This page was reviewed under our medical and editorial policy by
Frederick L. Durden, Jr, MD, Plastic and Reconstructive Surgeon & Microsurgical Reconstructive Surgeon.
This page was updated on October 20, 2022.
Basal cell skin cancer is the most common form of skin cancer. Approximately 80 percent of all skin cancers are basal cell carcinomas (BCC), meaning they occur in the skin’s basal cell layer, according to the American Cancer Society.
The other two main types of skin cancer are squamous cell cancer and melanoma. While BCC isn’t as deadly as melanoma, all types of skin cancer should be properly diagnosed and treated by a doctor.
This article will explore the following topics:
Your skin’s uppermost layer is called the epidermis, and the bottom layer of the epidermis is the basal cell layer. If your skin cancer starts in the basal cell layer, it’s a basal cell carcinoma.
Basal cell skin cancers tend to grow slowly and rarely spread, but this doesn’t mean you should ignore them. Untreated basal cell cancer can invade the bone or other tissues under the skin. It can also recur. If you’ve had basal cell skin cancer in the past, it may come back in the same place or elsewhere on your body.
There are four types of basal cell carcinomas, each of which looks slightly different than the others.
Nodular basal skin cell cancers: This type looks like a pimple, raised from the skin, and may appear flesh-colored, pink, pearly or shiny. It also may have little red blood vessels inside and a slightly raised edge. It’s slow-growing and may turn into an open sore and bleed.
Superficial spreading basal cell carcinoma: This type appears like a pink or red scaly patch. It’s flat to the skin and may develop a crust. The outer edge may look pearl-colored with small white bumps.
Sclerosing or infiltrating basal cell cancers: Also called morpheaform BCCs, these lighter-colored patches on the skin are shiny, smooth and may look like a scar. They may be difficult to see with undefined borders. They may also have indentations, little red blood vessels, and open sores or crusts.
Pigmented basal cell skin cancers: These may have a color to them, appearing brown, blue, black or red.
Basal cell and squamous cell carcinomas are the two most common types of skin cancer. According to the American Cancer Society, about 80 percent of nonmelanoma skin cancers are basal cell carcinomas, while about 20 percent are squamous cell carcinomas.
Both form in the outer layer of the skin, but in different types of cells:
Both skin cancers are most commonly the result of genetic changes caused by ultraviolet (UV) light and appear on sun-exposed areas of the body. However, squamous cell cancers may also grow in scars or skin sores that don’t heal on other parts of the body. Sometimes they grow around the genitals.
Basal cell carcinomas rarely spread to other parts of the body. It’s much more common for squamous cell carcinomas to spread.
Skin changes that develop before skin cancer may take the form of actinic keratosis, a precancerous lesion on the skin.
Actinic keratosis may have the following properties:
Similar to basal cell carcinoma, actinic keratosis is a thick, scaly patch that forms in parts of the body exposed to the sun, specifically the face and tops of the hands.
However, unlike basal cell carcinomas, actinic keratosis isn’t cancer. The chance of actinic keratosis developing into squamous cell cancer if not treated is low.
BCC develops from changes to the genetic material in the cells of the skin’s outermost layer. Environmental factors, such as UV light from the sun or indoor tanning, damage the DNA and lead to changes. These changes may build up over time and eventually turn the cells into cancer.
Exposure to the sun’s ultraviolet rays is the top risk factor for all types of skin cancer, including basal cell carcinoma. Basal cell skin cancers occur on parts of the body that are exposed to sun including the neck, scalp, chest, shoulders and back. If you had sunburns as a child, you’re at greater risk for basal cell skin cancers.
This form of skin cancer is more common in people older than 50, but it can strike younger people with a history of extensive sun exposure, too.In addition to history of exposure to the sun or other UV radiation, you’re at higher risk for developing basal cell skin cancer if you have:
The best way to reduce your risk for basal cell or any type of skin cancer is to:
When diagnosing basal cell carcinoma, symptoms may include:
Knowing what to look for can help you stay one step ahead of basal cell skin cancers.
If you’re concerned about a mark on your skin, schedule a visit with your dermatologist. It’s always better to be safe than sorry. Your doctor will examine the spot and if he or she is concerned, a biopsy is the next step. This involves taking a sample of the lesion and sending it off to a lab for analysis. The process can take around a week or more to get results.
Treatment plans for basal cell carcinoma is based on its size, depth and where it’s located.
Your surgeon may opt to excise the cancer, which means cut it out and stitch the remaining skin back together.
Mohs surgery is a skin cancer treatment that removes a mole layer by layer. Your surgeon looks at each layer under a microscope and continues to remove more layers until there is no evidence of the cancer. This tends to be preferred if the basal skin cell carcinoma is on the nose, ears and other areas of the face.
Treatments other than surgery may also be options, including:
If basal cell cancer has spread to other parts of your body, options may include newer chemotherapies. Both Erivedge® (vismodegib) and Odomzo® (sonidegib) block a key signaling pathway that encourages basal cell skin cancers to grow and spread.
Basal cell carcinoma is very common. It’s so common and treatable, in fact, that statistics like cases and survival rates for BCCs aren’t reported and tracked as they are with other cancers.
Because these statistics aren’t tracked, there’s no clear idea of how many people die from BCCs annually, though it’s estimated that basal cell and squamous cell carcinomas cause about 2,000 deaths a year, according to the American Cancer Society.
Those who die from BCCs are typically:
Healthy people who develop basal cell carcinoma typically have a positive prognosis. Surgery, or other treatment options, routinely are enough to remove the cancer, especially in the early stages.