Basal Cell Carcinoma Pictures

What this form of skin cancer can look like

Basal cell carcinoma (BCC) is the most common form of skin cancer. It originates in basal cells, which are located in the outermost layer of skin (epidermis) and are responsible for producing new skin cells and pushing them to the surface. Due to the location of these cells, BCC typically develops on areas of skin that are regularly exposed to sunlight and other forms of ultraviolet radiation.

BCC tends to grow slowly and develop on sun-exposed areas such as the face, ears, neck, scalp, chest, shoulders, and back. The lesions commonly appear as painless, raised nodules, often shiny with tiny blood vessels running through them.

Even so, BCC can vary in its size and appearance and may develop on parts of the body that are not sun-exposed. By recognizing the different manifestations of BCC, you may be able to spot them early and seek immediate treatment.

The early diagnosis and treatment of basal cell carcinoma is associated with a disease-free cure rate of between 85% and 95%.

Nodular Basal Cell Carcinoma

Basal cell carcinoma under the nose with telangiectasia

SkarmoutsosV / Wikimedia Commons

Nodular basal cell carcinoma is one of the three main subtypes of BCC. It appears as a small, dome-shaped nodule populated tiny branch-like blood vessels (referred to as telangiectasis).

Nodular basal cell carcinoma is the most common BCC subtype, accounting for over 50% of all BCC cases. The lesions predominate on the head, especially the cheeks, forehead, eyelids, and nasolabial folds (the "smile lines" that run from the corner of the nose to the corner of the mouth). The lesions often appear skin-colored, pinkish, or pearly white.

Non-Ulcerated Nodular BCC

Nodular basal cell carcinoma crusted

 jax10289 / Getty Images

Nodular BCC can change over time—a general warning sign that cancer is involved—and may suddenly enlarge, crust over, and form a central depression. Bleeding with mild trauma is common.

At this stage, the non-ulcerated lesion will be similar in appearance to conditions like molluscum contagiosum, sebaceous hyperpclasia, amelanotic melanoma, and intradermal melanocytic nevus (also known as a common mole).

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Ulcerated Nodular BCC

"Rodent ulcer" - a type of basal cell carcinoma

James Hellman, MD / Wikimedia Commons

Eventually, the center of the non-ulcerated BCC lesion may suddenly ulcerate, forming an open sore with a well-defined rolled border. Nodular lesions that have ulcerated are often referred to as "rodent ulcers" because the edges of the sore often look ragged and gnawed upon.

Rodent ulcers tend to be more aggressive. They often develop on the nasal ala (the lateral surface of the nose that flares out to form the nostrils), where they can cause extensive damage to tissues.

Ulcerated BCC lesions are often difficult to distinguish from another type of skin cancer, called squamous cell carcinoma, which can also ulcerate.

Micronodular Basal Cell Carcinoma

Micronodular basal cell carcinoma

Dr. P. Marazzi / Science Photo Library / Getty Images

Micronodular basal cell carcinoma is an aggressive subtype of nodular BCC. It is characterized by multiple small nodules that can be extremely small and uniform with well-defined borders.

Micronodular BCC lesions are skin-colored to slightly greyish and may appear a whitish-yellow when stretched. The lesions occur most commonly around the eyes and are often firm to the touch. Unlike nodular BCC, micronodular BCC is less prone to ulceration.

Even so, micronodular BCC is more likely to recur, because the lesions are so easily missed. Oftentimes, there are as many unseen lesions—that are either too small or are flat to the surface of the skin—as visible ones.

Superficial Basal Cell Carcinoma

Superficial basal cell carcinoma

National Cancer Institute 

Superficial basal cell carcinoma is the second most common type of BCC, accounting for around 15% of cases. As per its name, superficial BCC is characterized by a flat, distinct area of discoloration, referred to as a macule. It is usually pink-to-red in color with well-defined edges and a scaly appearance.

Some superficial BCC lesions have a thin rolled border or irregular crusty edges. Areas of the lesion can suddenly regress, leaving behind a lightened (hypopigmented) area of thinned skin.

Unlike nodular BCC, superficial BCC tends to favor the trunk and extremities but can also occur on the face. It is more frequently seen in fair-skinned adults under 50 but can occur in people as young as 20.

The flaky appearance of superficial BCC is easily mistaken for non-cancerous conditions like psoriasis and nummular eczema as well as precancerous conditions such as actinic keratosis.

Pigmented Basal Cell Carcinoma

Pigmented nodular basal cell carcinoma
jax10289 / Getty Images

Pigmented basal cell carcinoma is a variant of BCC that can occur with nodular and superficial BCC. It is distinguished by its darkened (hyperpigmented) coloration but is otherwise the same as its non-pigmented counterpart. The color is usually quite homogeneous, ranging from a dark brown to a bluish-black.

Because of its coloring and propensity for easy bleeding, pigmented nodular BCC is often mistaken for invasive melanoma, which shares many of the same features and characteristics. A pigmented nodular BCC lesion is typically well-demarcated and can grow quickly in the way that invasive melanoma can.

Pigmented nodular BCC cannot be distinguished from invasive melanoma by appearance alone. A newer, non-invasive diagnostic tool, called reflectance confocal microscopy (RCM), is an alternative to biopsy that can help differentiate the two based on close-up images of the skin created with low-powered laser beams.

Morpheaform Basal Cell Carcinoma

Morpheaform/infiltrative basal cell carcinoma

 sdigital / Getty Images

Morpheaform basal cell carcinoma is the third most common subtype of BCC, accounting for between 5% and 10% of cases.

Also known as sclerodermiform BCC because of its resemblance to the connective tissue disease scleroderma, morpheaform BCC lesions are pink-to-ivory in color with poorly defined borders and areas of induration (thickening and hardening of tissues).

The lesions will often manifest as a waxy depression in the skin, making them look more like a scar than a lesion, and are most commonly found around the middle of the face.

Morpheaform BCC tends to be more aggressive than nodular or superficial BCC and is notorious for being missed during a skin examination.

Morpheaform BCC is sometimes referred to as infiltrative or infiltrating BCC because the lesion can sometimes penetrate the epidermis and infiltrate the lower layer of skin, called the dermis. Because of this, there is a higher risk of recurrence compared to the other BCC subtypes.

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