Basal Cell Carcinoma Pictures, Symptoms, Causes, Treatments
Basal Cell Carcinoma
Basal Cell Carcinomas or BCCs are abnormal, uncontrolled growths or lesions that arise in the skin’s basal cells, which line the deepest layer of the epidermis (the outermost layer of the skin). BCCs often look like open sores, red patches, pink growths, shiny bumps, or scars. Usually caused by a combination of cumulative UV exposure and intense, occasional UV exposure, BCC can be highly disfiguring if allowed to grow, but almost never spreads (metastastasizes) beyond the original tumor site. Only in exceedingly rare cases can BCC spread to other parts of the body and become life-threatening.
There are an estimated 2.8 million cases of BCC diagnosed in the US each year. In fact, it is the most frequently occurring form of all cancers. More than one out of every three new cancers are skin cancers, and the vast majority are BCCs. It shouldn’t be taken lightly: this skin cancer can be disfiguring if not treated promptly. Are you at risk? We have the information you need about the prevention, detection, and treatment of basal cell carcinoma.
Frequently, two or more of these features are present in one tumor. In addition, BCC sometimes resembles noncancerous skin conditions such as psoriasis or eczema. Only a trained physician, such as a specialist in diseases of the skin, can decide for sure. If you observe any of the warning signs or some other worrisome change in your skin, consult your physician immediately.
Skin Cancer Facts
There are three main types of skin cancer: basal cell carcinoma, squamous cell carcinoma (the nonmelanoma skin cancers), and melanoma.
Skin cancer is the most common form of cancer in humans.
Ultraviolet light, which is in sunlight, is the main cause of skin cancer.
The most common warning sign of skin cancer is a change in the appearance of the skin, such as a new growth or a sore that will not heal. Unexplained changes in the appearance of the skin lasting longer than two weeks should be evaluated by a doctor.
Nonmelanoma skin cancer is generally curable. The cure rate for nonmelanoma skin cancer could be 100% if these lesions were brought to a doctor's attention before they had a chance to spread.
Treatment of nonmelanoma skin cancer depends on the type and location of the skin cancer, the risk of scarring, as well as the age and health of the patient. Methods used include curettage and desiccation, surgical excision, cryosurgery, radiation, and Mohs micrographic surgery.
Avoiding sun exposure in susceptible individuals is the best way to lower the risk for all types of skin cancer. Regular surveillance of susceptible individuals, both by self-examination and regular physical examination, is also a good idea for people at higher risk. People who have already had any form of skin cancer should have regular medical checkups.
Skin cancer is the most common form of human cancer. It is estimated that over 2 million new cases occur annually. The annual rates of all forms of skin cancer are increasing each year, representing a growing public concern. It has also been estimated that nearly half of all Americans who live to age 65 will develop skin cancer at least once.
The most common warning sign of skin cancer is a change in the appearance of the skin, such as a new growth or a sore that will not heal.
The term "skin cancer" refers to three different conditions. From the least to the most dangerous, they are:
basal cell carcinoma (or basal cell carcinoma epithelioma)
squamous cell carcinoma (the first stage of which is called actinic keratosis)
The two most common forms of skin cancer are basal cell carcinoma and squamous cell carcinoma. Together, these two are also referred to as nonmelanoma skin cancer. Melanoma is generally the most serious form of skin cancer because it tends to spread (metastasize) throughout the body quickly. Skin cancer is also known as skin neoplasia.
What is Basal Cell Carcinoma?
Basal cell carcinoma is a slow-growing form of skin cancer.
Basal cell carcinoma is the most common form of skin cancer and accounts for more than 90% of all skin cancer in the U.S. These cancers almost never spread (metastasize) to other parts of the body. They can, however, cause damage by growing and invading surrounding tissue.
Skin cancer falls into two major groups: Nonmelanoma and melanoma. Basal cell carcinoma is a type of nonmelanoma skin cancer.
Squamous cell skin cancer
Causes of Basal Cell Carcinoma
Basal cell carcinoma, or basal cell skin cancer, is the most common form of cancer in the United States. Most skin cancers are basal cell cancer.
Basal cell carcinoma starts in the top layer of the skin called the epidermis. Most basal cell cancers occur on skin that is regularly exposed to sunlight or other ultraviolet radiation. This includes the top of your head, or scalp.
Basal cell skin cancer is most common in people over age 40. However, it occurs in younger people, too.
You are more likely to get basal cell skin 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
Close relatives who have or had skin cancer
Many severe sunburns early in life
Long-term daily sun exposure (such as the sun exposure people who work outside receive)
Symptoms of Basal Cell Carcinoma
Basal cell skin cancer grows slowly and is usually 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
In some cases the skin may be 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 of Basal Cell Carcinoma
Your doctor will check your skin and look at the size, shape, color, and texture of any suspicious areas.
If your doctor thinks you might have skin cancer, a piece of skin will be removed and sent to a lab for examination under a microscope. This is called a skin biopsy. There are different types of skin biopsies.
A skin biopsy must be done to confirm basal cell skin cancer or other skin cancers.
Treatment of Basal Cell Carcinoma
Treatment depends on the size, depth, and location of the skin cancer, and your overall health.
Treatment may involve:
Excision: Cutting out the skin cancer and stitching the skin together.
Curettage and electrodesiccation: Scraping away cancer cells and using electricity to kill any that remain.
Cryosurgery: Freezing the cancer cells, which kills them.
Medication: Skin creams containing imiquimod or 5-fluorouracil for superficial (not very deep) basal cell cancer.
Johns surgery: Removing a layer of skin and looking at it immediately under a microscope, then removing many 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: Treatment using light.
Radiation may be used if a basal cell cancer cannot be treated with surgery.
Outlook (Prognosis) of Basal Cell Carcinoma
How well a patient does depends on many things, including how quickly the cancer was diagnosed. Most of these cancers are cured when treated early.
Some basal cell cancers may return. Smaller ones are less likely to come back. Basal cell carcinoma almost never spreads to other parts of the body.
If you have had skin cancer, you should have regular check-ups so that a doctor can examine your skin. You should also examine your skin once a month. Use a hand mirror to check hard-to-see places. Call your doctor if you notice anything unusual.
Possible Complications of Basal Cell Carcinoma
Basal cell skin cancer almost never spreads. But, if left untreated, it may grow into surrounding areas and nearby tissues and bone. This is most worrisome around the nose, eyes, and ears.
When to Contact a Medical Professional
Call your health care provider if you notice any changes in your skin. You should also call if an existing spot becomes painful or swollen, or if it starts to bleed or itch.
Prevention of Basal Cell Carcinoma
The best way to prevent skin cancer is to reduce your exposure to sunlight. Ultraviolet light is most intense between 10 a.m. and 4 p.m., so try to avoid sun exposure during these hours. Protect the skin by wearing hats, long-sleeved shirts, long skirts, or pants.
Always use sunscreen:
Apply high-quality sunscreens with sun protection factor (SPF) ratings of at least 15, even when you are only going outdoors for a short time.
Apply a large amount of sunscreen on all exposed areas, including ears and feet.
Look for sunscreens that block both UVA and UVB light.
Use a waterproof formula.
Apply sunscreen at least 30 minutes before going outside, and reapply it frequently, especially after swimming.
Use sunscreen in winter, too. Protect yourself even on cloudy days.
Other important facts to help you avoid too much sun exposure:
Avoid surfaces that reflect light more, such as water, sand, concrete, and white-painted areas.
The dangers are greater closer to the start of summer.
Skin burns faster at higher altitudes.
Avoid sun lamps, tanning beds, and tanning salons.
Examine the skin regularly for unusual growths or skin changes.
Alternative Names of Basal Cell Carcinoma
BCC; Basal cell skin cancer; Rodent ulcer; Skin cancer - basal cell; Cancer - skin - basal cell; Nonmelanoma skin cancer; Basal cell NMSC
What is a basal cell carcinoma?
This leaflet has been written to help you understand more about basal cell carcinomas. It tells you about what they are, what causes them, what can be done about them and where you can find out more about them.
A basal cell carcinoma (BCC) is a type of skin cancer. There are two main types of skin cancer: melanoma and non-melanoma skin cancer. BCC is a non-melanoma skin cancer, and is the most common type (> 80%) of all skin cancer (skin cancer incidence is < 1%) in the UK. BCC are sometimes referred to as ‘rodent ulcers’.
What causes basal cell carcinoma?
The commonest cause is too much exposure to ultraviolet (UV) light from the sun or from sunbeds. BCC can occur anywhere on your body, but is most common on areas that are often exposed to the sun, i.e. your face, head, neck and ears. It is also possible for a BCC to develop where burns, scars or ulcers have damaged the skin. BCC is not infectious.
BCC mainly affects fair skinned adults, but other skin types are also at risk. Those with the highest risk of developing a basal cell carcinoma are:
People with pale skin who burn easily and rarely tan (generally with light coloured or red hair, although some may have dark hair but still have fair skin).
Those who have had a lot of exposure to the sun, such as people with outdoor hobbies or outdoor workers, and people who have lived in sunny climates.
People who use sun beds or sunbathe.
People who have previously had a basal cell carcinoma.
Are basal cell carcinomas hereditary?
Apart from a rare familial condition called Gorlin’s syndrome, BCCs are not hereditary. However some of the things that increase the risk of getting one (e.g. a fair skin, a tendency to burn rather than tan, and freckling) do run in families.
What does a basal cell carcinoma look like?
BCC can vary greatly in their appearance, but people often first become aware of them as a scab that bleeds occasionally and does not heal completely. Some BCC are very superficial and look like a scaly red flat mark; others have a pearl-like rim surrounding a central crater. If left for years the latter type can eventually erode the skin causing an ulcer; hence the name “rodent ulcer”. Other BCC are quite lumpy, with one or more shiny nodules crossed by small but easily seen blood vessels. Most BCC are painless, although sometimes can be itchy or bleed if caught on clothes or picked up.
How will my basal cell carcinoma be diagnosed?
Sometimes the diagnosis is clear from its appearance. If further investigation is necessary to confirm the diagnosis then a small area of the abnormal skin (a biopsy) or the entire lesion (an excision biopsy) may be cut out and examined under the microscope. You will be given a local anaesthetic beforehand to numb the skin.
Can basal cell carcinomas be cured?
Yes, BCCs can be cured in almost every case, although treatment becomes complicated if they have been neglected for a very long time, or if they are in an awkward place, such as near the eye, nose or ear.
BCCs never spread to other parts of the body except very rarely (fewer than 1 in 20) if neglected for years, when it may spread to draining lymph nodes. Hence, although it is a type of skin cancer it never endangers life.
How can a basal cell carcinoma be treated?
The commonest treatment for BCC is surgery. Usually, this means cutting away the BCC, along with some clear skin around it, using local anaesthetic to numb the skin. The skin can usually be closed with a few stitches, but sometimes a small skin graft is needed.
Other types of treatment include:
Difficult or neglected BCC - Mohs micrographic surgery. This involves the excision of the affected skin that is then examined under the microscope straight away to see if all the BCC has been removed. If any residual BCC is left at the edge of the excision further skin is excised from that area and examined under the microscope and this process is continued until all the BCC is removed. The site is then usually covered with a skin graft. This is a time consuming process and only undertaken for certain BCC in difficult anatomical areas if simple surgery is not suitable.
Radiotherapy - shining X-rays onto the area containing the BCC.
Very superficial BCC:
Curettage and cautery - the skin is numbed with local anaesthetic and the BCC is scraped away (curettage) and then the skin surface is sealed by heat (cautery).
Cryotherapy - freezing the BCC with liquid nitrogen.
Creams - these can be applied to the skin. The two most commonly used are 5-fluorouracil (5-FU) and imiquimod.
Photodynamic therapy - a special cream is applied to the BCC which is taken up by the cells that are then destroyed by exposure to a specific wavelength of light. This treatment is only available in certain dermatology departments.
Surgical excision is the preferred treatment, but the choice of other treatments depends on the site and size of the BCC, the condition of the surrounding skin and number of BCC to be treated (some people have multiple ) as well as the overall state of health of each person to be treated.
What can I do?
Treatment will be much easier if your BCC is detected early. BCC can vary in their appearance, but it is advisable to see your doctor if you have any marks or scabs on your skin which are:
bleeding and never completely healing
changing appearance in any way
Check your skin for changes once a month. A friend or family member can help you particularly with checking areas that you cannot easily inspect, such as your back.
You can also take some simple precautions to help prevent a BCC appearing:
Top sun safety tips:
Protect your skin with clothing, and don’t forget to wear a hat that protects your face, neck and ears, and a pair of UV protective sunglasses.
Spend time in the shade between 10am and 3pm when it’s sunny. Step out of the sun before your skin has a chance to redden or burn. Keep babies and young children out of direct sunlight.
When choosing a sunscreen look for a high protection' SPF (SPF 30 or more) to protect against UVB, and the UVA circle logo and/or 4 or 5 UVA stars to protect against UVA. Apply plenty of sunscreen 15 to 30 minutes before going out in the sun, and reapply every two hours and straight after swimming and towel-drying.
The British Association of Dermatologists recommends that you tell your doctor about any changes to a mole or patch of skin. If your GP is concerned about your skin, make sure you see a Consultant Dermatologist – an expert in diagnosing skin cancer. Your doctor can refer you for free through the NHS.
While BCCs and other skin cancers are almost always curable when detected and treated early, it is best to prevent them in the first place. Make these sun safety habits part of your daily health care routine:
Seek the shade, especially between 10 AM and 4 PM.
Do not burn.
Avoid tanning and UV tanning booths.
Cover up with clothing, including a broad-brimmed hat and UV-blocking sunglasses.
Use a broad spectrum (UVA/UVB) sunscreen with an SPF of 15 or higher every day. For extended outdoor activity, use a water-resistant, broad spectrum (UVA/UVB) sunscreen with an SPF of 30 or higher.
Apply 1 ounce (2 tablespoons) of sunscreen to your entire body 30 minutes before going outside. Reapply every two hours or after swimming or excessive sweating.
Keep newborns out of the sun. Sunscreens should be used on babies over the age of six months.
Examine your skin head-to-toe every month.
See your doctor every year for a professional skin exam.
Basal Cell Carcinoma Treatment Options
After the physician’s examination, the diagnosis of BCC is confirmed with a biopsy. In this procedure, the skin is first numbed with local anesthesia. A piece of tissue is then removed and sent to be examined under a microscope in the laboratory to seek a definitive diagnosis. If tumor cells are present, treatment is required. Fortunately, there are several effective methods for eradicating BCC. Choice of treatment is based on the type, size, location, and depth of penetration of the tumor, the patient’s age and general health, and the likely cosmetic outcome of specific treatments.
Treatment can almost always be performed on an outpatient basis in the physician’s office or at a clinic. With the various surgical techniques, a local anesthetic is commonly used. Pain or discomfort during the procedure is minimal, and pain afterwards is rare.
Mohs Micrographic Surgery
Using local anesthesia, the physician removes the tumor with a very thin layer of tissue around it. The layer is immediately checked under a microscope thoroughly. If tumor is still present in the depths or peripheries of this surrounding tissue, the procedure is repeated until the last layer examined under the microscope is tumor-free. This technique saves the greatest amount of healthy tissue and has the highest cure rate, generally 98 percent or better. It is frequently used for tumors that have recurred, are poorly demarcated, or are in critical areas around the eyes, nose, lips, and ears. After removal of the skin cancer, the wound may be allowed to heal naturally or be reconstructed using plastic surgery methods.
After numbing the area with local anesthesia, the physician uses a scalpel to remove the entire growth along with a surrounding border of normal skin as a safety margin. The skin around the surgical site is then closed with a number of stitches, and the excised tissue is sent to the laboratory for microscopic examination to verify that all the malignant cells have been removed. The effectiveness of the technique does not match that of Mohs, but produces cure rates around 90 percent.
Curettage and Electrodesiccation
Using local anesthesia, the physician scrapes off the cancerous growth with a curette (a sharp, ring-shaped instrument). The heat produced by an electrocautery needle destroys residual tumor and controls bleeding. This technique may be repeated twice or more to ensure that all cancer cells are eliminated. It can produce cure rates approaching those of surgical excision, but may not be as useful for aggressive BCCs or those in high-risk or difficult sites.
X–ray beams are directed at the tumor, with no need for cutting or anesthesia. Total destruction generally requires several treatments per week for a few weeks. Radiation may be used for tumors that are hard to manage surgically and for elderly patients or others who are in poor health. Cure rates are around 90 percent, but the technique can involve long-term cosmetic problems and radiation risks, as well as multiple visits. No anesthesia is necessary.
Tumor tissue is destroyed by freezing with liquid nitrogen, without the need for cutting or anesthesia. The procedure may be repeated at the same session to ensure total destruction of malignant cells. The growth becomes crusted and scabbed, and usually falls off within weeks. Cryosurgery is effective for the most common tumors and is the treatment of choice for patients with bleeding disorders or an intolerance to anesthesia. This method is used less commonly today, and has a lower cure rate than the surgical techniques–approximately 85-90 percent depending on the physician’s expertise.
Photodynamic Therapy (PDT)
PDT can be useful when patients have multiple BCCs. A photosensitizing agent such as Topical 5-aminolevulinic acid (5-ALA) is applied to the tumors at the physician’s office. It is taken up by the abnormal cells. The next day, the patient returns, and those medicated areas are activated by a strong light. This treatment selectively destroys BCCs while causing minimal damage to surrounding normal tissue. PDT is FDA approved for treatment of superficial and nodular BCCs. Cure rates can vary considerably, ranging from 70 to 90 percent. Patients become photosensitive for 48 hours after the treatment and must stay out of the sun.
The skin’s outer layer and variable amounts of deeper skin are removed using a carbon dioxide or erbium YAG laser. Lasers give the doctor good control over the depth of tissue removed, and are sometimes used as a secondary therapy when other techniques are unsuccessful. Laser treatment has recurrence rates similar to those of PDT. It is not FDA-approved for BCC.
Imiquimod is FDA-approved only for superficial BCCs, with cure rates generally between 80 and 90 percent. The 5% cream is rubbed gently into the tumor five times a week for up to six weeks or longer. It is the first in a new class of drugs that work by stimulating the immune system.
5-Fluorouracil (5-FU) also has been FDA-approved for superficial BCCs, with similar cure rates to imiquimod. The 5% liquid or ointment is gently rubbed into the tumor twice a day for three to six weeks.
Trials with more invasive BCCs are under way for both imiquimod and 5-FU. Side effects are variable, and some patients do not experience any discomfort, but redness, irritation, and inflammation are predictable.
New Medicine for Advanced Basal Cell Carcinoma
In extraordinarily rare cases of metastatic BCC or locally advanced BCC, this cancer can become dangerous, sometimes even life-threatening. ErivedgeTM (vismodegib), the first medicine ever for advanced BCC, is an oral drug approved by the FDA in early 2012 only for very limited circumstances where the nature of the cancer precludes other treatment options (such as surgery or radiation). Due to a risk of birth defects, vismodegib must not be used by women who are pregnant or attempting to conceive.
What Is Basal Cell Carcinoma?
Basal cell carcinoma is the most common form of skin cancer, accounting for more than 90% of all skin cancer cases in the U.S. These cancers almost never spread (metastasize) to other parts of the body. They can, however, cause damage by growing and invading surrounding tissue.
What Are the Risk Factors for Getting Basal Cell Carcinoma?
Light-colored skin and sun exposure are both important factors in the development of basal cell carcinomas. About 20% of these skin cancers, however, occur in areas that are not sun-exposed, such as the chest, back, arms, legs, and scalp. The face, however, remains the most common location for basal cell lesions. Weakening of the immune system, whether by disease or medication, can also promote the risk of developing basal cell carcinoma.
According to the U.S. National Institutes of Health, ultraviolet (UV) radiation from the sun is the main cause of skin cancer. Artificial sources of UV radiation, such as sunlamps and tanning booths, can also cause skin cancer. The risk of developing skin cancer is also affected by where a person lives. People who live in areas that receive high levels of UV radiation from the sun are more likely to develop skin cancer. In the U.S., for example, skin cancer is more common in Texas than it is in Minnesota, where the sun is not as strong. Worldwide, the highest rates of skin cancer are found in South Africa, Israel, New Zealand, and Australia, which are areas that receive high amounts of UV radiation. Most skin cancers appear after age 50, but the sun's damaging effects begin at an early age. Therefore, protection should start in childhood in order to prevent skin cancer later in life.
What Does Basal Cell Carcinoma Look Like?
A basal cell carcinoma usually begins as a small, dome-shaped bump and is often covered by small, superficial blood vessels called telangectasias. The texture of such a spot is often shiny and translucent, sometimes referred to as "pearly." It is sometimes hard to tell a basal cell carcinoma from a benign growth like a flesh-colored mole without performing a biopsy. Some basal cell carcinomas contain melanin pigment, making them look dark rather than shiny.
Basal cell carcinomas grow slowly, taking months or even years to become sizable. Although spread to other parts of the body (metastasis) is very rare, a basal cell carcinoma can damage and disfigure the eye, ear, or nose if it grows nearby.
How Is Basal Cell Carcinoma Diagnosed?
To make a proper diagnosis, doctors perform a biopsy. This usually involves taking a sample by injecting a local anesthesia and scraping a small piece of skin. This method is referred to as a shave biopsy. The skin that is removed is then examined under a microscope to check for cancer cells.
How Is Basal Cell Carcinoma Treated?
There are many ways to successfully treat a basal cell carcinoma. The doctor's main goal is to remove or destroy the cancer completely with as small a scar as possible. To plan the best treatment for each patient, the doctor considers the location and size of the cancer, the risk of scarring, and the person's age, general health, and medical history.
Methods used to treat basal cell carcinomas include:
Curettage and desiccation: Dermatologists often prefer this method, which consists of scooping out the basal cell carcinoma by using a spoon like instrument called a curette. Desiccation is the additional application of an electric current to control bleeding and kill the remaining cancer cells. The skin heals without stitching. This technique is best suited for small cancers in non-crucial areas such as the trunk and extremities.
Surgical excision: The tumor is cut out and stitched up.
Radiation therapy: Doctors occasionally use radiation treatments for skin cancer occurring in areas that are difficult to treat with surgery, particularly in elderly patients. Obtaining a good result generally involves many treatment sessions, perhaps 15 to 20.
Cryosurgery: Some doctors trained in this technique achieve good results by freezing basal cell carcinomas. Typically, liquid nitrogen is applied to the growth to freeze and kill the abnormal cells.
Mohs micrographic surgery: Named for its pioneer, Dr. Frederic Mohs, this technique of removing skin cancer is better termed, "microscopically controlled excision." The surgeon meticulously removes a small piece of the tumor and examines it under the microscope. This sequence of cutting and microscopic exam is repeated in a painstaking fashion so that the basal cell carcinoma can be mapped and taken out without having to estimate or guess the width and depth of the lesion. This method removes as little of the healthy normal tissue as possible. The cure rate is very high, exceeding 98%. Mohs micrographic surgery is preferred for large basal cell carcinomas, those that recur after previous treatment, or lesions affecting parts of the body where experience shows that recurrence is common after treatment by other methods. Such body parts include the scalp, ears, and the corners of the nose. In cases where large amounts of tissue need to be removed, the Mohs surgeon sometimes works with a plastic (reconstructive) surgeon to achieve the best possible post-surgical appearance.
A new drug, vismodegib, has recently been approved by the FDA for locally recurrent or advanced basal cell carcinoma.
How Is Basal Cell Carcinoma Prevented?
Avoiding sun exposure in susceptible individuals is the best way to lower the risk for all types of skin cancer, including basal cell carcinoma. Regular surveillance of susceptible individuals, both by self-exams and regular physical exams, is also a good idea for people at higher risk. People who have already had any form of skin cancer should have regular medical checkups.
Common sense preventive techniques include:
Limiting recreational sun exposure
Avoiding unprotected exposure to the sun during peak radiation times (the hours surrounding noon)
Wearing broad-brimmed hats and tightly-woven protective clothing while outdoors in the sun
Regularly using a waterproof or water-resistant sunscreen with UVA and UVB protection and SPF number of 30 or higher
Undergoing regular checkups and bringing any suspicious-looking or changing lesions to the attention of the doctor