Skin - Nonmelanocytic tumors
Carcinoma (non-adnexal)
Basal cell carcinoma (BCC)

Author: Ghassan Tranesh, M.D. (see Authors page)
Editor (personal): Hong Qu, M.D.
Editorial Board review: Sara C. Shalin, M.D., Ph.D.

Revised: 13 October 2016, last major update March 2015

Copyright: (c) 2002-2016,, Inc.

PubMed Search: Basal cell carcinoma [title] skin

See also: Basal cell nevus syndrome

Cite this page: Basal cell carcinoma (BCC). website. Accessed October 26th, 2016.
Definition / General
  • BCC is most common malignancy of skin, constitutes ~ 80% of all skin cancers (eMedicine)
  • Patients with xeroderma pigmentosum, who have a diminished capability for repairing sun induced mutations, develop a large number of basal cell and squamous cell carcinomas (SCCs) early in life
  • Multiple BCCs develop early in life in patients with the basal cell nevus syndrome or Bazex syndrome
  • Trichoblastic carcinoma may be a more accurate term due to its predominant follicular differentiation and possible follicular origin
  • ~ 900,000 new individuals are diagnosed with BCC per year in US
  • Occurs in all races, but much more often in fair skinned people
  • Usually in patients > 40 years of age
  • More often in men than in women (male : female = 1.6:1)
  • Mainly sun exposed skin, in any hair bearing area (e.g. head and neck)
  • Also at sites with limited or no sun exposure
  • Mutations of PTCH gene identified in most syndromic and sporadic BCCs
  • Associated with UV light exposure (particularly intermittent intense exposure), history of radiation treatment
  • Associated with various syndromes: basal cell nevus syndrome; Bazex syndrome; xeroderma pigmentosum
Clinical Features
  • Clinical appearance often parallels the histologic subtype
  • Most common appearance is a papule or nodule with telangiectasias, which may be eroded or ulcerated (ulcus rodens / rodent ulcer)
  • Papules of BCC may clinically resemble a nevus, fibroma or folliculitis
  • Basal cell carcinoma may also manifest as an erythematous patch, papule, nodule or plaque, which is often eroded, ulcerated or indurated
  • Usually only local growth; may be locally destructive with significant morbidity depending on location and size
  • Pigmented BCC may mimic a melanocytic neoplasm
  • Metastases are exceedingly rare (preferred sites: lymph nodes, lung, bones)
Prognostic Factors
  • Histologic subtypes: infiltrative, morpheaform, micronodular, basosquamous
  • Dense fibrous stroma and loss of peripheral palisading
  • Reduced expression of syndecan-1 and BCL2
  • Greater expression of p53 and aneuploidy
  • Perineurial invasion
  • Positive margins