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Basal Cell Carcinoma: Causes, Symptoms & Treatment

Basal cell carcinoma is the most common form of skin cancer. It usually develops due to UV radiation, grows slowly, and rarely spreads to other organs.

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Things worth knowing about "Basal Cell Carcinoma"

Basal cell carcinoma is the most common form of skin cancer. It usually develops due to UV radiation, grows slowly, and rarely spreads to other organs.

What Is Basal Cell Carcinoma?

Basal cell carcinoma (BCC) is the most common malignant skin tumor worldwide. It originates from the basal cells of the deepest layer of the epidermis (outer skin). Although it is a form of cancer, basal cell carcinoma typically grows very slowly and rarely metastasizes (spreads to other organs). However, if left untreated, it can invade and destroy deep tissue, cartilage, and bone.

Causes and Risk Factors

The primary cause of basal cell carcinoma is long-term, cumulative damage to the skin by ultraviolet (UV) radiation – from both natural sunlight and artificial sources such as tanning beds. Additional risk factors include:

Fair skin, light eyes, and red or blonde hair
Frequent or intense sunburns, especially during childhood
Long-term use of immunosuppressive medications (e.g., after organ transplantation)
Exposure to ionizing radiation or certain chemicals such as arsenic
Genetic conditions such as Gorlin-Goltz syndrome (basal cell nevus syndrome)
Advanced age and male sex

Symptoms

Basal cell carcinoma often begins as a subtle change in the skin. Typical features include:

Nodular BCC: A pearly, skin-colored or reddish nodule with fine surface blood vessels (telangiectasias) – the most common subtype
Superficial BCC: A flat, reddish, scaly plaque, often on the trunk
Morpheaform (sclerosing) BCC: A scar-like, whitish-yellow, firm plaque – more difficult to detect and more aggressive
Small sores or crusts that do not heal
Occasional minor bleeding without an obvious cause

Common sites include the face (especially the nose, ears, and temples), neck, chest, and scalp – areas with high UV exposure.

Diagnosis

Diagnosis begins with a clinical examination by a dermatologist. Dermoscopy (epiluminescence microscopy) allows the physician to identify characteristic structures of the tumor. A definitive diagnosis requires a biopsy: a tissue sample is taken and examined histologically (under a microscope). If deep tissue invasion is suspected, imaging methods such as ultrasound or MRI may be used.

Treatment

Treatment depends on the size, location, tumor subtype, and the overall health of the patient.

Surgical Methods

Complete surgical excision with adequate safety margins is the most common and effective treatment. For tumors on the face or in areas where tissue preservation is critical, Mohs micrographic surgery is often preferred – a technique involving stepwise removal with immediate microscopic margin control to preserve as much healthy tissue as possible.

Non-Surgical Methods

Radiation therapy: Suitable for elderly patients or when surgery is not feasible
Cryotherapy: Freezing of the tumor with liquid nitrogen – only for small, superficial lesions
Photodynamic therapy (PDT): Use of photosensitizing agents and targeted light to destroy tumor tissue
Imiquimod cream or 5-fluorouracil cream: Topical medical treatment for superficial forms

Systemic Therapy for Advanced Disease

For locally advanced or metastatic basal cell carcinoma, Hedgehog pathway inhibitors such as vismodegib or sonidegib are used. These targeted agents block a signaling pathway that plays a central role in the development of these tumors.

Prognosis and Follow-Up

When treated promptly, the prognosis for basal cell carcinoma is excellent. Cure rates following surgical excision exceed 95%. However, patients face an increased risk of developing additional skin tumors. Regular dermatological follow-up examinations and consistent sun protection (sunscreen, protective clothing, and avoiding peak UV hours) are therefore essential.

References

Peris K. et al. – European consensus-based interdisciplinary guidelines for diagnosis and treatment of basal cell carcinoma. European Journal of Cancer, 2019; 118:10–34.
World Health Organization (WHO): Skin Cancers – Ultraviolet Radiation and Health. WHO, Geneva.
National Comprehensive Cancer Network (NCCN): Clinical Practice Guidelines in Oncology – Basal Cell Skin Cancer, 2023.

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