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What is BCC?

Basal cell carcinoma (BCC) is the most common type of non-melanoma skin cancer, affecting one in five Americans and over 3.3 million people each year.1-3 If not properly treated, BCC can cause significant tissue damage and disfigurement. While it rarely spreads to other parts of the body (only 1% of cases), it can recur in the same spot if not completely removed.2 BCC starts in the basal cell layer, the lower part of the epidermis, and usually develops on sun-exposed areas like the face, head, neck, and arms (Figure). It tends to grow slowly, and individuals who have had BCC are more likely to develop new ones in other areas.4

These cancers can appear as5:

  • Flat, pale or yellow areas, similar to a scar
  • Red patches that might be itchy
  • Small, pink or red, shiny bumps that may have blue, brown, or black areas
  • Open sores that do not heal, or that return after seemingly healed

Risk Factors

BCC is caused by DNA damage to basal cells in the skin, primarily due to UV radiation from the sun or indoor tanning.1 Other risk factors include:

  • UV Exposure: The primary cause of BCC, with risk increasing with more sun or tanning bed exposure1,6
  • History of Skin Cancer: Previous skin cancers, such as squamous cell carcinoma or melanoma, increase the risk1
  • Age: Most BCC cases occur in people over 50 years of age1
  • Skin Type: Lighter skin that burns easily, rarely tans, or is sensitive to the sun is at higher risk1,6
  • Gender: Men are more likely to develop BCC1
  • Chronic Skin Conditions: Infections, inflammation, burns, and scars increase the risk1
  • Occupation: Jobs with high sun exposure, such as farming, roofing, and military service, elevate risk6
  • Immune System: A weakened immune system, whether due to medical conditions or treatments, increases BCC risk6
  • Specific Conditions: Conditions like nevoid basal cell carcinoma syndrome, xeroderma pigmentosum, and others can lead to multiple BCCs6
  • Previous Treatments: Over 100 psoralen plus ultraviolent A (PUVA) sessions, X-Ray treatments for acne, or dialysis for kidney disease increase risk6
  • Arsenic Exposure: High levels of arsenic in food or water elevate BCC risk6

While these risk factors increase the likelihood of developing BCC, it can also occur in individuals without any known risk factors, affecting people of all skin colors, including those of African, Asian, and Latin descent.6

References

  1. Skin Cancer Foundation. Basal Cell Carcinoma Risk Factors. Last reviewed May 2019 (https://www.skincancer.org/skin-cancer-information/basal-cell-carcinoma/bcc-causes-and-risk-factors/).
  2. McDaniel B, Badri T, Steele RB. Basal Cell Carcinoma. In: StatPearls. StatPearls Publishing. Last reviewed March 13, 2024. (https://www.ncbi.nlm.nih.gov/books/NBK482439/).
  3. Work Group; Invited Reviewers, Kim JYS, et al. Guidelines of care for the management of basal cell carcinoma. J Am Acad Dermatol. 2018;78:540-559. doi:10.1016/j.jaad.2017.10.006
  4. American Cancer Society. What Are Basal And Squamous Cell Skin Cancers? Last revised October 31, 2024. (https://www.cancer.org/cancer/types/basal-and-squamous-cell-skin-cancer/about/what-is-basal-and-squamous-cell.html).
  5. NCCN Guidelines For Patients. Basal Cell Skin Cancer. 2022. (https://www.nccn.org/patients/guidelines/content/PDF/basal-cell-patient-guideline.pdf).
  6. American Academy of Dermatology Association. Skin Cancer Types: Basal Cell Carcinoma Causes. Last updated April 28, 2023. (https://www.aad.org/public/diseases/skin-cancer/types/common/bcc/causes).

All URLs accessed June 26, 2024

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