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Basal cell carcinoma

Definition

Basal cell carcinoma is a slow-growing form of skin cancer.

Skin cancer falls into two major groups: Nonmelanoma and melanoma. Basal cell carcinoma is a type of nonmelanoma skin cancer.

Alternative Names

Basal cell skin cancer; Rodent ulcer; Skin cancer - basal cell; Cancer - skin - basal cell; Nonmelanoma skin cancer; Basal cell NMSC

Causes, incidence, and risk factors

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
  • 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 people who work outside receive)
Symptoms

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
Signs and tests

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

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
  • Mohs 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.

Expectations (prognosis)

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.

Complications

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.

Calling your health care provider

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

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.

References

Basal cell and squamous cell cancers. NCCN Medical Practice Guidelines and Oncology. V.1.2009. Accessed July 15, 2009.

Neville JA, Welch E, Leffell DJ. Management of nonmelanoma skin cancer in 2007. Nat Clin Pract Oncol. 2007;4:462-469.

Eigentler TK, Kamin A, Weide BM, et al. A phase III, randomized, open label study to evaluate the safety and efficacy of imiquimod 5% cream applied thrice weekly for 8 and 12 weeks in the treatment of low-risk nodular basal cell carcinoma. J Am Acad Dermatol. 2007;57:616-621.

Hexsel CL, Bangert SD, Hebert AA, et al. Current sunscreen issues. 2007 Food and Drug Administration sunscreen labelling recommendations and combination sunscreen/insect repellant products. J Am Acad Dermatol. 2008;59:316-323.

Lautenschlager S, Wulf HC, Pittelkow MR. Photoprotection. Lancet. 2007;370:528-537.

Ridky TW. Nonmelanoma skin cancer. J Am Acad Dermatol. 2007;57:484-501.

Wood GS, Gunkel J, Stewart D, et al. Nonmelanoma skin cancers: basal and squamous cell carcinomas. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKenna WG, eds. Abeloff's Clinical Oncology. 4th ed. Philadelphia, Pa: Churchill Livingstone; 2008:chap 74.

Basal cell nevus syndrome - close-up of palm
Basal cell nevus syndrome is an inherited disorder characterized by wide-set eyes, saddle nose, frontal bossing (prominent forehead), prognathism (prominent chin), numerous basal cell carcinomas, and skeletal abnormalities. Skin manifestations include pits in the palms and soles, and numerous basal cell carcinomas. This picture is a close-up of the pits found in the palm of an individual with basal cell nevus syndrome.
Skin cancer, basal cell carcinoma - nose
The typical basal cell skin cancer appears as a small, pearly, dome-shaped nodule with small visible blood vessels (telangiectasias).
Skin cancer, basal cell carcinoma - pigmented
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.
Skin cancer, basal cell carcinoma - behind ear
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).
Skin cancer, basal cell carcinoma - spreading
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 nevus syndrome - plantar pits
Basal cell nevus syndrome is an inherited disorder characterized by wide-set eyes, saddle nose, frontal bossing (prominent forehead), prognathism (prominent chin), and skeletal abnormalities. Skin manifestations include pits in the palms and soles, and numerous basal cell carcinomas (skin cancers). This picture is a close-up of the pits found on the sole of the foot of an individual with basal cell nevus syndrome.
Basal cell nevus syndrome - face and hand
Basal cell nevus syndrome is an inherited disorder characterized by wide-set eyes, saddle nose, frontal bossing (prominent forehead), prognathism (prominent chin), numerous basal cell carcinomas (a type of skin cancer), and skeletal abnormalities. This individual has multiple flesh-colored, dome-shaped bumps on the face which are basal cell cancers, and palmar pits.
Multiple Basal cell cancer due to x-ray therapy for acne
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.
Basal Cell Carcinoma - face
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.
Basal cell carcinoma - close-up
This basal cell carcinoma appears as a multicolored flat lesion, with a periphery that has ulcerated and bled. Telangiectasia are present.
Basal cell cancer
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.

Review Date: 7/26/2011
Reviewed By: Kevin Berman, MD, PhD, Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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