What Is Basal Cell Carcinoma?

Basal cell carcinoma (BCC) is the most common cancer in the United States, with an estimated 3.6 million cases diagnosed each year. It arises from basal cells — small, round cells found in the deepest layer of the epidermis — and almost always develops on sun-exposed skin. It is the most common of the three main skin cancers — more common than squamous cell carcinoma or melanoma.

BCC grows slowly and rarely spreads (metastasizes) to other parts of the body. However, without treatment it can invade surrounding tissue, including bone and nerve, and become difficult to treat. Caught early — which is most of the time — it is highly curable.

Symptoms

BCC can look different depending on its type and location. Common presentations include:

Pearly or waxy bump: Often flesh-colored or pink, sometimes with visible blood vessels on the surface. Most common on the face, head, and neck.
Flat, flesh-colored or brown scar-like lesion: May look like a scar without a history of injury. Found on the chest or back.
Bleeding or scabbing sore that heals and returns: A small wound that doesn't fully resolve over weeks to months is a classic warning sign.
Pink growth with raised edges: A slightly elevated border with a crusted center.
White, waxy lesion (morpheaform BCC): Less common, can look like a scar and is often more aggressive.

BCC most commonly appears on the face, scalp, ears, neck, chest, back, and hands — areas with the most lifetime sun exposure.

Causes & Risk Factors

The primary cause of BCC is cumulative UV radiation exposure from sunlight and tanning beds. UV radiation damages the DNA in basal cells, eventually causing uncontrolled growth.

Risk factors include:

Chronic sun exposure: A lifetime of outdoor work, recreation, or living in a sun-intense climate like Florida
History of sunburns: Especially before age 18
Fair skin: Less melanin provides less natural protection against UV damage
Age: BCC is more common after 50, though it increasingly affects younger adults
Male sex: Men develop BCC at roughly twice the rate of women, likely due to higher occupational and recreational sun exposure
Prior skin cancer: Having had one BCC significantly increases the risk of developing additional lesions
Radiation exposure: Prior radiation therapy to the skin
Immunosuppression: Transplant recipients and others on immune-suppressing medications face elevated risk
Certain genetic conditions: Basal cell nevus syndrome (Gorlin syndrome), xeroderma pigmentosum

Diagnosis

A dermatologist diagnoses BCC through:

Clinical examination: The appearance of most BCCs is recognizable to an experienced dermatologist, often aided by dermoscopy
Shave or punch biopsy: A small sample of the lesion is sent to a pathologist, who examines it under a microscope to confirm the diagnosis and determine the subtype (superficial, nodular, morpheaform, etc.)

Subtype matters for treatment planning. Morpheaform (sclerosing) BCC has indistinct borders and a higher recurrence rate, requiring more aggressive surgical margins.

Treatment Options

Most BCCs are treated in an outpatient setting and are cured with a single procedure:

Surgical excision: The lesion is removed along with a margin of surrounding healthy tissue. Standard treatment for most BCCs. Cure rates exceed 95% for primary tumors.
Mohs micrographic surgery: The preferred technique for high-risk locations (nose, ears, eyelids, lips), large or recurrent tumors, and morpheaform subtype. Tissue is removed in thin layers and examined under a microscope in real time, minimizing the amount of healthy tissue removed while achieving complete excision.
Electrodessication and curettage (ED&C): Scraping and burning the lesion; appropriate for small, low-risk superficial BCCs on the trunk and extremities
Cryotherapy: Freezing with liquid nitrogen; used for small, superficial BCCs
Topical treatments: Imiquimod cream or 5-fluorouracil for superficial BCCs; not appropriate for deeper or high-risk lesions
Radiation therapy: For patients who are not surgical candidates
Hedgehog pathway inhibitors (vismodegib, sonidegib): Oral medications reserved for locally advanced or metastatic BCC that cannot be treated surgically

Prevention

Daily broad-spectrum sunscreen: SPF 30 or higher on all exposed skin, reapplied every two hours outdoors
Protective clothing: Wide-brimmed hats, UV-blocking sunglasses, long sleeves when possible
Shade during peak hours: 10 AM to 4 PM
No tanning beds
Monthly self-exams: Look for new lesions, persistent sores, or any spot that bleeds without injury
Annual full-body skin check: Particularly important for anyone with a history of BCC or significant sun exposure

When to See a Doctor

See a dermatologist if you notice:

A sore that bleeds or doesn't heal within 3–4 weeks
A new pearly, pink, or translucent bump on sun-exposed skin
Any lesion that looks different from your other spots
A previously treated BCC site that shows any change

BCC is almost always curable when caught and treated early. The key risk is delay — untreated lesions grow and become harder to treat. Regular skin checks are the most effective tool available.

References

Rogers HW, Weinstock MA, Feldman SR, Coldiron BM. Incidence estimate of nonmelanoma skin cancer (keratinocyte carcinomas) in the US population, 2012. JAMA Dermatology. 2015;151(10):1081–1086. doi:10.1001/jamadermatol.2015.1187
American Academy of Dermatology Association. Basal cell carcinoma: Overview. aad.org
Marzuka AG, Book SE. Basal cell carcinoma: pathogenesis, epidemiology, clinical features, diagnosis, histopathology, and management. Yale Journal of Biology and Medicine. 2015;88(2):167–179.
Trakatelli M, Morton C, Nagore E, et al. Update of the European guidelines for basal cell carcinoma management. European Journal of Dermatology. 2014;24(3):312–329. doi:10.1684/ejd.2014.2271
National Comprehensive Cancer Network. Basal Cell Skin Cancer (Version 2.2024). nccn.org
Bichakjian CK, Olencki T, Aasi SZ, et al. Basal cell skin cancer, version 1.2016, NCCN clinical practice guidelines in oncology. Journal of the National Comprehensive Cancer Network. 2016;14(5):574–597. doi:10.6004/jnccn.2016.0065
Centers for Disease Control and Prevention. Skin Cancer: Basic Information. cdc.gov/cancer/skin