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[Conditions](https://durgical.com/en/conditions/) · [Dermatology](https://durgical.com/en/conditions/)

# Basal cell carcinoma

Basal cell carcinoma is the most common skin cancer. It grows slowly on sun-exposed skin, mostly the face, and rarely spreads, but it can destroy tissue.

Updated 2026-11-01

## Structures involved

Tap one to see what it is and open it in 3D.

- [Skin](https://durgical.com/en/anatomy/skin/)
- [Nasal cartilages](https://durgical.com/en/anatomy/major-alar-cartilage/)
- [Eyelids](https://durgical.com/en/anatomy/superior-tarsus/)
- [Auricle](https://durgical.com/en/anatomy/auricle/)
- [Nasal bones](https://durgical.com/en/anatomy/nasal-bone/)

## In the clinical exam

- [The ABCDE of pigmented lesions](https://durgical.com/en/clinical-exam/the-abcde-of-pigmented-lesions/)

## Why it happens

- [Tumour suppressor genes: RB, TP53, APC, BRCA and the two-hit hypothesis](https://durgical.com/en/general-pathology/tumour-suppressor-genes-rb-tp53-apc-brca-and-the-two-hit-hypothesis/)
- [Radiation and cancer: ultraviolet and ionizing](https://durgical.com/en/general-pathology/radiation-and-cancer-ultraviolet-and-ionizing/)
- [Biopsy: excisional, incisional, core needle, punch and fine-needle aspiration](https://durgical.com/en/general-pathology/biopsy-excisional-incisional-core-needle-punch-and-fine-needle-aspiration/)
- [Ionizing radiation injury](https://durgical.com/en/general-pathology/ionizing-radiation-injury/)
- [Frozen section: the intraoperative consultation](https://durgical.com/en/general-pathology/frozen-section-the-intraoperative-consultation/)
- [Benign vs malignant tumours: the comparison table](https://durgical.com/en/general-pathology/benign-vs-malignant-tumours-the-comparison-table/)

## Show 3 more

- [Genomic instability: mismatch repair, BRCA and xeroderma pigmentosum](https://durgical.com/en/general-pathology/genomic-instability-mismatch-repair-brca-and-xeroderma-pigmentosum/)
- [Skin: epidermis layers, dermis, hypodermis](https://durgical.com/en/histology/skin-epidermis-layers-dermis-hypodermis/)
- [Keratinocytes, melanocytes, Langerhans and Merkel cells](https://durgical.com/en/histology/keratinocytes-melanocytes-langerhans-and-merkel-cells/)

## What it is

A slow-growing malignant tumour arising from the basal layer of the epidermis and hair follicles, usually on sun-exposed skin of the [head and neck](https://durgical.com/en/anatomy/region/head-and-neck/). It is locally invasive but almost never metastasises.

## Who gets it

The most frequent cancer in fair-skinned populations and the most common skin cancer in Colombia. High-altitude Andean cities receive intense UV radiation all year, and outdoor workers such as farmers are at particular risk. Mostly seen after middle age.

## Causes

- Cumulative and intermittent ultraviolet exposure
- Mutations in the Hedgehog signalling pathway (PTCH1, SMO)
- Ionising radiation and chronic arsenic exposure (less common)

## Risk factors

- Fair skin, light eyes and tendency to burn
- Long-term outdoor work or recreation and high-altitude sun
- Older age and male sex
- Previous basal cell carcinoma
- Immunosuppression (e.g. organ transplant)
- Inherited syndromes such as basal cell naevus (Gorlin) syndrome and xeroderma pigmentosum

## Pathophysiology

UV-induced mutations switch on the Hedgehog pathway in basal keratinocytes, which proliferate in nests with a characteristic palisading edge. The tumour depends on its surrounding stroma, which partly explains why it rarely metastasises, but it invades locally and can erode cartilage, bone and orbit if neglected.

## Classification

- Nodular: the classic pearly papule with telangiectasias, sometimes with a central ulcer (rodent ulcer)
- Superficial: a scaly pink patch, often on the trunk
- Morpheaform (sclerosing): a scar-like plaque with ill-defined borders, aggressive
- Pigmented: contains melanin and can mimic melanoma
- Low-risk versus high-risk by site (central face, eyelids, nose, ears), size, subtype and recurrence

## Symptoms and signs

- A pearly or translucent papule with rolled borders and fine surface vessels (telangiectasias)
- A sore that bleeds, crusts and does not heal, or heals and reopens
- A scaly pink patch on the trunk
- A whitish, scar-like area without previous injury
- Usually painless and slowly growing over months to years

## Red flags

- Tumour near the eye, on the nose or ear, where deep invasion and disfigurement are likely
- Rapid growth, ill-defined borders or recurrence after treatment
- Numbness or nerve symptoms near the lesion (possible perineural invasion)

## Diagnosis

**Clinical**
Typical appearance on examination of sun-exposed [skin](https://durgical.com/en/anatomy/skin/); dermoscopy shows arborising vessels and other characteristic patterns.

**Tests**
Skin biopsy (shave or punch) confirms the diagnosis and the histological subtype.

**Imaging**
Not usually needed; CT or MRI when deep invasion of bone, orbit or nerves is suspected.

## Differential diagnosis

- Cutaneous squamous cell carcinoma
- Amelanotic or pigmented melanoma
- Sebaceous hyperplasia or intradermal naevus
- Actinic keratosis or Bowen disease (for superficial lesions)
- Keratoacanthoma

## Goal of treatment

Remove the tumour completely while preserving function and appearance, especially on the face, and detect new tumours early.

## Treatment

**Surgical**
Standard surgical excision with clear margins is the usual treatment.

**Surgical**
Mohs micrographic surgery, with margin checks during the operation, for high-risk or recurrent tumours and for sites where tissue must be spared (nose, [eyelids](https://durgical.com/en/anatomy/superior-tarsus/), ears).

**Procedure**
Curettage and electrodesiccation or cryotherapy for small, low-risk superficial lesions; radiotherapy for patients who cannot have surgery.

**Medical**
Topical immune-response modifiers (imiquimod) or topical fluorouracil for superficial types; Hedgehog pathway inhibitors for locally advanced or rare metastatic disease.

**Follow-up**
Periodic full skin examinations, since new skin cancers are common after a first one.

## Complications

- Local tissue destruction and disfigurement
- Invasion of cartilage, bone or the orbit when neglected
- Recurrence after incomplete removal
- New primary skin cancers
- Metastasis (very rare)

## Prognosis

Excellent: most tumours are cured by complete removal. Risk of recurrence is higher for large, central-face, morpheaform or previously treated tumours, and about half of patients develop another skin cancer within a few years.

## Prevention

- Year-round sun protection, which matters at high altitude
- Avoiding tanning beds
- Regular skin checks in people with a previous skin cancer

## Test yourself

Think of the answer, then tap the question to see it.

## What is the most common skin cancer?

Basal cell carcinoma.

## What is the classic appearance of nodular basal cell carcinoma?

A pearly, translucent papule with rolled borders and telangiectasias, sometimes with central ulceration (rodent ulcer).

## Which signalling pathway is characteristically mutated in basal cell carcinoma?

The Hedgehog pathway (PTCH1 or SMO mutations).

## When is Mohs micrographic surgery preferred?

For high-risk, recurrent or ill-defined tumours and in sites where tissue must be spared, such as the nose, eyelids and ears.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/conditions/basal-cell-carcinoma/)

## Related conditions

- [Cutaneous squamous cell carcinoma](https://durgical.com/en/conditions/cutaneous-squamous-cell-carcinoma/)
- [Melanoma](https://durgical.com/en/conditions/melanoma/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Basal cell skin cancer](https://medlineplus.gov/ency/article/000824.htm) (MedlinePlus, US National Library of Medicine, 2026).

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Source: https://durgical.com/en/conditions/basal-cell-carcinoma/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/basal-cell-carcinoma/