How long can you have basal cell carcinoma before it spreads?

Basal cell carcinoma grows slowly. It rarely spreads to other parts of the body, but can become locally invasive. This can take years. Nevertheless, early diagnosis and treatment are still important.

What does the beginning of basal cell carcinoma look like?

A basal cell carcinoma that has not yet invaded deeper skin layers may look like a pink indentation, a scaly growth, a sore that doesn't heal, a raised patch of irritated/red skin, a mole-like growth, or a waxy scar-like patch.

Basal Cell Carcinoma Pictures

Basal cell carcinoma (BCC) is the most common form of skin cancer. If you're concerned you may have basal cell carcinoma, pictures of different stages or types of lesions can help you compare your skin to examples of BCC, but it's always best to get a full skin check to be sure.

BCC originates in basal cells located in the epidermis. This is the outermost layer of the skin responsible for producing new skin cells and pushing them to the surface.

BCC tends to grow slowly and develops on areas of skin regularly exposed to sunlight and other forms of ultraviolet radiation—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. However, BCC can vary in size and appearance and may develop on parts of the body that are not sun-exposed.

This article provides images and descriptions of the different manifestations of BCC, so you may be able to spot them early and seek immediate treatment.

Woman's skin being examined at doctor — BURGER/PHANIE/Canopy/Getty Images

The early diagnosis and treatment of BCC 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. Nodular BCC is the most common BCC subtype, accounting for over 50% of all BCC cases.

These lesions appear as small, dome-shaped nodules populated by tiny branch-like blood vessels (referred to as telangiectasias).

You're most likely to find them on your face, 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

If you notice a small growth on your skin that changes over time, pay attention. This is a typical characteristic of nodular BCC. It may suddenly enlarge, crust over, or form a central depression. The area may also bleed easily.

At this stage, the non-ulcerated lesion may appear similar to conditions such as: these

Molluscum contagiosum
Sebaceous hyperplasia
Amelanotic melanoma
Intradermal melanocytic nevus (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 form an open sore, known as an ulcer, 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). In this location, they can significantly damage nearby tissue.

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

Micronodular BCC lesions vary in shade from 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 likely to form ulcers. Often, lesions are not even noticed. They may be too small to be seen with the naked eye or are flat and seem harmless. Thus, micronodular BCC is more likely to recur because the lesions are not treated.

Superficial Basal Cell Carcinoma

Superficial basal cell carcinoma is the second most common type of BCC, accounting for around 15% of cases.

Superficial BCC characteristics include:

A flat, distinct area of discolored skin, referred to as a macule
Pink-to-red color
Possibly thin rolled border or irregular crusty edges.
Well-defined edges and a scaly appearance

Areas of the lesion may also 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 noncancerous 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 uniform, ranging from dark brown to bluish-black.

Because of its coloring and its tendency to bleed easily, pigmented nodular BCC is often mistaken for invasive melanoma. In fact, both forms of cancer share many of the same features. A pigmented nodular BCC lesion is typically well-demarcated and, like invasive melanoma, can grow quickly.

Since pigmented nodular BCC cannot be distinguished from invasive melanoma by appearance alone, your healthcare provider may need to run a special diagnostic test. This involves a non-invasive tool called reflectance confocal microscopy (RCM). Used as an alternative to biopsy, the RCM can help identify lesions 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 characterized by:

Pink-to-ivory color
Poorly defined borders
Areas of induration, which means the tissue has thickened and hardened
Lesions that may manifest as a waxy depression in the skin

Morpheaform BCC may look more like a scar than a lesion and is 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's a higher risk of recurrence compared to the other BCC subtypes.

How Basal Cell Carcinoma Is Treated

Skin Cancer Healthcare Provider Discussion Guide

Get our printable guide for your next healthcare appointment to help you ask the right questions.

Download PDF

Frequently Asked Questions

How long can you have basal cell carcinoma before it spreads?

Basal cell carcinoma grows slowly. It rarely spreads to other parts of the body, but can become locally invasive. This can take years. Nevertheless, early diagnosis and treatment are still important.
What does the beginning of basal cell carcinoma look like?

A basal cell carcinoma that has not yet invaded deeper skin layers may look like a pink indentation, a scaly growth, a sore that doesn't heal, a raised patch of irritated/red skin, a mole-like growth, or a waxy scar-like patch.

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