Basal Cell Carcinoma (BCC) is the most common type of skin cancer worldwide, particularly prevalent among fair-skinned individuals exposed to UV radiation. Though it grows slowly and rarely metastasizes, it can cause local tissue destruction if left untreated, especially on the face.
In this article, we’ll break down everything you need to know about BCC, using the handy mnemonic “All BP” (Basal layer, Palisading, Biopsy, Pull it out) to reinforce the core concepts. This comprehensive guide is suitable for MBBS students, NEET PG aspirants, dermatology residents, and patients seeking reliable education.
What is Basal Cell Carcinoma?
Definition:
Basal cell carcinoma is a malignancy of the basal cell layer of the epidermis, i.e., the lowest layer of the skin’s outer surface. These tumors arise from the basal keratinocytes and are characterized by slow growth, local invasion, and extremely rare metastasis.
It’s part of the non-melanoma skin cancers (NMSC) group, alongside squamous cell carcinoma (SCC).
Mnemonic: “All BP”
- B – Basal layer malignancy
- P – Peripheral Palisading
- B – Biopsy
- P – Pull it out
Epidemiology: How Common Is It?
- Most common skin cancer in the world.
- Fair-skinned individuals have the highest risk.
- Typically seen in middle-aged and elderly populations.
- Males are more affected than females.
- Strongly associated with chronic UVB exposure.
.jpg "Basal Cell Carcinoma Symptoms, Risk Factors & Treatment | Mnemonic: All “BP”")
Etiology and Risk Factors
According to the visual:
- UVB radiation: The primary carcinogen.
- Albinism: Lack of melanin increases UV sensitivity.
- Xeroderma Pigmentosum: A rare genetic disorder causing defective DNA repair.
Additional Risk Factors:
| Risk Factor | Explanation |
|---|---|
| Chronic sun exposure | Especially outdoor workers |
| Immunosuppression | Organ transplant recipients |
| Radiation therapy | Prior radiation exposure to the area |
| Age >50 | Degenerative skin changes |
| Family history | Genetic predisposition |
| Arsenic exposure | Environmental toxin associated with BCC |
| Fitzpatrick skin types I and II | Light-skinned, poor tanning ability |
Common Sites of BCC
As per the illustration:
Most commonly found on the upper lip, though generally:
Head and neck region is the most frequent site (80% of cases), including:
- Nose
- Eyelids
- Cheeks
- Scalp
- Forehead
BCC tends to occur on sun-exposed areas, often where the skin is thinnest.
Clinical Features of BCC
BCC can appear in different morphological subtypes:
| Clinical Variant | Features |
|---|---|
| Nodular BCC | Pearly, translucent papule with telangiectasia |
| Superficial BCC | Erythematous, scaly patch resembling eczema |
| Morpheaform BCC | Scar-like, ill-defined lesion; aggressive local invasion |
| Pigmented BCC | Dark lesion mimicking melanoma |
| Ulcerated (Rodent ulcer) | Central ulcer with rolled edges and crust |
Symptoms
- Painless initially
- May bleed or crust over time
- Non-healing lesion that enlarges slowly
- Occasional itching or burning
- Facial asymmetry or disfigurement in neglected cases
Histopathology – Peripheral Palisading
One of the hallmark features in BCC histology is:
- Peripheral Palisading: Cells at the edge of the tumor nest align in a fence-like pattern.
- Basaloid cells with hyperchromatic nuclei
- Clefting artifact between tumor islands and stroma
- May show melanin pigment in pigmented BCC
Mnemonic Clue: “All BP” → Basal layer, Palisading
Diagnostic Approach
1. Clinical Examination
Look for:
- Shiny, translucent bump
- Central ulceration
- Telangiectasia (fine blood vessels)
2. Dermoscopy
- Arborizing vessels
- Leaf-like areas
- Blue-gray ovoid nests
- Spoke-wheel areas
3. Skin Biopsy
Gold standard
Types:
- Punch biopsy
- Shave biopsy
- Excisional biopsy
4. Imaging (if invasive)
For deep lesions or recurrence:- MRI
- CT scan
Management of BCC
As per the image: “Biopsy & Pull it out”
| Modality | Description / Indications |
|---|---|
| Surgical Excision | Preferred in nodular and invasive types |
| Mohs Micrographic Surgery | High precision surgery for facial and recurrent lesions |
| Curettage and Electrodessication | For small superficial lesions |
| Cryotherapy | Uses liquid nitrogen; for superficial BCCs |
| Topical Therapy | Imiquimod or 5-fluorouracil (for superficial BCC) |
| Radiotherapy | Reserved for elderly or inoperable cases |
| Targeted Therapy | Vismodegib for metastatic or recurrent BCC |
Prognosis
Excellent when treated early.
Recurrence rate:
- ~5% for primary lesions
- ~15% for recurrent BCC
Prevention Strategies
| Preventive Measure | Description |
|---|---|
| Sun protection | Sunscreen SPF >30, wide-brim hats |
| Avoid tanning beds | Artificial UV exposure carries same risk |
| Early detection | Self-examination, regular dermatology checks |
| Skin protection during work | Use protective clothing, hats, gloves |
| Monitor high-risk patients closely | Especially those with albinism or XP |
BCC vs Squamous Cell Carcinoma (SCC)
| Feature | BCC | SCC |
|---|---|---|
| Cell of origin | Basal keratinocytes | Squamous keratinocytes |
| Metastasis | Rare | Higher metastatic potential |
| Appearance | Pearly papule, rolled edges | Scaly plaque, ulcer, keratinous |
| Common site | Upper lip, nose, eyelids | Lower lip, ears, dorsum of hand |
| Histology | Peripheral palisading | Keratin pearls |
Case Scenario
Patient: 65-year-old male with a non-healing lesion on the upper lip for 8 months.
Findings:
- Pearly nodule with central ulceration and telangiectasia
- No lymphadenopathy
Diagnosis: Basal cell carcinoma confirmed by punch biopsy (peripheral palisading seen).
Treatment: Mohs micrographic surgery with complete clearance.
Outcome: No recurrence at 2-year follow-up.
FAQs on Basal Cell Carcinoma
Q1. Can basal cell carcinoma spread to other parts of the body?
Rarely. BCC is locally invasive but very unlikely to metastasize.
Q2. Is BCC life-threatening?
Only if neglected for years. Early treatment ensures complete cure in >95% of cases.
Q3. Does skin cancer hurt?
Initially, no. Pain, bleeding, or crusting occurs in late or ulcerated lesions.
Q4. What is the best treatment for facial BCC?
Mohs surgery is ideal for preserving tissue and ensuring tumor clearance on the face.
Q5. Can BCC recur after treatment?
Yes, especially in:
- Incompletely excised lesions
- Aggressive histologic subtypes
- Immunocompromised patients
Conclusion: Early Recognition = Total Cure
Basal cell carcinoma may not be aggressive like melanoma, but its chronic and locally destructive nature makes early diagnosis critical. Using the mnemonic “All BP”—Basal origin, Peripheral Palisading, Biopsy, Pull it out—you can memorize and act upon the key steps in understanding and managing BCC.
If you or your patient presents with a persistent, non-healing skin lesion, especially on the face or sun-exposed area—think BCC. Timely dermatologic evaluation and histopathological confirmation can ensure complete and scar-minimizing treatment.
