What Is Basal Cell Carcinoma? Symptoms, Causes, and Treatment

What Is Basal Cell Carcinoma?

Basal cell carcinoma (BCC) is the most common type of skin cancer and the most frequently diagnosed cancer in humans. It develops in the basal cells, which are found at the bottom of the epidermis, the outermost layer of your skin. These basal cells are responsible for producing new skin cells as old ones die off, and when DNA damage causes them to grow uncontrollably, basal cell carcinoma develops.

While BCC is rarely life-threatening and almost never metastasizes (spreads to distant organs), it should never be ignored. Left untreated, basal cell carcinoma can grow deep into surrounding tissues, damaging nerves, blood vessels, and even bone. Early detection and proper treatment are essential to achieving the best possible outcome.

How Common Is BCC in Israel?

Israel has one of the highest rates of skin cancer in the developed world, driven by intense UV radiation and an outdoor lifestyle. The incidence of basal cell carcinoma in Israel is approximately 188 cases per 100,000 people, significantly higher than many European countries.

Several factors contribute to this elevated rate. Israel's geographic location near the equator means stronger UV exposure year-round. Additionally, a large portion of the population has fair skin of European descent, which is more susceptible to UV-induced DNA damage. The cultural emphasis on outdoor activities, military service in sun-exposed environments, and beach culture all increase cumulative sun exposure over a lifetime.

What Does Basal Cell Carcinoma Look Like?

Recognizing BCC early is the single most important factor in ensuring successful treatment. Basal cell carcinoma can present in several different forms, which is why it is sometimes called "the great imitator." Here are the most common appearances to watch for:

Pearly or Waxy Bump The classic presentation of BCC is a small, shiny bump that appears pearly or translucent. It may have visible tiny blood vessels (telangiectasias) running across its surface. These bumps are most commonly found on the face, ears, and neck, areas with the greatest sun exposure.

Pinkish Patch of Skin Some BCCs appear as a flat or slightly raised pinkish patch, similar in appearance to eczema or dermatitis. These patches may be slightly scaly and tend to occur on the trunk, arms, or legs. Because they resemble common benign skin conditions, they are often overlooked.

A Sore That Will Not Heal One of the most telling signs of BCC is a sore that bleeds, crusts over, appears to heal, and then reopens. This cycle of healing and reopening is highly characteristic and should prompt an immediate visit to a dermatologist.

Raised Reddish Patch Some BCCs present as a raised area that may itch or cause no discomfort at all. Over time, a central depression or crust may form.

Scar-Like Area In its most deceptive form, BCC can appear as a flat, waxy, scar-like area with poorly defined borders. This morpheaform or sclerosing variant is the most aggressive subtype and can extend far beneath the skin surface.

Risk Factors for Developing BCC

Understanding your risk factors can help you take preventive action and know when to seek screening. The primary risk factors for basal cell carcinoma include:

Ultraviolet (UV) Radiation Exposure Cumulative UV exposure from sunlight and tanning beds is the leading cause of BCC. Both UVA and UVB rays damage the DNA in skin cells, and this damage accumulates over decades. Intermittent, intense sun exposure (leading to sunburns) during childhood and adolescence is particularly harmful.

Fair Skin and Light Features Individuals with fair skin, light-colored eyes, red or blonde hair, and a tendency to freckle or burn easily are at significantly higher risk. However, BCC can develop in people of all skin types.

Age and Gender The risk of BCC increases with age, with most cases diagnosed in people over 50. Men are historically more likely to develop BCC than women, though this gap has been narrowing in recent decades.

History of Sunburns Even a single blistering sunburn during childhood can significantly increase the lifetime risk of developing BCC.

Immunosuppression Patients with weakened immune systems, including organ transplant recipients on immunosuppressive medications, have a significantly higher risk of BCC.

Previous Skin Cancer If you have had one BCC, your risk of developing another is substantially increased. Studies show that approximately 40-50% of patients who have had one BCC will develop a new one within five years.

How Is Basal Cell Carcinoma Diagnosed?

Diagnosis typically begins with a clinical examination by a dermatologist, often aided by dermoscopy, a technique that uses magnification and polarized light to examine skin structures invisible to the naked eye. If a lesion appears suspicious, a skin biopsy is performed to confirm the diagnosis.

During a biopsy, a small sample of tissue is removed under local anesthesia and sent to a pathology laboratory. Results usually return within one to two weeks and will confirm whether the lesion is BCC, its subtype, and help guide treatment decisions.

Treatment Options for BCC

The treatment approach for basal cell carcinoma depends on the tumor's size, location, subtype, and whether it is a primary or recurrent lesion. Treatment options include:

Mohs Micrographic Surgery: The Gold Standard Mohs surgery is widely recognized as the gold standard treatment for basal cell carcinoma, offering a cure rate of 99% for primary BCCs. During the procedure, thin layers of tissue are removed and examined under a microscope in real time. This layer-by-layer approach ensures complete tumor removal while preserving the maximum amount of healthy tissue.

Mohs surgery is particularly valuable for BCCs located on the face, ears, nose, eyelids, and other cosmetically or functionally sensitive areas. It is also the preferred treatment for aggressive subtypes, large tumors, and recurrent BCCs.

Standard Surgical Excision For less complex cases, standard excision with predetermined margins may be appropriate. The tumor is cut out along with a surrounding margin of normal-appearing skin. However, because the margins are not examined in real time, there is a higher recurrence rate compared to Mohs surgery.

Other Treatment Options Additional treatment options may include curettage and electrodesiccation (scraping and burning), topical medications (such as imiquimod or 5-fluorouracil) for superficial BCCs, cryotherapy (freezing), photodynamic therapy, and radiation therapy for patients who are not surgical candidates.

Prognosis and Long-Term Outlook

The prognosis for basal cell carcinoma is excellent when detected and treated early. With Mohs surgery, the five-year cure rate reaches 99%, making it the most effective treatment available. Even with standard excision, cure rates for primary BCCs range from 90-95%.

However, ongoing vigilance is essential. Patients who have had one BCC are at elevated risk for developing additional skin cancers and should commit to regular dermatological screenings, typically every six to twelve months, and diligent sun protection practices.

When to See a Dermatologist

If you notice any new, changing, or unusual skin growth, particularly a pearly bump, a pink patch that will not go away, or a sore that repeatedly heals and reopens, schedule an appointment with a dermatologist as soon as possible. In Israel, where BCC rates are among the highest in the world, proactive skin surveillance is not just recommended; it is essential.

At our clinic at Assuta and Herzliya Medical Center, Dr. Yehonatan Kaplan specializes in the diagnosis and Mohs surgical treatment of basal cell carcinoma. With diagnostic tools including digital dermoscopy and a commitment to tissue-sparing surgery, we ensure every patient receives the highest standard of care.

Early detection saves skin, preserves appearance, and delivers the best outcomes. Do not wait for a small spot to become a bigger problem.