Signs, risks and treatment for basal cell carcinoma

What is basal cell carcinoma?

Basal cell carcinoma (BCC) is the most common type of skin cancer in the U.S, with over a million cases diagnosed each year. It develops from basal cells, which are found in the deepest layer of the skin’s epidermis. BBC is malignant but typically slow-growing and rarely life-threatening.

People with fair skin, a history of prolonged sun exposure or repeated sunburns are at higher risk. Genetics may also play a role in who develops BBC.

What does basal cell carcinoma look like?

According to the American Academy of Dermatology Association, basal cell carcinoma symptoms can vary. However, common signs include:

• Pearly or waxy bumps, often with tiny visible blood vessels
• Flat, reddish or scaly patches that may resemble a rash
• Open sores that bleed, ooze or crust over and do not heal
• Scar-like, firm areas with poorly defined edges

These lesions typically appear on sun-exposed areas such as the face, neck, ears, scalp, shoulders and back.

How serious is basal cell carcinoma?

BCC is usually slow-growing and rarely spreads to other parts of the body. However, it can be locally invasive and cause tissue damage if untreated.

Some aggressive subtypes may grow more rapidly and require more extensive treatment.

Is basal cell carcinoma dangerous?

While BCC is rarely life-threatening, it can be dangerous if left untreated.

Untreated lesions can damage skin, cartilage or bone. Patients with one BCC are also at higher risk of developing additional skin cancers in the future.

What causes basal cell carcinoma?

The sun is responsible for over 90 percent of all skin cancers, including BCCs, which occur most frequently on sun-exposed areas of the body (e.g., face, ears, neck, scalp, shoulders and back).

UV exposure and tanning beds

UV radiation from the sun or tanning beds can damage DNA in skin cells, leading to cancerous growths. Intermittent, intense sun exposure, when it results in sunburn, increases a person’s risk.

Genetic and environmental factors

• Family history of BCC or other skin cancers
• Fair skin, light-colored hair and freckling
• Immunosuppression or long-term use of certain medications
• Previous radiation therapy

Basal cell carcinoma risk factors

• Chronic sun exposure and a history of repeated sunburns
• Use of tanning beds
• Older age and fair skin type
• Genetic predisposition or family history of skin cancer
• Immunosuppression or certain medical treatments
• Male sex (slightly higher risk than females

Who is at risk?

Anyone with a history of frequent or intermittent intense sun exposure can develop BCC, but several factors can increase risk:

Time spent outdoors

People who work outdoors (e.g., construction workers, groundskeepers, lifeguards, etc.) are at greater risk than people who work indoors, as are those who spend their leisure hours in the sun.

Skin type

Fair-skinned individuals who sunburn easily and tan minimally or not at all have a higher incidence of skin cancer than dark-skinned individuals. Check out this skin type chart to see how at risk you are.

Hours of sunlight

The more hours of sunlight in the day, the greater the incidence of skin cancer. For example, there are more cases in Arizona, Texas and Florida (states that are closer to the equator and get more sun) than in the more northern states of Maine, Oregon and Washington.

Family or personal history of skin cancer

Individuals with a personal or family history skin cancer or BCC are at increased risk. Genetics can play a role in susceptibility, making regular skin checks especially important for these individuals.

What are the warning signs?

The five most typical characteristics of basal cell carcinoma are shown in the pictures below. Frequently, two or more features are present in one tumor. In addition, BCC sometimes resembles noncancerous skin conditions such as psoriasis or eczema. Only a trained physician can decide for sure. If you notice any of the warning signs or any other changes in your skin, consult your physician immediately.

Open sore

An open sore that bleeds, oozes or crusts and remains open for a few weeks. A persistent, non-healing sore is a very common sign of an early basal cell carcinoma.

Reddish patch

A reddish patch or irritated area, frequently occurring on the chest, shoulders, arms or legs. Sometimes the patch crusts. It may also itch or hurt. At other times, it persists with no noticeable discomfort.

Shiny bump

A shiny bump or nodule that is pearly or translucent and is often pink, red or white. The bump can also be tan, black or brown, especially in dark-haired people and can be mistaken for a mole.

Pink growth

A Pink growth with a slightly elevated rolled border and a crusted indentation in the center. As the growth slowly enlarges, tiny blood vessels may develop on the surface.

Scar-like area

A scar-like area which is white, yellow or waxy and often has poorly defined borders. The skin itself appears shiny and taut. This warning sign can indicate the presence of small roots, which can make the tumor larger than it actually is on the surface.

When to seek a dermatologist evaluation

It’s normal to feel unsure about a spot on your skin. If you notice one or more of the following, it’s time to get checked by a dermatologist:

• A new bump, sore or growth that hasn’t healed in a few weeks
• Changes in an existing spot—color, size, shape or texture
• Shiny, pearly bumps, sometimes with tiny blood vessels
• Sores that bleed, crust over or keep coming back
• Firm, scar-like patches that slowly spread

Early evaluation makes a big difference. A BBC treatment dermatologist can quickly confirm if it’s basal cell carcinoma and guide you toward the right treatment, whether that’s a minor procedure, a topical option or another method.

Catching skin cancer early can prevent it from causing bigger problems and give you peace of mind.

Basal cell carcinoma symptoms

Early symptoms vs. advanced lesions

Early symptoms

• Early basal cell carcinoma symptoms can be subtle. Look out for:
• Small, pearly or translucent bumps, sometimes pink, red or brown
• Tiny visible blood vessels on the surface of a bump
• Flat, scaly or slightly reddish patches that may look like a rash
• Sores that bleed, ooze or crust over but heal and then return
• Slightly raised, firm areas that resemble a small scar

Advanced lesions

As BCC progresses, lesions may become more noticeable and persistent:

• Larger, thickened bumps that may ulcerate or bleed frequently
• Open sores that fail to heal for months
• Firm, scar-like patches that expand over time
• Lesions with irregular borders or uneven color
• Pain or tenderness around the affected area

Symptoms that suggest deeper growth

These signs may indicate the cancer is affecting deeper tissues.

Seek prompt evaluation if you notice any of the following:

• Lesions that feel hard or nodular beneath the skin surface
• Persistent bleeding or oozing that does not stop
• Ulcers that extend into the surrounding skin, cartilage or bone
• Numbness, tingling or loss of sensation in the area
• Rapid growth or sudden changes in an existing lesion

How is basal cell carcinoma diagnosed?

Basal cell carcinoma is usually diagnosed early and easily treated. A simple biopsy can confirm the diagnosis. Most BBCs respond well to treatment, but five to ten percent of BCCs can be more stubborn or aggressive, potentially damaging the surrounding skin, cartilage and bone.

The good news: BCC has an extremely low risk of spreading to other parts of the body. While untreated lesions can lead to scarring or disfigurement, they are rarely life-threatening. Early evaluation by a dermatologist is key to minimizing damage and achieving the best outcome.

Basal cell carcinoma biopsy

A biopsy is a quick procedure performed by a dermatologist to confirm whether a suspicious spot is BCC.

At Advanced Dermatology, P.C., one of our skilled dermatologists removes a small tissue sample from the lesion and examines it under a microscope to confirm the diagnosis.

Biopsies are usually straightforward, performed with local anesthesia and provide the information needed to choose the most effective treatment for basal cell carcinoma.

Dermoscopy and advanced skin imaging

Dermatologists often use dermoscopy, a specialized magnifying tool, to examine lesions more closely.

This allows them to spot early signs of BCC that might not be visible to the naked eye. In some cases, advanced imaging, like high-resolution skin scans or optical coherence tomography, can help determine the depth and extent of the lesion, guiding treatment decisions and improving outcomes.

Basal cell carcinoma stages and growth patterns

Nodular, superficial and morpheaform types

BCC can appear in different forms, each with its own growth pattern:

• Nodular BCC
  This is the most common type of BBC and typically appears as a shiny, pearly bump that may bleed or develop a central ulcer. They often grow slowly but can become quite noticeable if left untreated
• Superficial BCC
  This type looks like a flat, scaly, reddish patch. Common on the trunk or limbs and may resemble eczema or a persistent rash
• Morpheaform (sclerosing) BCC
  This is a rarer, more aggressive form of BBC. Appears as a pale, scar-like patch with ill-defined edges, often growing deeper into the skin and surrounding tissue

Understanding local vs. invasive BCC

Local BBC

Most BCCs remain local, meaning they grow only in the area where they started and do not spread to other parts of the body.

Local BCCs may slowly enlarge over time, sometimes causing minor tissue changes or scarring. Early detection and treatment usually prevent significant damage.

Invasive BBC
Some BCCs can become invasive, growing deeper into the skin, cartilage or bone. Invasive BCCs can be more challenging to treat and may require specialized surgical techniques (like Mohs surgery) to remove the tumor while preserving healthy tissue.

While invasive BCCs are rare, early evaluation is critical to prevent complications and minimize scarring.

How is BCC treated?

The vast majority of BCCs are not serious if detected early and treated quickly. The BCCs that cause trouble are those that have been neglected until they become so thick that they are hard to treat. There is no one best method to treat all skin cancers and precancers. The choice is determined by many factors, including

• The location, type and size
• Whether it is a primary or recurrent tumor
• The patient’s health and preferences
• The physician’s experience with the technique

For example, a treatment with a high cure rate and no pain, but that leaves a large scar, might be acceptable for a tumor on the body but not on the face.

Almost all treatments can be performed in the physician’s office or in a special surgical facility. Most skin cancer removal can be done using a local anesthetic. Rarely, extensive tumors may require general anesthesia and hospital admission.

Current methods of treating BCC are:

• Curettage-electrodessication
• Cryosurgery
• Chemotherapy: topical or injection
• Excisional surgery
• Mohs micrographic surgery
• Radiation
• Laser therapy
• Photodynamic therapy

Cure rates for most modes of therapy are excellent, ranging from 85 to 99 percent for primary basal cell carcinomas.

MOHs surgery for high-risk or facial BCC

Mohs surgery is used for high-risk or facial BCCs because it removes the cancer layer by layer and checks each layer under a microscope immediately.

This allows the surgeon to keep as much healthy skin as possible while achieving the highest cure rate.

Surgical excision for standard cases

Most BCCs are treated with a simple surgical excision, where the tumor and a small margin of surrounding skin are removed. It’s quick, effective and commonly used for low- to moderate-risk lesions.

Curettage and electrodessication

For small, superficial BCCs, dermatologists may use curettage and electrodessication. This involves scraping the lesion and using controlled heat to treat remaining cancer cells.

It’s fast, in-office and works well for low-risk spots.

Topical medications for early BCC

Early or superficial lesions may be treated with prescription creams that stimulate the immune system or directly target cancer cells. These nonsurgical options are only suitable for specific types of BCC.

Photodynamic therapy and laser options

Photodynamic therapy (PDT) uses a light-activated medication to destroy cancer cells and can be used for some superficial BCCs. Certain laser treatments may also support cosmetic healing or very early lesions in select cases.

Preventing basal cell carcinoma

Daily sun protection strategies

• Lower your risk of BCC with these strategies:
• Use broad-spectrum SPF 30+ sunscreen and reapply as directed
• Wear hats, sunglasses and protective clothing
• Seek shade during peak sun hours
• Avoid tanning beds

Routine skin exams and monitoring

Check your skin monthly for new or changing spots.

Schedule routine dermatologist exams at least once a year (more often if you’ve had skin cancer or frequent sun exposure).

Comprehensive skin cancer care at Advanced Dermatology, P.C.

Why choose our dermatologists for BCC treatment

At Advanced Dermatology, P.C., we understand that any skin cancer diagnosis can feel overwhelming. That’s why our dermatologists take the time to explain each step of your care and guide you toward the treatment approach that feels right for you.

Our board-certified dermatologists and fellowship-trained Mohs surgeons are experts in treating both routine and high-risk BCC, including delicate facial areas. We offer a wide range of treatment options to ensure your plan is personalized and clinically appropriate.

Our team provides thorough skin exams and uses advanced techniques designed to protect your health while supporting the best possible medical and cosmetic results.

Frequently Asked Questions