Basal cell carcinoma has a variety of appearances. It typically forms a small, skin-colored bump with visible tiny blood vessels. It may present as a “pimple” that never resolves, or become an open sore that never completely heals Table 01. The majority of BCCs are found on the head and neck. BCC lesions are usually translucent or pink bumps containing small, red, spider-like blood vessels. They may or may not have distinct borders. The lesions usually enlarge slowly. Sometimes an open sore forms in the center, which scabs over and appears to heal, only to open up later. Basal cell carcinoma can also form larger, more superficial reddish lesions that resemble a localized rash. This superficial form more commonly occurs on the trunk. Some lesions contain brown or black pigment.
Lesions may also develop on areas of the body that are protected from the sun, although this is not as common. There are types of BCC that grow “under” the skin and have a scar-like appearance.
Table 1. Basal Cell Carcinoma - What To Look For
Typical lesions Translucent or pink bump Apparent blood vessels Successively opens, scabs, and temporarily heals Usually on head or neck Less common lesions Anywhere on body Darkly pigmented Reddish, rash-like
Like all skin cancers, BCC is especially common in light-skinned people who have a history of excessive sun exposure or sunburns, and spend a lot of time in the sun. Basal cell carcinoma is considered to be a disease of Caucasian people. Individuals with fair skin, red or blond hair, and blue or green eyes are more likely to be affected. The condition is rarely found in African-Americans and other populations with dark skin. It usually occurs in older people, with its incidence increasing dramatically after age 40. There is no significant gender difference.
For the most part, the risk of developing BCC is proportional to the amount of sun that one has been exposed to. It is believed that the majority of damaging sun exposure occurs in childhood and early adolescence. The incidence of skin cancer is rising dramatically in the U.S. In addition, more people are living in the sun belt and spending more time outside in recreational pursuits. Another possible cause is the depletion of the ozone layer, leading to increased levels of ultraviolet radiation reaching the earth.
Other risk factors for BCC include inherited conditions as well as exposure to arsenic. Arsenic exposure is a hazard of certain occupations (e.g., glass manufacturing), is found in herbicides, and can contaminate drinking water. Arsenic exposure has been linked to the development of BCC. Gorlin's syndrome, or nevoid basal cell carcinoma syndrome, is a genetic disorder that affects skin cells' ability to repair the damaging effects of the sun. Individuals who have this condition develop multiple BCCs at an early age.
People who have been diagnosed with BCC have an increased risk of developing an additional BCC in the next 5 to 10 years.
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