Basal cell skin cancer
Basal cell carcinoma; Rodent ulcer; Skin cancer - basal cell; Cancer - skin - basal cell; Nonmelanoma skin cancer; Basal cell NMSC; Basal cell epithelioma
Basal cell cancer is the most common form of cancer in the United States. Most skin cancers are basal cell cancer.
Other common types of skin cancer are:
If you're like many Americans, you've spent hours in the sun trying to get the perfect, golden tan. But tanning has its downsides, including an increased risk of skin cancers like basal cell carcinoma. Most people who get skin cancer have the basal cell carcinoma form. The good news is that this type of skin cancer grows very slowly compared to the more dangerous melanoma type. The bad news is, it's still cancer. You're more likely to get basal cell carcinoma on the parts of your skin that are exposed to the sun, like your scalp, if you don't wear a hat when you go outside. People who are fair-skinned, with blonde hair and blue eyes are also at greater risk for skin cancer than those with darker skin. To find out if you may have basal cell carcinoma, first, do a skin check. Look in a mirror and check your body for any bumps that look white, pink, or brown, or that have crusted over and bleed but don't heal. If you spot anything unusual on your skin, see your dermatologist. The doctor can perform a biopsy removing some or all of the growth and sending it to a lab where it can be checked for cancer. Basal cell carcinoma doesn't grow very quickly, and it's not likely to spread. Your doctor should be able to remove the bumps by cutting, scraping, or freezing it off. Once the cancer is removed, there's a good chance you'll be cured. But because skin cancer can come back, you always want to keep a close eye on your skin, and call your doctor if you notice any new growths. A lot of diseases are beyond your control, but skin cancer is one condition you do have some control over. The best way to avoid getting it is to stop sun worshipping. Seek shade during the hours when the sun is strongest, usually from 10 a.m. to 4 p.m. and especially during the summer months. If you do have to be outside then, slather on a thick layer of sunscreen with an SPF of at least 30, one that protects against both UVA and UVB rays. Reapply it often, if you're in the water where the sunscreen can wash off. Also wear a wide-brimmed hat, sunglasses, and long sleeves. If you want a healthy glow, get one from a bottle. Rubbing on a tanning cream is safer than exposing your skin to the sun.
The typical basal cell skin cancer appears as a small, pearly, dome-shaped nodule with small visible blood vessels (telangiectasias).
This skin cancer appears as a 2 to 3 centimeter skin spot. The tissue has become destroyed (forming an atrophic plaque). There is a brownish color because of increased skin pigment (hyperpigmentation) and a slightly elevated, rolled, pearl-colored margin. This growth is located along the hair line.
You've noticed a mole, sore, or growth on your skin that doesn't look right. It might be a melanoma and time to see a doctor. Melanoma is skin cancer caused by changes in cells called melanocytes. These cells make a skin pigment called melanin. Melanin's what gives you your skin and hair color. Melanoma can appear on normal skin, or it may begin as a mole or other area that has changed in appearance. Some moles you have when you're born can develop into melanoma. There are four types, superficial spreading melanoma is the most common. It's usually flat and irregular in shape and color, with different shades of black and brown. It's most common in Caucasians. Nodular melanoma usually starts as a raised area that is dark blackish-blue or maybe bluish-red. Lentigo melanoma usually occurs in older adults. It's more common on sun-damaged skin on your face, neck, and arms. It's usually large, flat, and tan, with areas of brown. Lastly, acral lentigenous melanoma is the least common form. It usually occurs on your palms, soles, or under your nails. And it's more common in African-Americans. The risk of developing melanoma increases with age, but it is often also seen in young people. You are more likely to get melanoma if you have fair skin, blue or green eyes, or red or blond hair. People who live in sunny climates or at high altitudes are also at risk. As are people who spend a lot of time in the sun, or had one or more blistering sunburns during childhood, or use tanning devices. So, how do you know you have melanoma? You may have a mole, sore, lump, or growth on your skin that just doesn't look right. You may notice a sore or growth that bleeds or changes color. One half of the growth may be different from the other. The edges of the growth may be irregular. The color of the growth may change from one area to another. The spot may be larger than 6mm in diameter, about the size of a pencil eraser. The mole may keep changing in appearance. So, what do you do about melanoma? To treat melanoma successfully, you have to recognize the symptoms early. Make sure somebody sees all of your skin at least once a year and pay attention to your own skin. Call your doctor if you notice anything unusual. Your doctor will examine your skin for size, shape, color, and texture of any suspicious areas. If your doctor thinks you may have skin cancer, you'll have a piece of skin removed and sent to a laboratory for testing. This is called a biopsy. You may also have a lymph node biopsy to see if the cancer has spread to nearby lymph nodes. If you are diagnosed with melanoma, you may have other tests to see if the cancer has spread further. You will need surgery if you have melanoma. The doctor will remove the skin cancer and some of the surrounding tissue. If the cancer has spread to nearby lymph nodes they will also be removed. After surgery, you may need medicine called interferon. If the cancer has spread to organs, it may not be able to be cured. Treatment then might focus on shrinking the cancer and making you as comfortable as possible. You may need chemotherapy, immunotherapy, radiation treatment, and more surgery. Caught early, some of the types of melanoma can be cured. Melanoma that is very deep or has already spread to lymph nodes is more likely to return after treatment. And the odds are even worse if it has spread farther to other organs. If you have melanoma and recovered, it's important you continue to examine your body for any unusual changes because the cancer may return many years later. One more reason that the earlier you catch it the better.
This skin cancer appears as a 1 to 1.5 centimeter flesh-colored nodule with a central depression and a raised, pearly border. Small blood vessels are visible (telangiectatic).
The skin uses sunlight to help manufacture vitamin D, which is important for normal bone formation. But there’s a downside. The sun's ultraviolet light can cause major damage to the skin. The outer layer of the skin has cells that contain the pigment melanin. Melanin protects skin from the sun's ultraviolet rays. These can burn the skin and reduce its elasticity, leading to premature aging. People tan because sunlight causes the skin to produce more melanin and darken. The tan fades when new cells move to the surface and the tanned cells are sloughed off. Some sunlight can be good as long as you have proper protection from overexposure. But too much ultraviolet, or UV, exposure can cause sunburn. The UV rays penetrate outer skin layers and hit the deeper layers of the skin, where they can damage or kill skin cells. People, especially those who don’t have much melanin and who sunburn easily, should protect themselves. You can protect yourself by covering sensitive areas, wearing sunblock, limiting total exposure time, and avoiding the sun between 10 am and 2 pm. Frequent exposure to ultraviolet rays over many years is the chief cause of skin cancer. And skin cancer should not be taken lightly. Check your skin regularly for suspicious growths or other skin changes. Early detection and treatment are key in the successful treatment of skin cancer.
This skin cancer, a basal cell carcinoma, is 5 to 6 centimeters across, red (erythematous), with well defined (demarcated) borders and sprinkled brown pigment along the margins. This cancer is located on the person's back.
Basal cell carcinomas are more prevalent on sun or radiation exposed areas of skin. Here the typical lesion with raised, rolled, pearly borders with ulcerated center is seen on the back of a person previously irradiated for acne.
This flesh-colored, verrucal, pearly, smooth, non-scaling papule is a basal cell carcinoma. It is occurring in a common, sun-exposed area of the face, on the forehead.
This basal cell carcinoma appears as a multicolored flat lesion, with a periphery that has ulcerated and bled. Telangiectasia are present.
Basal cell cancer is a malignant skin tumor involving cancerous changes of basal skin cells. Basal cell skin cancers usually occur on areas of skin that are regularly exposed to sunlight or other ultraviolet radiation. Once a suspicious lesion is found, a biopsy is needed to prove the diagnosis of basal cell carcinoma. Treatment varies depending on the size, depth, and location of the cancer. Early treatment by a dermatologist may result in a cure rate of more than 95%, but regular examination by a health care provider is required to watch for new sites of basal cell cancer.
Causes
The top layer of the skin is called the epidermis. The bottom layer of the epidermis is the basal cell layer. With basal cancer, cells in this layer are the ones that become cancerous. Most basal cell cancers occur on skin that is regularly exposed to sunlight or other ultraviolet radiation.
This type of skin cancer is most common in people over age 50. But it can also occur in younger people who have had extensive sun exposure. Basal cell cancer is almost always slow-growing. It rarely spreads to other parts of the body.
You are more likely to develop basal cell cancer if you have:
- Light-colored or freckled skin
- Blue, green, or grey eyes
- Blond or red hair
- Overexposure to x-rays or other forms of radiation
- Many moles
- Close relatives who have or had skin cancer
- Many severe sunburns early in life
- Long-term daily sun exposure (such as the sun exposure received by people who work outside)
Other risk factors include:
- Smoking
- Weakened immune system, such as being on medicines that suppress the immune system after an organ transplant
- Inherited skin diseases, such as nevoid basal cell carcinoma syndrome
- Having had photodynamic therapy
Symptoms
Basal cell cancer usually grows slowly and is often painless. It may not look that different from your normal skin. You may have a skin bump or growth that is:
- Pearly or waxy
- White or light pink
- Flesh-colored or brown
- A red, scaly patch of skin
In some cases, the skin is just slightly raised, or even flat.
You may have:
- A skin sore that bleeds easily
- A sore that does not heal
- Oozing or crusting spots in a sore
- A scar-like sore without having injured the area
- Irregular blood vessels in or around the spot
- A sore with a depressed (sunken) area in the middle
Exams and Tests
Your health care provider will check your skin and look at the size, shape, color, and texture of any suspicious areas.
If your provider thinks you might have skin cancer, a piece of skin will be removed. This is called a skin biopsy. The sample is sent to a lab for examination under a microscope.
A skin biopsy must be done to confirm basal cell cancer or other skin cancers. The diagnosis cannot be based only on the appearance of your skin.
Treatment
Treatment depends on the size, depth, and location of the skin cancer and your overall health. Each treatment has its risks and benefits. You and your provider can discuss the treatment that's right for you.
Treatment may involve any of the following:
- Excision: Cutting out the skin cancer and stitching the skin together
- Curettage and electrodessication: Scraping away cancer cells and using electricity to kill any that remain; used to treat cancers that are not large or deep; often curettage is used alone without electrodessication
- Cryosurgery: Freezing the cancer cells, which kills them; used to treat cancers that are not large or deep
- Medicine: Skin creams that have medicine; used to treat cancers that are not large or deep
- Mohs surgery: Removing a layer of skin and looking at it immediately under a microscope, then removing additional layers of skin until there are no signs of the cancer; usually used for skin cancers on the nose, ears, and other areas of the face
- Photodynamic therapy: Using a light-activated chemical to treat cancers that are not large or deep
- Radiation therapy: May be used if a basal cell cancer cannot be treated with surgery
- Chemotherapy: May be used in the rare instances of basal cell cancer that has spread to other parts of the body or that cannot be treated with surgery
- Biologic therapies (immunotherapies): Medicines that target and kill basal cell skin cancer and are used when standard treatments do not work
Support Groups
You can ease the stress of illness by joining a cancer support group. Sharing with others who have common experiences and problems can help you not feel alone.
Outlook (Prognosis)
Most of these cancers are cured when treated early. Some basal cell cancers return in the same location. Smaller ones are less likely to come back.
Basal cell skin cancer almost never spreads beyond the original location. Left untreated, however, it may spread into surrounding areas and nearby tissues and bone.
When to Contact a Medical Professional
Contact your provider for an appointment if you have a sore or spot on your skin that changes in:
- Appearance
- Color
- Size
- Texture
Also contact your provider if a spot becomes painful or swollen, or if it starts to bleed or itch.
Prevention
Experts disagree about the value of routine skin examinations by your provider. But all agree it's important to know your own skin and to contact your provider if you notice anything unusual.
The best way to prevent skin cancer is to reduce your exposure to sunlight. Always use sunscreen:
- Apply sunscreen with sun protection factor (SPF) of at least 30, even when you are going outdoors for a short time.
- Apply a large amount of sunscreen on all exposed areas, including ears and feet.
- Look for sunscreen that blocks both UVA and UVB light.
- Use a water-resistant sunscreen.
- Apply sunscreen at least 30 minutes before going out. Follow package instructions about how often to reapply. Be sure to reapply after swimming or sweating.
- Use sunscreen in winter and on cloudy days too.
Other measures to help you avoid too much sun exposure:
- Ultraviolet light is most intense between 10 a.m. and 4 p.m. Try to avoid the sun during these hours.
- Protect your skin by wearing wide-brim hats, long-sleeve shirts, long skirts, or pants. You can also buy sun-protective clothing.
- Avoid surfaces that reflect light more, such as water, sand, concrete, and areas that are painted white.
- The higher the altitude, the faster your skin burns.
- Do not use sun lamps and tanning beds (salons). Spending 15 to 20 minutes at a tanning salon is as dangerous as a day spent in the sun.
References
American Cancer Society website. Skin cancer prevention and early detection.
Dinulos JGH. Premalignant and malignant nonmelanoma skin tumors. In: Dinulos JGH, ed. Habif's Clinical Dermatology. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 21.
National Cancer Institute website. Skin cancer treatment (PDQ) - health professional version.
National Comprehensive Cancer Network website. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Basal cell skin cancer. Version 2.2024.
US Preventive Services Task Force, Mangione CM, Barry MJ, et al. Screening for skin cancer: US Preventive Services Task Force recommendation statement. JAMA. 2023;329(15):1290-1295. PMID: 37071089
Version Info
Last reviewed on: 7/1/2023
Reviewed by: Ramin Fathi, MD, FAAD, Director, Phoenix Surgical Dermatology Group, Phoenix, AZ. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
