Skin Cancer · Burien & Bellevue, WA
Basal Cell Carcinoma
The most common cancer in the United States. BCC is highly treatable — especially when detected early — with multiple effective options ranging from Mohs surgery to radiation-based therapy.
Schedule an AppointmentWhat Is Basal Cell Carcinoma?
Basal cell carcinoma is a malignant tumor that arises from basal cells — the deepest layer of the epidermis (outer skin). It is the most common cancer not just among skin cancers, but of any kind in the entire United States, accounting for approximately 3.6 million new diagnoses each year. Despite its prevalence, BCC is one of the most manageable cancers when identified and treated early.
BCC grows slowly and almost never spreads (metastasizes) to other organs — making it rarely life-threatening. However, it should never be ignored. Left untreated, BCC can cause significant local destruction, invading deeper layers of skin, connective tissue, cartilage, and even bone, particularly around the nose, eye sockets, and ears.
How Does BCC Appear?
BCC can look very different depending on its subtype and location. Common presentations include:
- A pearly, translucent, or shiny bump — often with a rolled edge and visible blood vessels (telangiectasias) running across its surface
- A flat, pale, scar-like patch that looks waxy or ivory-colored
- A pink or reddish patch of skin, sometimes slightly scaly, that may bleed when scratched
- An open sore that heals partially and then recurs — a classic warning sign
- A brownish or bluish lesion with a pearlescent sheen
BCCs most frequently develop on the head, face, and neck — areas with the greatest lifetime UV exposure. They can also appear on the trunk and extremities, especially in people who spent significant time outdoors or used tanning beds.
Subtypes of Basal Cell Carcinoma
Knowing the histologic subtype of a BCC is essential for selecting the right treatment:
Nodular BCC
The most common subtype, appearing as a shiny, round nodule with rolled edges and surface blood vessels. It grows in a relatively well-contained manner, making it amenable to excision or Mohs surgery.
Superficial BCC
Presents as a flat, pink, or scaly patch, often on the trunk. It tends to spread outward rather than deep into the skin. Superficial BCC can sometimes be treated with topical agents (imiquimod or 5-FU) or ED&C for low-risk lesions, though surgical approaches are generally more reliable.
Morpheaform (Sclerosing) BCC
The most aggressive subtype. It appears as a flat, scar-like, indurated plaque that is often poorly defined — meaning the tumor extends well beyond what is visible on the surface. This subtype has a much higher recurrence rate with standard excision and requires Mohs surgery for the best outcome.
Infiltrative BCC
Similar to morpheaform in behavior, with strands of tumor cells spreading diffusely through the dermis. Also best treated with Mohs surgery due to poorly defined margins.
Risk Factors
- Cumulative UV exposure — the single greatest modifiable risk factor
- History of sunburns, especially severe or blistering burns at any age
- Fair skin, light hair, and light eyes (lower melanin protection)
- Personal history of BCC or any skin cancer
- Immunosuppression from organ transplant medications, chemotherapy, or HIV
- Radiation therapy to the skin (for previous cancers or other conditions)
- Exposure to arsenic in drinking water, pesticides, or industrial settings
- Genetic conditions such as basal cell nevus syndrome (Gorlin syndrome)
Treatment Options for BCC
The treatment chosen depends on the tumor's subtype, size, location, and the patient's health and preferences.
Mohs Micrographic Surgery
The gold standard for BCCs on the head, face, neck, and other areas where tissue preservation is critical. Mohs achieves a cure rate exceeding 98% for primary BCC while removing the minimum amount of healthy tissue. It is especially important for aggressive or poorly defined subtypes.
Standard Surgical Excision
Appropriate for low-risk BCCs in non-facial locations. The tumor is removed with a pre-set margin of normal tissue, and the specimen is sent to a pathology laboratory. Cure rates are high for nodular and superficial subtypes on the trunk and extremities.
Electronic Brachytherapy (eBT)
A surgery-free radiation option ideal for elderly or medically fragile patients, or for tumors on the nose, ear, or eyelid where surgery would be complex. Eight outpatient sessions over four weeks deliver a curative radiation dose with excellent cosmetic results.
Electrodesiccation & Curettage (ED&C)
Used for small, low-risk superficial or nodular BCCs on the trunk and extremities only. The tumor is scraped away with a curette and then cauterized. It is not appropriate for the face or for aggressive subtypes.
Schedule a Skin Check
Noticed a new spot, a sore that won't heal, or a shiny bump on your face? Our dermatologists can evaluate and biopsy suspicious lesions the same day in most cases.
Schedule an AppointmentQuick Facts
- ~3.6 million cases diagnosed in the US each year
- Most common cancer of any type in the US
- Rarely metastasizes (<0.1% of cases)
- Sun-exposed areas most commonly affected
- Highly curable when treated early
- Mohs surgery preferred for facial tumors
Frequently Asked Questions
What does basal cell carcinoma look like?
BCC can appear in several ways: a pearly or translucent bump, often with visible blood vessels on the surface; a flat, flesh-colored or slightly pink scar-like lesion; a pink or red patch that is slightly scaly; or an open sore that heals and then reopens. It most commonly appears on sun-exposed areas like the face, head, neck, and hands. If you notice a spot that is new, unusual, or failing to heal, have it evaluated promptly.
Can basal cell carcinoma spread to other organs?
Metastatic BCC is extremely rare — occurring in less than 0.1% of cases. However, BCC can be locally very destructive. If left untreated for years, it can invade deeper layers of the skin, muscle, cartilage, and even bone. This is why treatment, even for small lesions, is always recommended.
Which treatment is best for my BCC?
The best treatment depends on the subtype, size, location, and your overall health. Mohs surgery is preferred for BCCs on the face, head, and neck and for aggressive or recurrent tumors. Standard excision works well for low-risk tumors on the trunk and extremities. Electronic brachytherapy is ideal for patients who cannot undergo surgery. ED&C is appropriate for superficial, low-risk lesions. Your dermatologist will recommend the best option based on your specific tumor characteristics.
Will basal cell carcinoma come back after treatment?
With definitive treatment such as Mohs surgery, the five-year recurrence rate for primary BCC is less than 2%. Recurrence rates are somewhat higher with other treatment methods and for certain aggressive subtypes. After treatment, regular skin exams are important — patients with one BCC have a significantly elevated risk of developing additional skin cancers in the future.
How can I reduce my risk of getting another BCC?
Daily broad-spectrum sunscreen (SPF 30 or higher), protective clothing including wide-brimmed hats, seeking shade during peak UV hours (10 a.m.–4 p.m.), and avoiding tanning beds are the most effective preventive measures. Annual full-body skin checks with your dermatologist allow early detection if new lesions develop.
Is basal cell carcinoma related to having fair skin?
Yes, fair skin is a major risk factor. People with lighter skin produce less melanin, which normally provides some protection against UV radiation. However, BCC can and does occur in people with darker skin tones, so regular skin exams are important for everyone, regardless of skin color.
Get Expert BCC Care in Burien & Bellevue
Basal cell carcinoma is very curable — but only if treated. Our board-certified dermatologists and fellowship-trained Mohs surgeons provide comprehensive BCC care from diagnosis to reconstruction.