symptoms of basal cell carcinoma?

Basal cell carcinoma

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Basal cell carcinoma often develops on sun-exposed skin, such as on the head or neck.

Kelly Nelson (Photographer), Public domain, via Wikimedia Commons

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Basal cell carcinoma lesions can be pink or reddish with a dip in the center.

Dermatology11/Shutterstock

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In some cases, basal cell carcinoma spots may crust or bleed.

jax10289/Shutterstock

BCC usually develops on skin that has had significant UV radiation exposure, like the skin on the head and neck. However, it can appear anywhere, even on the palms of the hands.

BCC can have several appearances. Most commonly, it looks like a shiny, red, raised growth. It can be easy to mistake it for a pimple or a harmless bump, and it can also look flat, like a scar.

Here are seven warning signs of BCC from the American Academy of Dermatology Association:

  • growths or scaly patches on or around the ear
  • a pink or reddish area that dips in the center
  • a round growth that may be pink, red, brown, black, tan, or flesh-colored
  • a scar-like lesion that may be skin-colored, white, or yellow and may appear waxy or shiny
  • a scaly patch that may be slightly raised and look irritated
  • a sore that may bleed or crust but recurs or does not heal
  • a spot that feels scaly or looks like an age spot

Some people have other symptoms on the affected patch of skin, such as itchiness or numbness.

How do doctors diagnose basal cell carcinoma?

After performing a physical examination and assessing your medical history, your doctor can use a dermoscopy to closely evaluate the area of concern. Dermatoscopes, which use light and magnification, allow doctors to examine your skin for cancerous characteristics.

Doctors typically use a biopsy to confirm a BCC diagnosis. There are a few biopsy techniques:

  • Shave biopsy: Doctors remove a thin piece of skin with a sharp blade.
  • Punch biopsy: Doctors use a circular, round instrument to remove a round piece of skin.
  • Excisional biopsy: Doctors cut out an area of affected tissue and a small amount of surrounding healthy tissue.

Your doctors can confirm a diagnosis by microscopically examining the skin samples.

What are the treatments for basal cell carcinoma?

BCC treatment depends on the location and stage of the cancer. In the early stages, it is highly treatable.

One of the main treatments for BCC is surgery to remove the cancer. Surgical techniques include:

  • Excision: For this procedure, doctors cut out the cancer and some of the healthy skin surrounding it.
  • Mohs surgery: This procedure removes the cancer layer by layer until no cancer cells are present under a microscope. This approach is very useful for tumors that are large or not well-defined around the edges.
  • Curettage and electrodessication: This procedure allows doctors to scrape away the growth and remove any remaining cancer cells with an electrical current.

For some patients, doctors recommend an alternative to surgery. One nonsurgical option is cryotherapy, which freezes off the growth. Another option is photodynamic therapy, a type of therapy that involves a special chemical treatment activated by certain kinds of light.

Radiation therapy may be an option when the affected areas are hard to treat with surgery. If radiation therapy is ineffective, doctors may recommend targeted therapy or immunotherapy.

In some cases, topical medications can treat superficial BCC.

What is the outlook for people with basal cell carcinoma?

If doctors can diagnose and treat BCC early, the outlook for people with BCC is good. BCC grows slowly and rarely spreads to other areas of the body. A delay in diagnosis and treatment can lead to worse outcomes.

Because BCC can recur, frequent skin examinations and follow-ups with your dermatologist will be necessary.

What are the potential complications of basal cell carcinoma?

Without treatment, BCC can grow deep into the tissues underlying the initial site. It can severely affect bone and other tissues in its path, causing functional deformity and disfigurement.

Early detection and treatment are essential to curing BCC and preventing these complications.

What are the risk factors for basal cell carcinoma?

The main risk factor for developing BCC is excess UV light exposure from the sun or indoor tanning beds or lights. Living in areas with intense year-round sunlight may contribute to your overall UV exposure and skin cancer risk.

Other BCC risk factors include:

  • having fair skin or skin that freckles or burns easily
  • a history of skin cancer or blistering sunburns in your youth
  • having light hair or eyes
  • a weakened immune system
  • having kidney disease requiring dialysis
  • an exposure to arsenic

Can you prevent basal cell carcinoma?

Because BCC has a known trigger, it is a highly preventable disease. One of the keys to lowering your risk is avoiding exposure to UV light.

The Skin Cancer Foundation recommends the following tips to limit UV light damage to your skin:

  • avoiding indoor tanning
  • covering up with protective clothing, including accessories such as hats and sunglasses
  • seeking shade when outside and scheduling outdoor activities before 10 a.m. or after 4 p.m.
  • using a daily UVA/UVB sunscreen with a sun protection factor (SPF) of at least 30

As part of your skin cancer defense, you should perform self-exams routinely. Add a professional skin check if you are at increased risk.

Also, talk with your doctor or pharmacist about your medications. Some may make your skin more sensitive to the sun and more likely to burn.

Other frequently asked questions

These are a few other common questions people may ask about BCC. Dr. Samika Ramachandran has reviewed the answers.

How common is basal cell carcinoma?

BCC is the most common type of cancer in the world, with experts estimating that around 2 million people receive a diagnosis each year in the United States.

How long does basal cell carcinoma take to spread?

BCC grows slowly and rarely spreads to other parts of the body. However, without treatment, it can reach deep into the skin and affect underlying structures.

Can you pick off basal cell carcinoma?

You should not try to pick a BCC lesion off your skin. BCC requires removal by a professional to ensure that all of the cancerous cells are gone.

Summary

BCC is a slow-growing and highly treatable cancer in its early stages. While treatment generally involves surgery, some people may also benefit from cryotherapy, radiation therapy, or other treatment methods.

Contact your doctor if you notice something new or changing on your skin. If you are at high risk of developing skin cancer or have already had it, talk with your doctor about professional screenings and how often you need them.

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Medical Reviewer: Sarika Ramachandran, MD
Last Review Date: 2022 Sep 28
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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