Basal cell carcinoma (BCC) is the most common type of skin cancer. It arises most commonly from the basal cells in the top layer of skin called the epidermis. It is common on sun exposed areas in individuals with fair skin and a history of sun exposure. UV radiation leads to mutations in cellular machinery which becomes disrupted and leads to skin cancer.There are multiple subtypes of BCC including less aggressive types such as nodular or superficial types and more aggressive types such as infiltrative, morpheaform, metatypical, micronodular, and basosquamous. Of note, though superficial subtypes are not aggressive, they can have subclinical extension that is not apparent to the naked eye and only discovered during Mohs surgery.

These cancers usually grow slowly over time, most often becoming a sore or “pimple” that doesn’t heal and may bleed. Fortunately, BCCs rarely spread to other parts of the body and are easily treated using both surgical and non-surgical methods. For BCCs in higher risk areas on the head, neck, hands, and feet, Mohs surgery offers the best cure rate (~98%). In other anatomic locations these tumors are easily treated with standard surgical excisions, curettage, cryotherapy, or topical creams such as imiquimod or 5-fluorouracil for superficial subtypes.

Though these tumors have a negligible risk of causing death or serious harm, if not caught early they could grow to a larger size and cause local destruction of skin or nearby important structures. Some studies show that longer wait times for treatment of BCC leads to larger surgical defects. In neglected tumors, the cancer cells can eat away at the skin creating an ulcer, this was known as a rodent ulcer in the past due to it’s “chewed out” appearance.

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