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Basal cell skin cancer

Definition

Basal cell cancer is the most common form of cancer in the United States. Most skin cancers are basal cell cancer.

Basal cell cancer is almost always slow-growing.

Other common types of skin cancer are:

Alternative Names

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

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 40. But it can also occur in younger people who have had extensive sun exposure.

You are more likely to get 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)
Symptoms

Basal cell 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
  • 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 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. 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.

Treatment

Treatment depends on the size, depth, and location of the skin cancer, and your overall health.

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
  • Cryosurgery: Freezing the cancer cells, which kills them; used to treat cancers that are not large or deep
  • Medication: 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 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; used to treat cancers that are not large or deep
  • Radiation: May be used if a basal cell cancer cannot be treated with surgery
  • Chemotherapy: May be used to treat basal cell cancer that has spread to other parts of the body or that cannot be treated with surgery
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. Smaller ones are less likely to come back.

Possible Complications

Basal cell skin cancer almost never spreads. If it is left untreated, it may spread into surrounding areas and nearby tissues and bone. In these cases, treatment can injure the appearance of the skin.

When to Contact a Medical Professional

Call for an appointment with your health care provider if you have a sore or spot on your skin that changes in:

  • Appearance
  • Color
  • Size
  • Texture

Also call your provider if a spot becomes painful or swollen, or if it starts to bleed or itch.

Prevention

The American Cancer Society recommends that a provider examines your skin every year if you are older than 40 and every 3 years if you are 20 to 40 years old. You should also examine your own skin once a month.

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 the skin by wearing wide-brim hats, long-sleeve shirts, long skirts, or pants.
  • 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

National Cancer Institute: PDQ Skin Cancer Treatment. Bethesda, MD: National Cancer Institute. Date last modified July 15, 2015. http://www.cancer.gov/types/skin/hp/skin-treatment-pdq#section/_222. Accessed September 10, 2015.

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Basal cell and squamous cell skin cancers. Version 1.2015. http://www.nccn.org/professionals/physician_gls/pdf/nmsc.pdf. Accessed September 10, 2015.

Spencer JM, Walls BM. Basal cell carcinoma. In: Lebwohl MG, Heymann WR, Berth-Jones J, Coulson I, eds. Treatment of Skin Disease: Comprehensive Therapeutic Strategies. 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 22.

U.S. Food and Drug Administration. FDA sheds light on sunscreens. Last updated February 13, 2015. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm258416.htm. Accessed September 10, 2015.

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: 7/23/2015
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, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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