Basal Cell Carcinoma: Common Skin Cancer, pathophysiology, Features, Histology, DDx and Treatment, Exam FAQs

Table of Contents

Basal Cell Carcinoma (BCC) is the most common type of skin cancer, originating from basal cells in the epidermis. Despite its high prevalence, it is rarely life-threatening, but early detection and appropriate management are crucial for preventing complications and disfigurement. This blog delves into the various aspects of BCC, including its general characteristics, epidemiology, pathophysiology, risk factors, clinical features, clinical variants, differential diagnosis, investigations, and management.

Definition of Basal Cell Carcinoma (BCC):

Basal Cell Carcinoma (BCC) is a type of skin cancer that originates in the basal cells, which are located in the deepest layer of the epidermis. BCC is the most common form of skin cancer, and it is typically caused by prolonged exposure to ultraviolet (UV) radiation from the sun or artificial sources. It often appears as a small, pearly bump or a pinkish patch on the skin and usually grows slowly. While BCCs rarely metastasize, they can cause significant local damage if left untreated. Early detection and treatment are crucial for preventing further complications and ensuring successful outcomes.

Importance of Understanding BCC:

Understanding Basal Cell Carcinoma is essential for various reasons. Firstly, BCC is highly prevalent, affecting millions of individuals worldwide, making it crucial for public health awareness. Secondly, recognizing the risk factors, such as UV exposure and genetic predisposition, empowers individuals to take preventive measures to protect their skin. Moreover, being aware of the signs and symptoms of BCC enables early detection, leading to timely medical intervention and improved treatment outcomes. Additionally, understanding BCC helps dispel myths and misconceptions surrounding skin cancer and promotes a proactive approach towards skin health.

General Characteristics

Basal Cell Carcinoma arises from basal cells, which are located in the basal layer of the epidermis. It typically occurs on sun-exposed areas, such as the face, neck, and hands. BCC grows slowly and is characterized by a thread-like margin or central depression. It rarely metastasizes but can cause local tissue destruction if left untreated.

  1. Description of BCC:

    Basal Cell Carcinoma (BCC) is a type of skin cancer that originates in the basal cells, which are found in the deepest layer of the epidermis, the outermost layer of the skin. BCC is typically caused by long-term exposure to ultraviolet (UV) radiation from the sun or artificial sources like tanning beds. It is the most common form of skin cancer, accounting for about 80% of all skin cancer cases. BCCs usually appear as small, waxy, or pearly bumps on the skin, and they may have visible blood vessels or a central depression. They can vary in color, ranging from flesh-colored to pink, red, or brown. BCCs grow slowly and are rarely life-threatening, but they can cause local damage if left untreated.
  2. Types of BCC:

    There are several types of Basal Cell Carcinoma, each with distinct characteristics and growth patterns. Some common types include:
  3. Superficial BCC:

    Appears as a red, scaly patch that grows slowly on the skin surface.
  • Nodular BCC:

    Presents as a raised, flesh-colored or pinkish bump with a smooth, shiny surface.
  • Morpheaform BCC:

    Displays a scar-like, white or yellowish area with poorly defined borders.
  • Infiltrative BCC:

    Infiltrates surrounding tissues and may not have a well-defined border, making it challenging to remove completely.
  • Pigmented BCC:

    Contains dark or black areas due to increased melanin production.
  • Fibroepithelioma of Pinkus:

    A rare subtype that occurs most commonly on the lower back, presenting as a pinkish or skin-colored, dome-shaped growth.
  1. Proliferation and Growth Patterns:

    BCCs originate from the uncontrolled proliferation of basal cells in the epidermis. The tumors grow slowly and locally invade surrounding tissues. While BCCs typically do not metastasize to distant organs, they can cause significant damage to nearby structures, including bones and nerves. The growth rate and invasiveness vary based on the BCC subtype, with some being more aggressive than others. Regular and prolonged exposure to UV radiation is the primary contributing factor to the development and progression of BCCs.
  2. Key Histological Features:

    Histologically, Basal Cell Carcinoma exhibits characteristic features. These include clusters of basaloid cells with hyperchromatic nuclei (dark-staining nuclei with increased DNA content) and scant cytoplasm. Palisading of tumor cells around the periphery is often seen, resembling a “picket fence” appearance. The presence of retraction artifact, where tumor cells separate from the surrounding stroma, is also a common histological finding in BCC.
  3. Common Locations:

    Basal Cell Carcinoma can occur on any part of the body, but certain areas are more commonly affected due to greater sun exposure. Common locations include the face (especially the nose, cheeks, and forehead), ears, neck, scalp, and shoulders. Additionally, BCCs can develop on the trunk, arms, and legs, especially in individuals with a history of frequent sun exposure or a genetic predisposition to skin cancer.
  1. Epidemiology

BCC is the most common form of skin cancer, accounting for approximately 80% of all skin cancers. Its incidence is steadily rising, particularly in fair-skinned individuals exposed to excessive ultraviolet (UV) radiation. The highest prevalence is observed in individuals aged 50 years and older.

  1. Global Incidence Rates:

    Basal Cell Carcinoma (BCC) is the most common form of skin cancer worldwide. The global incidence rates of BCC have been steadily increasing over the years. It accounts for approximately 80% of all diagnosed skin cancer cases. The exact incidence rates vary between different regions and countries, with higher rates observed in areas with greater exposure to ultraviolet (UV) radiation, such as sunny and tropical climates.
  2. Age and Gender Distribution:

    BCC primarily affects older individuals, with the majority of cases occurring in people over the age of 50. However, it can also develop in younger individuals, especially those with a history of intense sun exposure or genetic predisposition. Regarding gender distribution, BCC is more common in men than in women, though both genders are susceptible to the disease.
  3. Geographical and Environmental Factors:

    Geographical location and environmental factors play a significant role in the incidence of BCC. Regions with high UV radiation exposure, such as areas closer to the equator, tend to have higher rates of BCC. Additionally, fair-skinned populations living in sunny climates are at a higher risk of developing BCC. Moreover, certain occupations that involve prolonged outdoor work may contribute to increased BCC incidence in specific regions.
  4. Impact of Sun Exposure:

    Exposure to UV radiation from the sun is the primary risk factor for the development of Basal Cell Carcinoma. Overexposure to sunlight, especially during childhood and adolescence, increases the likelihood of BCC later in life. Activities such as sunbathing, tanning, and using tanning beds further exacerbate the risk. UV radiation damages the DNA in skin cells, leading to the uncontrolled growth of basal cells and the development of BCC.
  5. Trends in BCC Incidence:

    In recent years, there has been a noticeable trend of increasing BCC incidence worldwide. This rise is attributed to several factors, including changes in lifestyle, increased outdoor activities, and depletion of the ozone layer, which results in higher levels of UV radiation reaching the Earth’s surface. Additionally, improved awareness and early detection practices may contribute to the increase in reported cases. Public health campaigns promoting sun protection and regular skin examinations aim to combat the rising incidence of BCC.
  1. Pathophysiology

BCC arises from mutations in genes involved in the Hedgehog signaling pathway, particularly PTCH1 and SMO. These mutations lead to uncontrolled cell growth, resulting in the formation of tumors. The primary cause of these mutations is prolonged exposure to UV radiation.

  1. Genetic Alterations and Tumor Suppressor Genes:

    Basal Cell Carcinoma (BCC) is associated with specific genetic alterations, particularly involving tumor suppressor genes. The most common genetic alteration in BCC is the mutation of the PTCH1 gene, located on chromosome 9q. PTCH1 is a tumor suppressor gene that normally inhibits the Hedgehog signaling pathway. Mutations in PTCH1 lead to the activation of this pathway, promoting uncontrolled growth of basal cells and the development of BCC. In addition to PTCH1, mutations in the TP53 gene are also frequently found in BCC. TP53 is another crucial tumor suppressor gene, and its mutations play a role in BCC carcinogenesis.
  2. Role of the Hedgehog Signaling Pathway:

    The Hedgehog signaling pathway plays a pivotal role in the development and progression of Basal Cell Carcinoma. Under normal conditions, PTCH1 inhibits this pathway, keeping it in check. However, when PTCH1 is mutated, the pathway becomes activated, leading to the overexpression of Gli proteins, which regulate cell growth and survival. Overactive Hedgehog signaling results in the uncontrolled proliferation of basal cells, contributing to the formation of BCC tumors.
  3. Impact of Ultraviolet (UV) Radiation:

    Ultraviolet (UV) radiation from the sun is the most significant environmental factor contributing to the development of Basal Cell Carcinoma. UV radiation damages the DNA in skin cells, leading to genetic mutations that can trigger the formation of cancerous cells. Prolonged exposure to UV radiation, especially during childhood and adolescence, increases the risk of developing BCC later in life. Skin areas that receive higher sun exposure, such as the face, ears, neck, and scalp, are more commonly affected by BCC.
  4. Tumor Microenvironment and Angiogenesis:

    The tumor microenvironment plays a crucial role in BCC progression. As BCC tumors grow, they create their microenvironment, involving interactions between tumor cells, immune cells, and surrounding stromal cells. Angiogenesis, the formation of new blood vessels, is a critical process in tumor growth and enables the tumor to receive nutrients and oxygen, supporting its continued expansion. BCC cells secrete factors that promote angiogenesis, ensuring their survival and facilitating further invasion into surrounding tissues.
  1. Risk Factors

 Several risk factors contribute to the development of BCC. These include:

  • Prolonged exposure to UV radiation, such as from sunlight or tanning beds.
  • Fair skin, blue or green eyes, and blond or red hair, which indicate reduced melanin protection against UV damage.
  • Age, as the risk of BCC increases with advancing age.
  • Immunosuppression, which weakens the body’s ability to control abnormal cell growth.
  1. Sun Exposure and Sunburns:

    One of the most significant risk factors for Basal Cell Carcinoma (BCC) is prolonged and unprotected exposure to ultraviolet (UV) radiation from the sun. Cumulative sun exposure over time increases the risk of developing BCC. People who spend considerable time outdoors, such as outdoor workers and individuals with outdoor hobbies, are at higher risk. Sunburns, especially during childhood and adolescence, are also a significant risk factor for BCC, as intense UV radiation damages the DNA in skin cells, promoting the development of cancerous cells.
  2. Fitzpatrick Skin Types:

    Fitzpatrick skin types categorize individuals based on their skin’s response to sun exposure and the likelihood of developing sun-related skin conditions. People with fair skin (Fitzpatrick types I and II), light-colored hair, and blue or green eyes are at higher risk of developing BCC. These skin types have less melanin, the pigment that provides some natural protection against UV radiation, making them more susceptible to sun damage and skin cancer.
  3. Family History and Genetic Predisposition:

    A family history of skin cancer, particularly Basal Cell Carcinoma, increases an individual’s risk of developing BCC. Genetic factors play a role in skin cancer susceptibility, and individuals with a family history of BCC may have inherited genetic mutations that predispose them to the disease. Specific genetic syndromes, such as Gorlin syndrome (also known as nevoid basal cell carcinoma syndrome), can significantly increase the risk of multiple BCCs.
  4. Immunosuppression:

    Individuals with weakened immune systems, such as those undergoing organ transplantation or living with certain medical conditions, have an increased risk of developing BCC. A compromised immune system may fail to detect and control the growth of abnormal cells, making these individuals more susceptible to skin cancer, including BCC.
  5. Occupational Exposures:

    Certain occupational exposures may contribute to an increased risk of BCC. Occupations that involve prolonged outdoor work, such as agriculture, construction, and lifeguarding, expose individuals to higher levels of UV radiation, elevating their risk of developing BCC. Additionally, some occupations involve exposure to carcinogens or chemicals that may contribute to the development of skin cancer.
  1. Clinical Features

      Typical features of BCC include:

  • Slow progressive growth with peripheral extension.
  • Thread-like margin or central depression.
  • Translucent or pearly appearance with raised telangiectatic edges.
  • Superficial lesions may exhibit scaling or crusting.
  • Pigmentation, when present, is unevenly distributed throughout the tumor.
  1. Presentation and Variations in Appearance:

     Basal Cell Carcinoma (BCC) can present in various ways, depending on the subtype and location on the body. Commonly, BCC appears as a pearly, flesh-colored, or pinkish bump on the skin with a smooth, shiny surface. However, the appearance can vary, and BCCs may also present as red, scaly patches or nodules with raised edges. Some BCCs can be pigmented, displaying dark or black areas due to increased melanin production. The size of BCCs can range from small lesions to larger growths, and they may grow slowly over time.
  2. Common Locations and Morphological Patterns:

    BCC can occur on any part of the body, but certain locations are more commonly affected due to greater sun exposure. The most common locations include the face (especially the nose, cheeks, and forehead), ears, neck, scalp, and shoulders. BCCs on the trunk, arms, and legs may also occur, especially in individuals with a history of frequent sun exposure. Morphologically, BCCs often have well-defined borders, but some aggressive subtypes may infiltrate the surrounding tissues and lack clear margins.
  3. Ulceration and Other Clinical Signs:

    Ulceration is a clinical sign commonly observed in some BCCs. As the tumor grows, it can outgrow its blood supply, leading to necrosis and ulceration on the surface. The ulcerated BCC may have a raw, crusted appearance. Other clinical signs of BCC include telangiectasia (visible blood vessels) on the surface and occasional bleeding or oozing from the lesion.
  4. Clinical Subtypes and Variants:

    Basal Cell Carcinoma has various clinical subtypes and variants, each with distinct characteristics. Some common subtypes include superficial BCC, nodular BCC, morpheaform BCC, and infiltrative BCC. Each subtype may exhibit different growth patterns and clinical appearances, making accurate diagnosis important for appropriate management.
  5. Importance of Early Detection:

    Early detection of Basal Cell Carcinoma is crucial for successful treatment and improved outcomes. BCCs are generally slow-growing and rarely metastasize, making early intervention highly effective in preventing further complications. Regular skin examinations, self-checks, and seeking medical evaluation for suspicious lesions can aid in early detection. Early-stage BCCs are more amenable to simple surgical excision or other non-invasive treatments, minimizing the potential for scarring or extensive surgery. Delaying treatment can lead to larger tumors and more invasive procedures, potentially impacting cosmetic and functional outcomes.

7. Clinical Variants

Different clinical variants of BCC exist, each with unique histological features and characteristics:

  1. Superficial BCC
  2. Nodular BCC
  3. Micronodular BCC
  4. Morpheaform BCC
  5. Infiltrative BCC
  6. Basosquamous or Metatypical BCC

Superficial Basal Cell Carcinoma:

Superficial Basal Cell Carcinoma (BCC) is a subtype characterized by its location at the surface of the skin. It appears as a red, scaly patch or a slightly raised, pinkish lesion with a well-defined border. Superficial BCC tends to grow horizontally rather than penetrating deep into the skin. It is more common in younger individuals and often occurs on the trunk, arms, and legs. This subtype of BCC has a relatively better prognosis and responds well tovarious treatment modalities, including topical therapies and cryotherapy.

Nodular Basal Cell Carcinoma:

Nodular Basal Cell Carcinoma is one of the most common clinical variants of BCC. It presents as a raised, pearly or flesh-colored nodule with a smooth and shiny surface. Nodular BCC often has well-defined borders and may contain small blood vessels (telangiectasia) on the surface. It can occur on any part of the body but is frequently found on the face, especially around the nose and eyes. This subtype is typically slow-growing but can become more aggressive if left untreated.         

Micronodular Basal Cell Carcinoma:

Micronodular Basal Cell Carcinoma is a more aggressive subtype characterized by small clusters of tumor cells (micronodules) that infiltrate the surrounding tissue. It appears as a firm, raised nodule with a translucent or pearly appearance. Micronodular BCC is more likely to be invasive and has a higher potential for recurrence compared to other subtypes. It is commonly found on the face and scalp and may be mistaken for other skin conditions due to its subtle clinical presentation.

Morpheaform Basal Cell Carcinoma:

Morpheaform Basal Cell Carcinoma, also known as sclerosing or fibrosing BCC, is a less common but highly aggressive variant. It has a firm, scar-like appearance with poorly defined borders, making it challenging to remove completely. Morpheaform BCC tends to invade deeply into surrounding tissues, including nerves and bones, leading to extensive local destruction. Its subtle clinical features can cause delays in diagnosis and treatment, contributing to poorer outcomes.

Infiltrative Basal Cell Carcinoma:

Infiltrative Basal Cell Carcinoma is a subtype that infiltrates the surrounding tissues, making complete surgical excision more challenging. It appears as a flat, ill-defined lesion that lacks the typical raised appearance seen in other BCC subtypes. Infiltrative BCC often spreads along tissue planes and can be more extensive than it appears on the surface. This variant is associated with a higher risk of recurrence and requires careful management to ensure complete removal.

Basosquamous or Metatypical Basal Cell Carcinoma (BCC):

Rare and more aggressive variant of BCC that exhibits characteristics of both basal cell carcinoma and squamous cell carcinoma. This subtype accounts for a small percentage of all diagnosed BCC cases, and its behavior is often more unpredictable than typical BCC.

Clinical Presentation:

Basosquamous BCC presents as a mixed tumor with features of both basal cell and squamous cell carcinomas. It may appear as a combination of nodular and ulcerated growths, showing a variation in clinical presentation.

Histological Features:

Histologically, basosquamous BCC exhibits a combination of basaloid and squamous cell features. The tumor contains nests of basaloid cells with hyperchromatic nuclei and palisading at the periphery, similar to typical BCC. Additionally, it contains areas of squamous differentiation with cells showing more prominent keratinization, similar to squamous cell carcinoma.


Metatypical BCC is considered more aggressive than typical BCC, with a higher propensity for local invasion and recurrence. The presence of squamous differentiation may contribute to a greater potential for aggressive behavior, especially when compared to other BCC subtypes.

Diagnosis and Management:

The diagnosis of basosquamous BCC is confirmed through a skin biopsy and histopathological examination. It is crucial to differentiate it from other skin malignancies due to its more aggressive nature and potential to metastasize in rare cases. The management of this subtype typically involves surgical excision with appropriate margins to ensure complete removal of the tumor.


The prognosis of basosquamous BCC depends on various factors, including the tumor size, depth of invasion, presence of perineural invasion, and the extent of squamous differentiation. Prompt diagnosis and treatment are essential for a better prognosis and to prevent local tissue destruction and potential complications.


As with other types of BCC, sun protection measures, such as wearing protective clothing, using sunscreen, and seeking shade, are essential in reducing the risk of developing basosquamous BCC. Regular self-skin examinations and seeking medical evaluation for any suspicious skin lesions can aid in early detection and timely intervention, contributing to better treatment outcomes.


Metastasis of Basal Cell Carcinoma (BCC) is an extremely rare occurrence, with an estimated incidence of 1:1000 to 1:35000. While BCCs typically remain indolent and do not spread to distant sites, there have been a few reported cases of metastatic BCCs. These rare cases are characterized by aggressive tumors displaying perineural spread of tumor cells. The most common progression pattern for metastatic BCCs involves lymph node metastasis, followed by metastasis to the lung and bone.

Diagnosis of metastatic BCC is based on its unique morphology, although it is essential to distinguish it from poorly differentiated variants of Squamous Cell Carcinoma (SCC).

9.0 Features of high-Risk BCC:

Differential Diagnosis with Key Points

Distinguishing BCC from other skin lesions is essential for accurate diagnosis. Key points for differential diagnosis include:

  • Differentiating nodular BCC from melanocytic nevus based on pigmentation and the presence of hairs.
  • Scrutinizing scaling or crusting to differentiate BCC from warts, keratoacanthoma, SCC, or molluscum contagiosum.
  • Discerning BCC from malignant melanoma by examining the margin, pigmented halo, and color.

Nodular BCC DDx:

Investigations with Results in Table

Diagnosis of BCC is primarily clinical, but biopsies may be necessary in challenging cases. Dermoscopy, high-frequency ultrasound, and in vivo confocal microscopy are helpful non-invasive techniques to aid in diagnosis and subtyping.





Uses cross-polarized light to identify characteristic features for differentiating BCC subtypes.

White and grey-brown structureless areas, blue-grey ovoid nests, etc.

High-frequency Ultrasound

Provides high-resolution imaging to visualize tissue characteristics.

Subepidermal or intradermal aggregations, palisading, etc.

In vivo Confocal Microscopy

Allows real-time observation of cellular morphology for diagnosis.

High-resolution individual images, mosaics of large areas.

    1. Clinical Assessment and Examination:

      The initial investigation for Basal Cell Carcinoma (BCC) begins with a thorough clinical assessment and examination of the skin. A dermatologist or healthcare professional examines the suspicious lesion(s) and surrounding skin to identify any characteristic features of BCC. The clinical examination helps determine the size, location, shape, color, and texture of the lesion, as well as the presence of any ulceration or other clinical signs.
    2. Biopsy Techniques and Histological Examination:

      A skin biopsy is a crucial diagnostic procedure for confirming the presence of BCC. Various biopsy techniques, such as shave biopsy, punch biopsy, or excisional biopsy, may be used to obtain a tissue sample from the suspicious lesion. The biopsy specimen is then sent to a pathology laboratory for histological examination. A pathologist analyzes the tissue under a microscope to identify the characteristic features of BCC, including the presence of basaloid cells, palisading nuclei, and other histological markers.
    3. Dermoscopy and Imaging Modalities:

      Dermoscopy, also known as dermatoscopy or epiluminescence microscopy, is a non-invasive imaging technique used to visualize skin lesions in greater detail. A dermatoscope, a handheld device with a magnifying lens and light source, is used to examine the surface and subsurface structures of the skin lesion. Dermoscopy aids in differentiating between benign and malignant skin lesions, including BCC. Certain dermoscopic patterns, such as arborizing vessels and ulceration, are characteristic of BCC.
    4. Role of High-Frequency Ultrasound:

      High-frequency ultrasound (HFUS) is a valuable imaging modality used to assess the depth and extent of BCC invasion into the skin layers. HFUS can provide valuable information about the tumor size, margins, and involvement of underlying structures, such as nerves and blood vessels. This imaging technique helps in preoperative planning, especially for large or complex BCCs located in critical areas, such as the face.


The choice of treatment for BCC depends on tumor and patient factors. Management options include:

Surgical options:



Basal Cell Carcinoma is the most common skin cancer that arises from basal cells in the epidermis due to prolonged exposure to UV radiation. It typically occurs in fair-skinned individuals on sun-exposed areas and grows slowly with a thread-like margin and central depression.


Basal Cell Carcinoma, though rarely life-threatening, remains a significant public health concern due to its high prevalence. Understanding its risk factors, clinical features, and management options is essential for both patients and healthcare providers. Early detection and appropriate treatment play a crucial role in ensuring the best possible outcomes for individuals affected by BCC.

FAQs (frequently-asked questions)

Tagging of BCC (Basal Cell Carcinoma) is performed to precisely locate the medial, lateral, upper, and lower borders of the specimen during a surgical procedure.

If the histopathology report shows an unclear margin at the 3’O clock position of the biopsy sample, the recommended course of action is to re-excise the area at the 3’O clock position.

These are following:

Dermoscopy with cross-polarized light can reveal the following features in BCC:

  • White and grey-brown structureless areas.
  • Blue-grey ovoid nests.
  • Blue-grey globules.
  • Maple-leaf-like areas.
  • Spoke-wheel areas.
  • Concentric structures.
  • Blue-grey dots.

Vascular patterns that may be observed include:

  • Atypical red vessels.
  • Arborizing, comma, and telangiectatic vessels.
  • Short fine telangiectasias.
  • Vascular blush.

There are several non-surgical methods available for treating BCC, including:

  1. Curretage
  2. Cauterization
  3. CO2 ablation
  4. Cryotherapy

When it comes to medical treatment options for BCC, the following options can be considered:

  1. 5-fluorouracil
  2. Topical imiquimod

Another potential treatment option for BCC is Photodynamic therapy.

After the initial treatment, it is essential for BCC patients to follow these guidelines:

  • Undergo 6-12 monthly follow-ups for a period of 3-5 years.
  • Patients should be aware that they may develop NMSC (Non-Melanoma Skin Cancer) within 5 years.

Mohs surgery is recommended in the following cases:

  1. High-risk BCC
  2. Recurrent BCC
  3. Poor clinical margins
  4. Incomplete excised margins
  5. High risk of metastasis
  6. Evidence of perineural invasion.

Basal cell carcinoma (BCC) and Gorlin syndrome (also known as nevoid basal cell carcinoma syndrome or NBCCS) are related but distinct medical conditions.

Basal Cell Carcinoma (BCC) is linked to specific gene mutations, including:

  1. Gain of function mutation in SMO (Smoothened) gene.
  2. Loss of function mutation in the PTCH1 (Patched 1) gene.

Squamous Cell Carcinoma (SCC) can manifest in various clinical presentations, such as:

  1. Plaque-like appearance.
  2. Verrucous (wart-like) growth.
  3. Tumid (swollen) lesions.
  4. Ulcerated areas.

Several risk factors contribute to the development of BCC, including:

  1. Fitzpatrick skin types I and II (fair skin).
  2. Solar UV radiation exposure.
  3. Human papillomavirus (HPV) infection.
  4. Iatrogenic causes (resulting from medical treatment).
  5. Immunosuppression.
  6. Acquired immunodeficiency syndromes (AIDS).
  7. Non-Hodgkin lymphoma.
  8. PUVA therapy (Psoralen plus ultraviolet A therapy).
  9. Photosensitizing drugs.
  10. UVB phototherapy.
  11. Ionizing radiation exposure.
  12. Occupational factors.
  13. Arsenic exposure.
  14. Previous history of basal cell carcinomas.

BCC is linked to various syndromes, including:

  1. Nevoid Basal Cell Carcinoma Syndrome (Gorlin-Goltz Syndrome).
  2. Bazex-Dupré-Christol Syndrome.
  3. Rombo Syndrome.
  4. Xeroderma Pigmentosum.
  5. Generalized Follicular Basaloid Hamartoma Syndrome.
  6. Happle-Tinschert Syndrome.

Basal cell carcinoma (BCC) is the most common type of skin cancer that originates in the basal cells, which are found in the lower layer of the epidermis. It is primarily caused by cumulative exposure to ultraviolet (UV) radiation from the sun or tanning beds over the years.

BCC often appears as a pearly or translucent bump on the skin with a rolled or raised edge. It may also present as a nodule with a central depression, an ulcerated area, or a slowly expanding rodent ulcer. Superficial BCC can manifest as red, scaly patches on the skin.

BCC is the most common form of skin cancer and predominantly affects individuals with fair skin, light-colored eyes, and a history of sun exposure. It is more prevalent among older adults but can occur in people of all ages.

There are several clinical variants of BCC, including superficial, nodular, micronodular, morpheaform, infiltrative, and basosquamous (metatypical). Each variant has distinct histological and morphological characteristics that influence its treatment and prognosis.

Yes, BCC can sometimes be mistaken for other skin conditions like melanocytic nevus, molluscum contagiosum, or sebaceous hyperplasia. Accurate diagnosis is achieved through clinical evaluation, dermoscopy, and, if needed, a biopsy for histological examination.

The primary method of diagnosing BCC is through clinical examination by a dermatologist. In challenging cases, a biopsy may be required to confirm the diagnosis. Dermoscopy, high-definition optical coherence tomography (HD-OCT), and confocal microscopy are additional non-invasive techniques that aid in diagnosis.

Treatment options for BCC include surgical excision, Mohs micrographic surgery, curettage and electrodesiccation, cryosurgery, radiotherapy, and the use of hedgehog pathway inhibitors like vismodegib for advanced cases. The choice of treatment depends on the subtype, risk level, and location of the tumor.

BCC typically progresses slowly over time. Some tumors may grow very slowly and remain benign for extended periods, while others may be more aggressive. Regular skin checks are essential to detect and treat BCC at an early stage.

Yes, self-check methods include regularly examining the skin for any new or changing growths, paying attention to any persistent sores that do not heal, and being aware of any unusual bumps or patches on the skin.

If left untreated, BCC can continue to grow and invade surrounding tissues, leading to disfigurement and destruction of nearby structures. To prevent its spread, early detection, timely treatment, and sun protection measures like using sunscreen and wearing protective clothing are crucial.

While BCC is not usually hereditary, individuals with a family history of BCC may have a slightly increased risk of developing the condition. Family members should remain vigilant and adopt sun safety practices to minimize their risk.

Protecting your skin from UV radiation is crucial in preventing BCC. This includes wearing sunscreen with a high SPF, seeking shade during peak sun hours, wearing protective clothing, and avoiding indoor tanning.

With appropriate treatment, the long-term outcomes for BCC are generally positive. Complete excision and regular follow-up can reduce the risk of recurrence. However, individuals with a history of BCC should continue regular skin checks as recurrences are possible.

BCC is generally a localized cancer and does not frequently metastasize to distant organs. However, in rare cases, it can spread to nearby tissues and structures. Signs of potential metastasis include changes in the appearance of the tumor, persistent ulceration, or enlargement of lymph nodes.

If you notice any skin changes, such as new growths, non-healing sores, or changes in existing moles, it is essential to consult a dermatologist promptly. Early detection and treatment of BCC lead to better outcomes and higher chances of successful treatment.

No, BCCs virtually never develop metastases. However, there have been rare reports of metastatic cases with an estimated incidence of 1:1000 to 1:35000.

 Aggressive BCCs, like morpheaform BCC, show persistent local invasion and tissue destruction but do not progress to metastatic disease. Non-aggressive forms, such as superficial and nodular BCC, continue to grow without becoming more aggressive.

BCCs are dependent on a specific loose connective tissue stroma produced by dermal fibroblasts for their continued growth.

Despite exhibiting genomic stability, there have been rare cases of BCCs with metastases, which are likely associated with aggressive tumors showing perineural spread of tumor cells.

In morpheaform BCCs, myofibroblasts secrete hepatocyte growth factor (HGF), which promotes invasion of epithelial cells via binding to c-Met, a tyrosine kinase receptor expressed in BCC epithelium.

BCC cells and stromal cells show increased expression of enzymes such as metalloproteinases and collagenases, facilitating the degradation of dermal tissue and spread of tumor cells.

BCCs often present as multicentric tumors, with superficial BCCs showing discontinuous buds of tumor cells connected to the basal cell layer of the overlying epidermis.

The most frequently altered gene in BCCs is PTCH1, located on chromosome 9q, followed by TP53 gene mutations.

TP53 mutations occur early in BCC carcinogenesis, affecting at least 50% of BCCs, and may play a role in expanding the number of susceptible target cells.

BCCs maintain their limitless replicative potential through high telomerase activity, similar to high-grade malignancies.

Slow progressive course of peripheral extension.

It’s important to clarify that basal cell carcinoma (BCC) is a type of skin cancer, and over-the-counter (OTC) treatments are not recommended for managing or treating cancer. BCC requires medical evaluation, diagnosis, and appropriate management by a qualified healthcare professional.

If you suspect you have a BCC or have noticed any skin abnormalities that could be concerning, it’s crucial to seek medical attention promptly. A dermatologist or healthcare provider will assess the skin lesion, possibly perform a biopsy to confirm the diagnosis, and then recommend the most suitable treatment based on the specific characteristics of the BCC, its size, location, and other factors.

Treatment options for BCC may include:

  1. Surgical Excision: The most common and effective treatment for BCC involves surgically removing the cancerous tissue, along with a margin of healthy skin to ensure complete removal.
  2. Mohs Surgery: This specialized surgical procedure is often used for larger BCCs or those located in critical areas like the face, where preservation of healthy tissue is essential. It involves removing the cancer layer by layer and examining the tissue under a microscope to ensure complete removal while minimizing damage to surrounding healthy tissue.
  3. Curettage and Electrodesiccation: This method involves scraping off the tumor (curettage) and then using an electric current to destroy any remaining cancer cells (electrodesiccation).
  4. Radiation Therapy: In some cases, radiation therapy may be used to treat BCC, especially when surgery is not suitable or as a follow-up treatment after surgery to ensure any remaining cancer cells are destroyed.
  5. Topical Medications: In certain cases of superficial BCCs, topical treatments like imiquimod or 5-fluorouracil (5-FU) may be prescribed to help eliminate the tumor.
  6. Photodynamic Therapy (PDT): PDT involves applying a photosensitizing agent to the BCC, which is then activated by light, leading to the destruction of cancer cells.
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