Photos
Basal cell carcinoma has no precursor lesion. The earliest lesions of basal cell carcinoma are generally seen as a small pink papule sometimes only 1 to 3 mm across. This papule commonly bleeds on minor trauma such as dragging a fingernail across it. This can be a useful diagnostic sign in the identification of an early basal cell carcinoma, particularly if the small papule has been present for many months and is thus obviously not a simple folliculitis.
As basal cell carcinomas grow the most common types develop the more characteristic nodularity, translucency, and telangiectasia.
There are four main clinical variants of basal cell carcinoma. These are nodular, superficial spreading, sclerosing and pigmented basal cell carcinomas.
a) Nodular Basal Cell Carcinoma
Nodular basal cell carcinoma is clinically manifested as a translucent nodule, often with telangiectatic vessels being very evident. As the nodule expands beyond 1 cm the center can begin to break down causing an ulcer surrounded by a rolled edge. The alternative name for this is "rodent ulcer".
Nodular basal cell carcinomas are common on the face, particularly along embryonal fusion planes such as the inner canthus, peri-nasal skin and peri-auricular skin. They can occur anywhere on the body that has been subject to intermittent severe sun exposure.
Childhood exposure appears to be of considerable significance, as it is for melanoma, in the development of basal cell carcinoma.
b) Superficial Spreading Basal Cell Carcinoma
Superficial spreading basal cell carcinoma is most common on the upper back. It consists of shallow plaques, pink to almost skin coloured, that slowly expand over many years. The shallowness of the lesion prevents ulceration until quite late. Typically, these lesions are very friable, and minor trauma such as dragging a fingernail across the lesion while often result in multiple pinpoint bleeding areas.
Superficial spreading basal cell carcinomas are almost all secondary to sun damage.
c) Sclerosing Basal Cell Carcinoma
Sclerosing basal cell carcinoma is often a significant diagnostic problem. The early lesion can look like a small white scar on the skin. This scar-like area slowly expands. Nodules of basal cell carcinoma can be apparent in late lesions but the sclerotic scarred area can expand to a very large size before it is clinically obvious as a skin cancer. It is most common on the face, and can produce quite significant morbidity because of its size at the time of diagnosis.
Because the margins of sclerosing basal cell carcinoma are almost always very poorly defined, it is commonly recurrent after simple surgical excision. Micrographic surgery, if available, is the surgical treatment of choice or, in patients over 60, radiation therapy with generous margins. In all cases, the lesion must be examined carefully under very good light to ascertain the approximate margins.
d) Pigmented Basal Cell Carcinoma
Pigmented basal cell carcinoma occurs in dark skinned individuals, particularly Asians. Nodular basal cell carcinomas can be pigmented, as can superficial spreading basal cell carcinomas. Nodular basal cell carcinomas that are pigmented may be confused clinically with nodular melanoma. The differentiating feature, if completely pigmented, is that there are pigment flecks around the base of the nodule that are absent in melanoma. These flecks are the engorged melanocytes. In many cases the only way to clearly differentiate is a biopsy.
ON THIS PAGE: You will find out more about changes and other things that can signal a problem that may need medical care. Use the menu to see other pages. People with a basal cell carcinoma, squamous cell carcinoma, or Merkel cell cancer may experience the following symptoms or signs. Symptoms are changes that you can feel in your body. Signs are changes in something measured, like by taking your blood pressure or doing a lab
test. Together, symptoms and signs can help describe a medical problem. Sometimes, people with non-melanoma skin cancer do not have any of the symptoms and signs described below. Or, the cause of a symptom or sign may be a medical condition that is not cancer. Changes in the skin are the main warning sign for skin cancer. Each type of skin cancer can appear differently, so it is important to talk with your doctor when you notice a change in your skin. The skin features that frequently
develop are listed below. For basal cell carcinoma, 2 or more of the following features may be present: An open sore that bleeds, oozes, or crusts and remains open for several weeks
A reddish, raised patch or irritated area that may crust or itch, but rarely hurts
A shiny pink, red, pearly white, or translucent bump
A pink growth with an elevated border and crusted central indentation
A scar-like, white, yellow, or waxy area, often with a poorly defined border
See pictures of these features of basal cell carcinoma. (Please note that this link will take you to a separate website.)
Squamous cell carcinoma can often crust, bleed, and appear as:
A wart-like growth
A persistent, scaly red patch with irregular borders that may bleed easily
An open sore that persists for weeks
A raised growth with a rough surface and a central depression
See pictures of these signs of squamous cell carcinoma. (Please note that this link will take you to a separate website.)
Merkel cell cancer often occurs as:
Painless, firm, shiny lumps on the skin
These lumps can be red, pink, or blue
Some types of skin cancer spread along the nerves. If this happens, it can cause itching, pain, numbness, tingling, or a feeling like there are ants crawling under the skin. Other signs may include a lump or bump under the skin in areas such as the neck, armpit, or groin.
If you are concerned about any changes you experience, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This may include when you first noticed the skin feature, how long it has been there, and any other symptoms you may be experiencing. This is to help figure out the cause of the problem, called a diagnosis.
For most cases of skin cancer, removing the cancer with surgery or using a topical treatment will cure the disease. In more complicated cases, a multidisciplinary team of doctors will meet with a patient to discuss different types of treatments to develop a plan with the best chances of curing or controlling this disease (see Types of Treatment).
Particularly with advanced skin cancer, relieving symptoms will be an important part of cancer care and treatment. Managing symptoms may also be called "palliative care" or "supportive care." Once started, it is continued throughout treatment. Be sure to talk with your health care team about the symptoms you experience, including any new symptoms or a change in symptoms.
The next section in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. Use the menu to choose a different section to read in this guide.