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Basal cell carcinoma

Rodent ulcer; Skin cancer - basal cell; Cancer - skin - basal cell
Last reviewed: February 5, 2008.
Basal cell carcinoma is a slow-growing form of skin cancer.
See also:

Squamous cell skin cancer

Melanoma

Causes, incidence, and risk factors

Skin cancer is divided into two major groups: nonmelanoma and melanoma. Basal cell
carcinoma is a type of nonmelanoma skin cancer, and is the most common form of cancer in the
United States. According to the American Cancer Society, 75% of all skin cancers are basal cell
carcinomas.
Basal cell carcinoma starts in the top layer of the skin called the epidermis. It grows slowly and
is painless. A new skin growth that bleeds easily or does not heal well may suggest basal cell
carcinoma. The majority of these cancers occur on areas of skin that are regularly exposed to
sunlight or other ultraviolet radiation. They may also appear on the scalp. Basal cell skin cancer
used to be more common in people over age 40, but is now often diagnosed in younger people.
Your risk for basal cell skin cancer is higher if you have:

Light-colored skin

Blue or green eyes

Blond or red hair

Overexposure to x-rays or other forms of radiation

Basal cell skin cancer almost never spreads. But, if left untreated, it may grow into surrounding
areas and nearby tissues and bone.

Symptoms
Basal cell carcinoma may look only slightly different than normal skin. The cancer may appear
as 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

Appearance of 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 skin cancer is a possibility, a piece of skin will be removed from the area and examined under
a microscope. This is called a skin biopsy. This must be done to confirm the diagnosis of basal
cell carcinoma or other skin cancers. There are many types of skin biopsies. The exact procedure
depends on the location of the suspected skin cancer.

Treatment

Treatment varies depending on the size, depth, and location of the basal cell cancer. It will be
removed using one of the following procedures:

Excision cuts the tumor out and uses stitches to place the skin back together.

Curettage and electrodesiccation scrapes away the cancer and uses electricity to kill any
remaining cancer cells.

Surgery, including Mohs surgery, in which skin is cut out and immediately looked at
under a microscope to check for cancer. The process is repeated until the skin sample is
free of cancer.

Cryosurgery freezes and kills the cancer cells.

Radiation may be used if the cancer has spread to organs or lymph nodes or for tumors
that can't be treated with surgery.

Skin creams with the medications imiquimod or 5-fluorouracil may be used to treat
superficial basal cell carcinoma.

Expectations (prognosis)
The rate of basal cell skin cancer returning is about 1% with Mohs surgery, and up to 10% for
other forms of treatment. Smaller basal cell carcinomas are less likely to come back than larger
ones. Basal cell carcinoma rarely spreads to other parts of the body.
You should follow-up with your doctor as recommended and regularly examine your skin once a
month, using a mirror to check hard-to-see places. Call your doctor if you notice any suspicious
skin changes.

Complications
Untreated, basal cell cancer can spread to nearby tissues or structures, causing damage. 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 the color, size, texture, or appearance
of any area of 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 at midday, 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 SPF (sun protection factor) ratings of at least 15.

Look for sunscreens that block both UVA and UVB light.

Apply sunscreen at least 30 minutes before going outside, and reapply it frequently.

Use sunscreen in winter, too.

Examine the skin regularly for development of suspicious growths or changes in:

Color

Size

Texture

Appearance

Also note if an existing skin sore bleeds, itches, is red and swollen (inflamed), or is painful.

References
1. Habif TP. Clinical Dermatology. 4th ed. St. Louis, Mo: Mosby; 2004:724-735.
2. Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKena WG. Clinical
Oncology. 3rd ed. Orlando, Fl: Churchill Livingstone; 2004:449-452.
3. Noble J. Textbook of Primary Care Medicine. 3rd ed. St. Louis, Mo: Mosby; 2001:772773.
4. Neville JA, Welch E, Leffell DJ. Management of nonmelanoma skin cancer in 2007. Nat
Clin Pract Oncol. 2007;4(8):462-469. [PubMed]
5. 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(4):616-621. [PubMed]
Review Date: 2/5/2008.

Reviewed by: Kevin Berman, MD, PhD, Associate, 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.
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001827/