Basal cell carcinoma

Synonyms: BCC, Basaliom, Basalzellkarzinom

By Dr. Pascal Bafteh · last updated 09/2026

General

Basal cell carcinoma Origin: follicular/perifollicular pluripotent stem cells, Mutation of PTCH1/SMO in the Hedgehog signaling pathway or p53.

• Incidence: approx. 1:1000, semi-malignant, metastasis approx. 0.0025%.
• Special form: Pinkus tumor (Fibroepithelioma).

Risk Factors

General Risk Factors

• RF: UV exposure, arsenic, fair skin type, noxious agents, radiation.
• Further RF: Albinism, Xeroderma pigmentosum.
• Medications: AZA, Ciclosporin, MTX, TNF-α, Calcineurin inhibitors.

Basal Cell Carcinoma Syndrome (Gorlin-Goltz)

• Diagnostic criteria: multiple BCCs <30 years, palmar pits, jaw cysts, calcified falx, BCC in first-degree relatives, flat nasal root.
• Important: no radiation, rather PDT.

Clinical Presentation

• Lesions: Skin-colored or red or reddish-brown papules, plaques, nodules, or ulcers.
• Typical: pearled border and telangiectasias.
• Further signs: Surface sheen, bizarre tumor vessels.

Dermoscopy of BCC

• Entry criterion: A BCC shows no pigment network — only once a network is absent are the BCC criteria applied at all.
• Vascular criterion: arborizing (tree-like branching) telangiectasias — bold, sharply focused vessels branching dichotomously on the tumour surface. Superficial BCC instead shows short, fine telangiectasias.
• Pigment criteria (especially pigmented BCC): blue-grey ovoid nests (large, sharply demarcated pigment aggregates), multiple blue-grey globules, maple-leaf-like areas at the periphery, spoke-wheel areas and concentric structures.
• Further signs: ulceration or multiple small erosions, and shiny white blotches and strands (visible only under polarized light).
• Note: spoke-wheel areas and arborizing vessels are highly specific; the absent pigment network separates pigmented BCC from melanoma.

Clinical Subtypes

• Nodular BCC: most common type; pearly papule with telangiectasias, usually face.
• Superficial BCC: erythematous, sharply demarcated plaque, usually trunk.
• Sclerodermiform (morpheaform) BCC: scar-like, infiltrative, ill-defined margin, high recurrence risk.
• Pigmented BCC: darkly pigmented; DD: melanoma.
• Infiltrative BCC: aggressive growth, ill-defined border.
• Micronodular BCC: small tumor nests, aggressive.
• Fibroepithelioma of Pinkus: lumbosacral, skin-colored papule, benign BCC variant.
• Basosquamous carcinoma: mixed BCC + SCC features, higher metastatic potential.

Differential diagnoses

• Keratoacanthoma
• Dermatofibroma
• Melanoma
• Trichoepithelioma
• Actinic keratosis
• Seborrhoeic keratosis
• Cutaneous squamous cell carcinoma
• Sebaceous hyperplasia

Sources (selection)

1. Epstein et al. 2008
2. AWMF S3 BCC 2023
3. Ramachandran et al. 2000
4. PMC PMC4445438

More skin tumours

• Melanoma
• Lentigo maligna
• Cutaneous squamous cell carcinoma
• Actinic keratosis
• Actinic cheilitis
• Merkel cell carcinoma
• Microcystic adnexal carcinoma
• Dermatofibroma

Note: This page is intended for medical education and does not replace diagnosis or treatment decisions in individual cases. Treatment and follow-up content is available in the app.