Clinical Reference / Therapeutic Strategies / Non-Melanoma Skin Cancers (NMSC): Basal Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC)

Non-Melanoma Skin Cancers (NMSC): Basal Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC)

Initial Evaluation: Basal Cell Carcinoma

Basal cell carcinomas (BCCs) have several key clinical features:

  • BCC is the most common cancer in humans.
  • It commonly presents as a pearly papule or plaque or nodule (i.e., nodular BCC) sometimes with exaggerated telangiectasias or central ulceration.
  • Some forms are hyperkeratotic (i.e., superficial BCC), pigmented (i.e., pigmented BCC), or scar-like (i.e., morpheaform BCC).
  • In general, BCCs are relatively slow-growing tumors and may develop over months to years and invade locally rather than metastasize. If left untreated, the tumor will progress to invade subcutaneous tissue, muscle, or even bone.

BCCs are best managed by physicians expert in their recognition, natural history, and treatment. Failure to correctly manage tumors initially may lead to significant cosmetic deformity. A biopsy to confirm the diagnosis should be performed before treating any lesion.

Classic basal cell carcinomas present as a pearly papule with exaggerated telangiectasia and central ulceration within

Superficial basal cell carcinomas: erythematous scaly plaques with sharply-demarginated borders

Pigmented basal cell carcinomas: pearly plaques with pigmentation

Morpheaform basal cell carcinomas: indurated flesh-colored or hypopigmented plaques with dermal infiltration, telangiectasias

Differential Diagnosis

Actinic keratoses

Bowen’s disease (squamous cell carcinoma in situ): erythematous hyperkeratotic plaques with slight induration and crusting