Basal cell carcinoma
What is basal cell carcinoma?
The most common type of skin cancer, basal cell carcinoma can show up on the skin in many ways.
Is basal cell carcinoma contagious? No
Basal cell carcinoma is common
If you’ve been diagnosed with basal cell carcinoma or BCC, you have plenty of company. As the most common type of cancer in the world, doctors diagnose millions of people with BCC every year. In the United States alone, it’s estimated that about 2 million Americans hear, “You have basal cell carcinoma,” each year.1
Most people who develop this skin cancer have fair skin that they seldom protected with sunscreen or sun-protective clothing. Before they developed skin cancer, they often noticed signs of sun damage on their skin, such as age spots, patches of discolored skin, and deep wrinkles.
Dermatologist examining patient for signs of skin cancer
You have a greater risk of developing this skin cancer if you’ve seldom protected your skin from the sun throughout your life or used tanning beds.
Although BCC is most common in people who have fair skin, people of all colors get this skin cancer.
For most people, BCC is not life-threatening. It tends to grow slowly. It seldom spreads to another part of the body. Even so, treatment is important.
When found early, this skin cancer is highly treatable. An early BCC can often be removed during an appointment with your dermatologist.
Given time to grow, this skin cancer can grow deep, injuring nerves, blood vessels, and anything else in its path. As the cancer cells pile up and form a large tumor, the cancer can reach into the bone beneath. This can change the way you look, and for some people the change may be disfiguring.
Finding and treating this skin cancer early can prevent it from growing deep. To do this, it helps to know the signs and symptoms of BCC.
One common sign is a slowly growing, non-healing spot that sometimes bleeds. BCC can also appear on the skin in other ways.
What are the signs and symptoms of basal cell carcinoma?
Basal cell carcinoma is a type of skin cancer that can show up on the skin in many ways. Also known as BCC, this skin cancer tends to grow slowly and can be mistaken for a harmless pimple, scar, or sore.
Common signs and symptoms of basal cell carcinoma
This skin cancer often develops on the head or neck and looks like a shiny, raised, and round growth.
To help you spot BCC before it grows deep into your skin, dermatologists share these 7 warning signs that could be easily missed.
If you find any of the following signs on your skin, see a board-certified dermatologist.
7 warning signs of basal cell carcinoma that you could mistake as harmless
Warning sign: A pink or reddish growth that dips in the center
A pink or reddish growth that dips in the center
The BCC on this patient’s cheek could be mistaken for a minor skin injury.
Warning sign: A growth or scaly patch of skin on or near the ear
A growth or scaly patch of skin on or near the ear
BCC often develops on or near an ear, and this one (circled in purple) could be mistaken for a minor skin injury.
Warning sign: A sore that doesn't heal (or heals and returns) and may bleed, ooze, or crust over
A sore that doesn't heal, or heals and returns
This patient mistook the BCC on his nose for a non-healing pimple.
Warning sign: A scaly, slightly raised patch of irritated skin, which could be red, pink, or another color
A scaly, slightly raised patch of irritated skin
This BCC could be mistaken for a patch of dry, irritated skin.
Warning sign: A round growth that may be pink, red, brown, black, tan, or the same color as your skin
A round growth that may be same color as your skin
Would you recognize this as a skin cancer, or would you dismiss it as a harmless growth on your face?
Warning sign: A spot on the skin that feels a bit scaly
A spot on the skin that feels a bit scaly or looks like an age spot
This BCC could easily be mistaken for an age spot, which is why it’s so important to have a dermatologist examine your skin before you treat an age spot.
Warning sign: A scar-like mark on your skin that may be white, yellow, or skin-colored and waxy. The affected skin may look shiny and the surrounding skin often feels tight.
A scar-like mark on your skin that may be skin-colored or waxy
Appearing on an elderly woman’s skin, this BCC could easily have been mistaken for a scar.
More pictures of basal cell carcinoma (BCC)
While the above pictures show you some common ways that BCC can appear on the skin, this skin cancer can show up in other ways, as the following pictures illustrate.
Scaly patch with a spot of normal-looking skin in the center
On the trunk, BCC may look like a scaly patch with a spot of normal-looking skin in the center and a slightly raised border, as shown here.
Basal cell carcinoma can be lighter in some areas and darker in others
While BCC tends to be one color, it can be lighter in some areas and darker in others, as shown here.
Basal cell carcinoma can be brown in color
Most BCCs are red or pink; however, this skin cancer can be brown, as shown here.
Basal cell carcinoma can look like a group of shiny bumps
BCC can look like a group of small, shiny bumps that feel smooth to the touch.
Basal cell carcinoma can look like a wart or a sore
The BCC on this patient’s lower eyelid looks like a wart* in one area and a sore** in another area.
If you see a spot or growth on your skin that looks like any of the above or one that is growing or changing in any way, see a board-certified dermatologist.
Where does BCC develop?
As the above pictures show, this skin cancer tends to develop on skin that has had lots of sun exposure, such as the face or ears. It’s also common on the bald scalp and hands. Other common areas for BCC include, the shoulders, back, arms, and legs.
While rare, BCC can also form on parts of the body that get little or no sun exposure, such as the genitals.
What color is BCC?
This skin cancer tends to be one color, but the color can vary from one BCC to the next. This cancer may be:
Red or pink (most common)
Brown, black, or show flecks of these colors
The same color as your skin
Yellowish
White
Does BCC hurt?
For many people, the only sign of this skin cancer is a slow-growing bump, sore-like growth, or rough-feeling patch on their skin. However, some people develop symptoms where they have this skin cancer.
Symptoms include:
Numbness
A pins-and-needles sensation
Extreme sensitivity
Itching
How do people find BCC on their skin?
Many people find it when they notice a spot, lump, or scaly patch on their skin that is growing or feels different from the rest of their skin. If you notice any spot on your skin that is growing, bleeding, or changing in any way, see a board-certified dermatologist. These doctors have the most training and experience in diagnosing skin cancer.
What causes basal cell carcinoma?
The cause of basal cell carcinoma, the most common type of skin cancer, is well known. Most people develop it because their skin has been badly damaged by ultraviolet (UV) light from:
The sun
Indoor tanning equipment (such as tanning beds or sunlamps)
Both
If you use a tanning bed, you have a higher risk of developing skin cancer
Use a tanning bed just once, and you increase your risk of developing basal cell carcinoma by 29%.
How can UV light cause skin cancer?
Every time UV light hits our skin, it can damage some of the DNA inside our skin’s cells. The body tries to repair this damage.
As UV light from the sun, indoor tanning equipment, or both, continues to hit our skin, the damage builds up. Eventually, it becomes too much for the body to repair. When the body cannot repair the damage, changes called mutations develop. When the mutations build up in the skin, we get skin cancer.
The type of skin cancer we get depends on where the mutations develop in the skin. Basal cells are found deep inside the first layer of our skin, so we get basal cell carcinoma (or BCC) when mutations develop inside these cells.
Do some people have a higher risk of getting basal cell carcinoma?
Yes. The main risk factor (anything that increases your risk of getting a disease) for getting this skin cancer is:
UV-damaged skin caused by the sun or tanning beds. Each time you go outdoors without protecting your skin from the sun or use a tanning bed, you increase your risk of getting skin cancer.
There are other risk factors for BCC, which include:
Color of your skin, hair, and eyes. This skin cancer develops in skin damaged by UV light, and skin is more easily damaged by UV light if you have one or more of the following:
Skin that burns easily and rarely tans
Sun-sensitive skin that freckles easily
Naturally blonde or red hair
Blue or green eyes
Sunburns. If you’ve had sunburns, especially blistering ones in your youth, you have a higher risk of developing this skin cancer.
Where you live. Living in an area that gets intense sunlight year-round, such as Florida or California, increases your risk of getting skin cancer. People who live at a high altitude also have an increased risk.
Previous skin cancer. If you’ve had any type of skin cancer, you have a greater risk of getting another one.
Weakened immune system. Anything that weakens your immune system increases your risk of getting this skin cancer. In fact, BCC is one of the cancers most likely to develop when the immune system weakens.
Some medical conditions. If you have one of the following medical conditions, you have an increased risk of developing BCC. Some people who have one of these conditions develop 100's of skin cancers.
Nevoid basal cell carcinoma syndrome (aka Gorlin syndrome)
Xeroderma pigmentosum
Rombo syndrome
Bazex-Dupre-Christol syndrome
100+ PUVA sessions. Used to treat psoriasis and some other conditions that affect the skin, this therapy involves taking a medication called psoralen, which makes your skin more sensitive to UV light. After the medication takes effect, the skin that needs treatment is exposed to controlled UV light.
X-ray treatments for acne. While no longer used to treat acne, some people received these treatments in their youth.
Dialysis for kidney disease. People who are receiving dialysis have a much greater risk of developing BCC.
Arsenic in your food or water. Many researchers have found that the more arsenic found in your food or water, the greater your risk of developing BCC.
While having a risk factor for BCC increases your risk of developing it, some people who get this skin cancer don’t have risk factors. People of all colors get this skin cancer, including people of African, Asian, and Latin descent.
Dermatologist treating BCC
When found early, basal cell carcinoma is highly treatable.
How dermatologists diagnose basal cell carcinoma
When you see a board-certified dermatologist, your dermatologist will:
Examine your skin carefully
Ask questions about your health, medications, and symptoms
If your dermatologist finds a spot on your skin that could be any type of skin cancer, your dermatologist will first numb the area and then remove all (or part) of it. This can be done during an office visit and is called a skin biopsy. This is a simple procedure, which a dermatologist can quickly, safely, and easily perform.
Having a skin biopsy is the only way to know for sure whether you have any type of skin cancer. After your dermatologist removes the spot, a doctor, such as your dermatologist or a dermatopathologist, will examine it under a high-powered microscope. The doctor is looking for cancer cells.
If the doctor sees cancerous basal cells, the diagnosis is BCC.
After the doctor examines the removed skin under a microscope, the doctor writes a report. Called a biopsy report or a pathology report, this document explains in medical terms what was seen under the microscope.
If the diagnosis is any type of skin cancer, the information in this report will tell your dermatologist the key facts needed to treat the cancer, including:
The type of BCC you have
How deeply the cancer has grown (when possible to tell)
Your dermatologist will carefully consider your health and the findings in the report before choosing how to treat the cancer.
How dermatologists treat basal cell carcinoma
When possible, BCC is treated with a procedure called “surgical removal.” If you have an early BCC, this can often be performed in your dermatologist’s office while you remain awake. The following explains the types of surgical removal used to treat BCC, along with other treatment options.
Surgical removal: Three types of surgical removal are used to treat BCC. The type of surgical removal you receive depends largely on the type of BCC you have, where it’s located, and how deeply it goes.
Here’s what involved with each type of surgical removal:
Excision: Your dermatologist cuts out the skin cancer and an area of normal-looking skin around it. Removing some normal-looking skin helps to remove stray cancer cells.
Mohs (pronounced moes) surgery: On some areas of the body, such as an eyelid or your nose, removing an area of normal-looking skin along with the cancer would cause problems. There’s not enough skin in these areas.
Curettage and electrodesiccation: During this type of surgical removal, your dermatologist first scrapes the BCC from your skin, using a technique called curetting. Then, a procedure called electrodesiccation is used to destroy any remaining cancer cells with heat.
Freezing or light therapy: While surgical removal (described above) is often the preferred way to treat BCC, one of these following procedures may be recommended for some patients.
Freezing: The procedure is called cryotherapy (cry-oh-ther-ah-pee), and it can be performed during an office visit. Cryotherapy involves spraying an extremely cold substance, such as liquid nitrogen, on the BCC to destroy the tumor.
Light therapy: The medical name for this procedure is photodynamic therapy (PDT). It’s a two-part procedure. First, a solution that makes your skin more sensitive to light is applied to the cancer and a bit of skin around it. You’ll sit with this solution on your skin for one to several hours.
Medication applied to the skin: This is a treatment that you would use at home as prescribed. It’s often used before or after another treatment for BCC. When prescribed as the first treatment, applying medication to the skin cancer helps to reduce the size of the cancerous tumor. Applying the medication after having another treatment helps to kill any remaining cancer cells.
For a few patients, this may be the only treatment prescribed.
Two medications that you apply to the skin have been approved by the U.S. Food and Drug Administration (FDA) to treat BCC:
Imiquimod (eh-mick-quie-mod): This medication is usually applied once a day or once every other day for 6 weeks or longer.
5-FU: This medication is usually applied twice a day for 3 to 6 weeks.
As these medications destroy cancer cells, you will likely feel the effects on the treated area. Side effects of these medications include skin redness, swelling, sores, crusting, itching, and tingling sensations.
Radiation treatments: If this is prescribed to treat BCC, you will need to go to a hospital or treatment center for radiation treatments. These are usually given over a period of several weeks.
For some patients, radiation may be the only treatment given. Radiation can also be used as a follow-up treatment for an aggressive BCC to help destroy cancer cells.
Radiation is typically only used to treat this skin cancer in people who are 60 years of age or older.
How is basal cell skin cancer treated when it grows deep or spreads?
While this skin cancer tends to grow slowly, early treatment is recommended. Without treatment, BCC can grow deep, destroying what lies in its way. This can be disfiguring. The medical term for this is advanced basal cell carcinoma.
It’s also possible for BCC to spread to other parts of your body, but this is rare. When the cancer spreads, it typically travels first to the lymph nodes closest to the tumor. From there, it tends to spread through the blood to bones, the lungs, and other parts of the skin. When this skin cancer spreads, it is called metastatic basal cell carcinoma.
For cancer that has grown deep or spread to the closest lymph nodes, treatment may involve:
Surgery to remove the tumor (and cancerous lymph nodes)
Follow-up treatment with radiation to kill any remaining cancer cells
For some patients, medication that works throughout the body may be an option. Medication may also be used to treat cancer that:
Returns after surgery or radiation treatments
Has spread to another part of the body
Two such medications have been approved by the U.S. Food and Drug Administration (FDA). Both come in pill form and are taken every day. A patient only stops taking the medication if the cancer starts to grow, or the side effects become too severe.
The two medications are:
Sonidegib (so-nī-deh-gib)
Vismodegib (vis-moe-deh-gib)
In clinical trials, these medications have been shown to stop or slow down the spread of the cancer and shrink the cancerous tumors in some patients.
Your oncologist (doctor who specializes in treating cancer) may talk with you about another medication used to treat advanced basal cell carcinoma. It’s called cemplimab (semi-ply-mab).
Cemplimab may be an option if sonidegib or vismodegib:
Is not an option for you
Stops working
Causes side effects that prevent you from continuing to take it
Cemplimab is a type of medication called immunotherapy. This means it works with your immune system to find and destroy cancer cells. When this happens, tumors can shrink.
Cemplimab is given by infusion, so you would go to your oncologist’s office, a hospital, or cancer treatment center to be treated. Patients receive an infusion once every three weeks. You only stop treatment with cemplimab if it stops working or side effects prevent you from continuing with it.
Newer treatments for deep basal cell skin cancers and ones that have spread are being studied in clinical trials. If you have advanced BCC, you may be eligible for one of these trials.
What is the likely outcome for someone who has BCC?
When found early and treated, this skin cancer can often be removed. However, this skin cancer can return. You also have a higher risk of developing another BCC or other type of skin cancer.
Once you’ve had basal cell carcinoma (BCC), you have a higher risk of developing another skin cancer, including melanoma, the most serious skin cancer.
You’ll have this increased risk for the rest of your life.
To help you reduce these risks and find skin cancer early, dermatologists recommend the following to their patients who have had BCC:
Keep all your dermatology appointments. Your dermatologist will tell you how often you will need to come in. During these appointments, your dermatologist will check you for signs of skin cancer.
Learn how to examine your own skin for signs of skin cancer, and do this as often as your dermatologist recommends. The purpose of the skin self-exam is to find skin cancer early when it’s most treatable.
During your skin self-exam, you want to examine all your skin, even places that rarely get sun. Make an appointment to see your dermatologist if you notice a spot on your skin that:
Differs from the others
Changes
Itches
Bleeds
When you make an appointment to see your dermatologist, be sure to mention that you’ve been treated for skin cancer.
Protect your skin from the sun. While many people feel that the damage has already been done once they develop skin cancer, protecting your skin from the sun has benefits. Sun protection can prevent further damage to your skin and may allow your body to repair some of the existing damage.
Avoid the sun whenever possible. When you’re outdoors during the day, seek shade and try to avoid being outdoors when the sun is strongest, between 10:00 a.m. and 2:00 p.m.
Protect your skin by wearing sunscreen every single day. Even when it’s cloudy, raining, or snowing outdoors, wear sunscreen that offers broad-spectrum protection, SPF 30 or higher, and water resistance. You should apply this every day, even if you’re only spending a few minutes outdoors.
Wear clothing that protects your skin from the sun. Before going outdoors during the day, you want to put on a wide-brimmed hat and sunglasses. Whenever possible, wear long sleeves, pants, shoes, and socks.
Seek shade when outdoors
After getting basal cell carcinoma, protecting your skin from the sun can reduce your risk of getting another skin cancer.
Never use a tanning bed or other indoor tanning equipment. Indoor tanning is not safer than the sun.