Basal Cell Carcinoma Updates: Latest Recommendations for Managing the Most Common Skin Cancer

Hearing “skin cancer” worries many people. But not all skin cancers are the same. Basal cell carcinoma, also called “basal cell skin cancer” by many, grows very slowly and is highly treatable if caught early.

Basal cell carcinoma can look harmless at first, like a small bump or patch. People may even put off seeing a dermatologist until it starts bleeding, growing, or causing disfigurement. By then, the tumor may have already spread deeply and become harder to treat.

As with any cancer, early action makes all the difference in treating basal cell carcinoma. In this article, we’ll walk through updates on the main causes, risks, treatment choices, and prevention tips to help you stay ahead of this condition.

What Is Basal Cell Carcinoma?

Before we talk about basal cell cancer, let’s breeze through some skin basics. The epidermis comprises the outermost layer of skin, made mostly of cells called “keratinocytes,” which protect against water loss, injury, and infection. At the base of the epidermis lies the basal layer, where new cells divide before moving up to form the skin barrier.

Young skin cells multiply rapidly, making them prone to DNA damage. Basal cell carcinoma develops when DNA changes cause basal cells to grow abnormally.

Basal cell skin cancer can appear in different forms. The nodular type is the most common, looking like a shiny bump with visible surface blood vessels and a rounded, elevated edge. The bump can form a crater-like sore in the middle.

Less common types of basal cell skin cancer may appear as:

• A dark spot that can be mistaken for melanoma, a cancerous mole
• A reddish, clearly outlined patch that looks like eczema or any allergic rash
• A scar-like area that may form over old wounds, such as from trauma or skin cancer treatment
• A small pinkish bump that may resemble a skin tag

Basal cell carcinomas often grow on sun-exposed areas above the chest—the face, neck, and scalp. However, they may occasionally develop in frequently shielded places, like the torso and genitals, especially in high-risk individuals. Identifying these lesions can be tricky since they may be confused with common skin conditions or a more serious tumor like melanoma.

Who Usually Gets Basal Cell Carcinoma?

Basal cell skin cancer is mostly linked to sun exposure, primarily due to UV rays. Other UV sources, like tanning beds and light therapy machines, can add to the risk.

People who live in sunny places, such as high mountains or areas near the equator, have a higher risk of skin cancer. Men are often more affected than women because they spend more time outdoors for work or recreation but are less likely to use sun protection.

UV rays can damage the DNA in basal cells. Not all DNA damage leads to cancer, but changes in growth-related genes can. Melanin, the pigment made by skin cells referred to as “melanocytes,” acts like a natural shield against UV or sun damage. People with fair skin, red or blonde hair, and light-colored eyes have less melanin, which makes them more likely to get basal cell skin cancer than individuals with darker skin, hair, or eyes.

Getting older adds to skin cancer risk. DNA damage piles up, repairs aren’t as quick, inflammation builds, and melanocytes create less melanin to guard against UV rays. You may check out our previous article on the subject for more information.

A weak immune system lowers the skin’s defenses against basal cell carcinoma. That’s why people who’ve had cancer therapy or an organ transplant are more at risk. Other risk factors include a family or personal history of skin cancer, old scars or wounds that don’t heal, past exposure to x-rays or other strong radiation types, inherited skin conditions, prolonged or repeated contact with arsenic, and excessive intake of some kinds of polyunsaturated fat.

Basal skin cancer often develops slowly, mostly from years of sun exposure. However, extra risks such as weakened immunity or family history can make it appear sooner, growing in both sun-exposed and covered skin areas.

When Should You Seek Help for Basal Cell Cancer?

Knowing the signs of basal cell skin cancer is important, but it’s also worth remembering that this skin condition may be caught early, even prevented. As mentioned, some early basal cell carcinomas can look just like harmless marks.

Regular self-skin checks and dermatologist visits can help you identify lingering or changing lesions right away. People with a higher risk benefit most from these skin cancer screening measures.

That said, signs that a lesion may be cancerous include changes in size, shape, or color, as well as a tendency to bleed with little or no injury. An open sore that doesn’t heal presents another red flag.

Itching alone isn’t a reliable sign of basal cell skin cancer. In many cases, a very itchy lesion is actually non-cancerous, as we’ve covered in a previous article.

While some tumors can start on normal skin, people with basal cell carcinoma often also have other cancerous lesions, such as squamous cell carcinoma, melanoma, or Merkel cell carcinoma, or benign spots that could become cancer later. So, any new or unusual blemish shouldn’t be ignored. See your care provider if you notice any of these warning signs, especially if you’re at higher risk for skin cancer.

What Can You Expect During a Dermatologist Visit for Basal Cell Carcinoma?

During your initial consultation, your dermatologist will ask about your medical history and carefully examine your skin. A handheld device called a “dermoscope” helps them detect early skin cancer in up to 75% of cases. The exam may include a full-body check to look for tumors in hidden areas or lymph node involvement.

A skin biopsy helps confirm the diagnosis. The doctor may also order imaging tests, like a CT scan or MRI, if they think the lesion may affect bone or other deep tissues.

After the tests, the doctor will help you explore various treatment options. It’s important to know if the tumor is high-risk to make sure you get the best care. Signs of high-risk basal cell carcinoma include the following:

• Large size (2 cm or more) for tumors on the trunk or extremities
• Growth in the central face, eyebrows, nose, lips, chin, ear, temple, genitals, nipples, hands, feet, ankles, or nails, where cancers can be harder to treat or spread easily
• Unclear edges
• Recurrence
• Appearance in areas previously treated with radiation therapy
• Fast-growing basal cell cancer type
• Nerve involvement
• Spread to lymph nodes or other regions in the body

Age can also play a role in deciding care, since older patients may have health issues that make surgery risky. Personal preference and access to the right resources are other factors when choosing therapy.

How Do Doctors Remove Basal Cell Skin Cancer?

The gold standard treatment option for basal cell carcinoma is Mohs micrographic surgery. This procedure removes the tumor tissue layer by layer until no cancer cells are left, giving the best chance of cure while protecting the appearance and function of nearby healthy tissue.

Mohs surgery is recommended, whether the tumor is low- or high-risk. However, Mohs procedures may not be for everyone due to limiting factors like cost and availability of specially trained skin surgeons.

Standard excision is an alternative that may be used for both low- and high-risk tumors. The procedure removes the lesion along with a small margin of surrounding tissue.

Unlike Mohs surgery, the edges of the removed tissue aren’t checked immediately after standard excision, so some tumor cells may remain unnoticed until later. This treatment works well, though Mohs surgery usually does a better job at removing all cancerous cells and keeping the surrounding skin looking normal.

Surgical options for low-risk basal cell cancer include curettage and electrodesiccation (scooping out and burning the tumor), shave removal (cutting off the diseased skin cell layers), and cryotherapy (freezing the lesion with liquid nitrogen). While effective, these methods are not as precise as Mohs surgery, so the chance of recurrence is a bit higher, and the skin may not look as smooth afterward.

Radiation therapy involves cancer cell exposure to high-energy light. This treatment is recommended when surgery isn’t an option because of tumor location in sensitive areas or involvement of vital structures, advanced age, medical risks, or patient choice. Radiotherapy can also provide relief or comfort by easing symptoms when curing the cancer isn’t possible.

Radiation therapy can treat leftover cancer cells following surgery. But it shouldn’t be used for patients with inherited skin cancers or tumors that return after previous radiation treatment.

Other nonsurgical options for low-risk basal cell cancer include topical cancer cream application and photodynamic therapy. Medicine creams may contain imiquimod, calcipotriene, or 5-fluorouracil. Photodynamic therapy involves using a special light to activate a drug that kills cancer cells.

When basal cell carcinomas become advanced, treatment is usually aimed at alleviating symptoms rather than curing the disease. Surgery, radiotherapy, chemotherapy, or combinations of these methods may be offered to patients. Chemotherapy drug options include vismodegib, sonidegib, and cemiplimab, which stop cancer cells from multiplying and spreading.

How Can BHSkin Dermatology Help You Get Rid of Basal Cell Carcinoma?

At BHSkin Dermatology, our skincare experts specialize in the diagnosis and treatment of this common cancer. They’re committed to giving individualized care, focused on safety and effectiveness.

Our board-certified Mohs surgeons are among California’s best, targeting the cancerous tissue precisely while keeping the surrounding skin looking normal and working properly. They also offer a variety of other therapy options to tackle the specific needs of every patient.

How Can You Prevent Basal Cell Skin Cancer?

The best way to avoid skin cancers like basal cell cancer, squamous cell carcinoma, melanoma, and Merkel cell carcinoma is to minimize UV light exposure. Keep away from tanning beds, and use sunscreen regularly. Follow dose recommendations carefully if you’re receiving UV light therapy for skin conditions.

Vitamin B3 (nicotinamide) and drugs like celecoxib, acitretin, capecitabine, and tazarotene may help stop actinic keratosis, a precancerous skin growth caused by UV light, from becoming malignant. However, more research is needed to fully understand their benefits for people with skin cancer.

Among modifiable factors, reducing arsenic exposure may lower risk. However, no clinical trial currently supports dietary fat control or immunity enhancement, such as from vaccination or supplementation with other vitamins, as effective basal skin cancer prevention strategies.

For individuals who have had basal cell carcinoma treatment, the National Comprehensive Cancer Network’s 2025-2026 guidelines recommend skin exams with a doctor every 6-12 months for the first five years, then annually for life. The American Cancer Society also suggests monthly self-skin checks for everyone, regardless of skin cancer risk.

Recap: Smart Moves for Checkmating Basal Cell Carcinoma

Basal skin cancer involves the abnormal growth of basal cells in the outer skin layer due to DNA damage from UV exposure. Similar to other cancer types, early diagnosis and quick treatment improve the chances of cure.

Various basal cell cancer treatments are available. Mohs surgery stands out, offering superior success rates while preserving appearance and function. Yet, the best defense is still prevention. Sun protection, regular self-skin exams, and doctor-performed skin checks are vital strategies to avoid this condition.

Finally, when it comes to a serious problem like skin cancer, expertise matters most. Accurate identification and effective treatment come only from a qualified skin cancer specialist. Ensure your care is in the best hands by trusting only a board-certified dermatologist.

Fight Skin Cancer With the Help of LA’s Top Dermatologists

Basal skin cancer may initially seem harmless until it becomes problematic. Risk varies among people. Whether you’re concerned about getting rid of an existing skin lesion or preventing new ones, you’ve turned to the right team.

At BHSkin Dermatology, our board-certified skin cancer experts are some of the most trusted in the Golden State. They’ve treated a wide range of skin cancer cases, from common tumors like basal and squamous cell carcinoma to rare lesions like Merkel cell carcinoma and melanoma, upholding the highest standards while showing genuine care. Visit our Glendale or Encino clinic or use our telederm platform for your initial consultation.

Your path to healthy skin and peace of mind begins here. Book your appointment today!

References:

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8. Roberts, C. A., Goldstein, E. K., Goldstein, B. G., Jarman, K. L., Paci, K., & Goldstein, A. O. (2021). Men’s Attitudes and Behaviors About Skincare and Sunscreen Use Behaviors. Journal of Drugs in Dermatology. 20(1), 88–93. https://pubmed.ncbi.nlm.nih.gov/33400407/
9. Tang, J. Y., Epstein, Jr. E. H., & Oro, A. E. (2019). Chapter 111: Basal Cell Carcinoma and Basal Cell Nevus Syndrome. Fitzpatrick’s Dermatology, 9th ed. https://accessmedicine.mhmedical.com/content.aspx?bookid=2570&sectionid=210434418
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Author: Don Mehrabi

Don Mehrabi, MD, FAAD, is LA's leading board-certified dermatologist is the president of BHSkin Dermatology and proud father of 3 wonderful children. He treats patients in both Encino-Tarzana and Glendale. This blog builds on medical studies combined with Dr. Mehrabi's first-hand experiences from his practice.