Basal cell carcinoma (BCC) is the most common type of cancer in the United States, with about 3.6 million cases a year, according to the Skin Care Foundation. It is becoming more common and affecting younger people. At one time, BCC developed mostly among people in their 50s and older. But now dermatologists see basal cell carcinoma in people as early as in their 20s. Although rarely life-threatening, the condition can damage the skin and soft tissue and cause scarring if left untreated.

BCC is caused by ultraviolet radiation that comes from the sun or tanning beds. It often shows up on areas of the skin that are exposed to the sun, such as the face, neck, scalp, hands. But it can appear anywhere—even in places you might not expect, like on the feet or genitals.

A basal cell carcinoma could look like:

• A shiny red or pink bump
• A patch of irritated, flaky, or red skin
• A scab that heals and comes back

If you notice a new skin lesion, you should be checked by a dermatologist. You can protect your skin by avoiding tanning beds, wearing wide-brimmed hats and protective clothing, using umbrellas for shade, and applying sunscreen (SPF of 50 or higher). Once you have had BCC, you have a greater chance of developing another in the future.

Diagnosis

At the Kimberly and Eric J. Waldman Melanoma and Skin Cancer Center, our dermatologists begin with a comprehensive full-body skin exam. If they see a lesion that might be a BCC, they will perform a biopsy. This involves removing a small sample of skin and sending it to the lab for analysis. There are three types of BCC:

• Nodular: The most common form of BCC, nodular lesions usually look like a shiny bump (resembling a pimple). Sometimes they scab or bleed. We generally remove them surgically in an outpatient procedure. We might simply cut the lesion out (excision) or use a procedure called Mohs surgery.
• Superficial: Another common type of BCC, these lesions appear as red, scaly patches. They are sometimes confused with eczema or psoriasis. We typically treat them with a cream, destroy them with heat or cold, or remove them surgically.
• Infiltrative/Sclerosing/Morpheaform/Micronodular: These are more aggressive types that can have deeper and broader “roots.” We generally treat them with Mohs surgery.

Treatment

We use a number of approaches, including:

• Topical medication: You typically apply this at home.
• Liquid nitrogen: We spray this on the tumor.
• Scraping and burning (also called electrodesiccation and curettage): After numbing the area, we scrape the tumor with a long, thin instrument called a curette. Then we use an electric needle (an electrode) to remove any remaining cancer cells. We may need to do this more than once during the office visit.
• Simple excision: First we numb the area. Then we remove the tumor surgically and stitch the wound. 
• Mohs surgery: This technique involves removing the tumor with a narrow margin of surrounding skin that appears normal. Then we examine it under a microscope to determine if cancer cells remain. If necessary, we remove and analyze some more tissue. We repeat this process until the cancer is fully removed. This approach is highly precise, preserving healthy tissue and minimizing scarring.

Treatment depends on the type of BCC and where it is on the body.

• Superficial BCC in a low-risk location such as chest, back, arms, and legs: If the lesions are on the chest, back, arms, and legs (not including the shins), the goal is to destroy the cancer. We may use a topical medication, liquid nitrogen, or an approach that involves scraping and burning the lesion (called electrodesiccation and curettage). If these tumors appear on the head, neck, hands, feet or genitals, we may perform Mohs surgery.
• Nodular BCC in a low-risk location (chest, back, arms, or legs): We surgically remove these tumors with a four- to five-millimeter margin of healthy skin. We send this tissue to a laboratory to make sure the skin cancer is fully removed. We use this approach in locations where the tumor is less likely to come back, such as the chest and back. If these tumors are on the head, neck, hands, feet, or genitals, we perform Mohs surgery.
• Aggressive BCC (micronodular, infiltrative, morpheaform, sclerosing in any location): We typically use Mohs micrographic surgery for cancers in cosmetically sensitive and functionally important areas. This includes the head and neck, hands, feet, or genitals. We also use this approach for aggressive basal cell carcinoma.