BCC originates in basal cells located in the epidermis. This is the outermost layer of the skin responsible for producing new skin cells and pushing them to the surface.
BCC tends to grow slowly and develops on areas of skin regularly exposed to sunlight and other forms of ultraviolet radiation—the face, ears, neck, scalp, chest, shoulders, and back. The lesions commonly appear as painless, raised nodules, often shiny with tiny blood vessels running through them. However, BCC can vary in size and appearance and may develop on parts of the body that are not sun-exposed.
This article provides images and descriptions of the different manifestations of BCC, so you may be able to spot them early and seek immediate treatment.
These lesions appear as small, dome-shaped nodules populated by tiny branch-like blood vessels (referred to as telangiectasias).
You’re most likely to find them on your face, especially the cheeks, forehead, eyelids, and nasolabial folds (the “smile lines” that run from the corner of the nose to the corner of the mouth). The lesions often appear skin-colored, pinkish, or pearly white.
At this stage, the non-ulcerated lesion may appear similar to conditions such as: these
Molluscum contagiosum Sebaceous hyperplasia Amelanotic melanoma Intradermal melanocytic nevus (known as a common mole).
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Rodent ulcers tend to be more aggressive. They often develop on the nasal ala (the lateral surface of the nose that flares out to form the nostrils). In this location, they can significantly damage nearby tissue.
Micronodular BCC lesions vary in shade from skin-colored to slightly greyish and may appear a whitish-yellow when stretched. The lesions occur most commonly around the eyes and are often firm to the touch.
Unlike nodular BCC, micronodular BCC is less likely to form ulcers. Often, lesions are not even noticed. They may be too small to be seen with the naked eye or are flat and seem harmless. Thus, micronodular BCC is more likely to recur because the lesions are not treated.
Superficial BCC characteristics include:
A flat, distinct area of discolored skin, referred to as a maculePink-to-red color Possibly thin rolled border or irregular crusty edges. Well-defined edges and a scaly appearance
Areas of the lesion may also suddenly regress, leaving behind a lightened (hypopigmented) area of thinned skin.
Unlike nodular BCC, superficial BCC tends to favor the trunk and extremities but can also occur on the face. It is more frequently seen in fair-skinned adults under 50 but can occur in people as young as 20.
Because of its coloring and its tendency to bleed easily, pigmented nodular BCC is often mistaken for invasive melanoma. In fact, both forms of cancer share many of the same features. A pigmented nodular BCC lesion is typically well-demarcated and, like invasive melanoma, can grow quickly.
Since pigmented nodular BCC cannot be distinguished from invasive melanoma by appearance alone, your healthcare provider may need to run a special diagnostic test. This involves a non-invasive tool called reflectance confocal microscopy (RCM). Used as an alternative to biopsy, the RCM can help identify lesions based on close-up images of the skin created with low-powered laser beams.
Also known as sclerodermiform BCC because of its resemblance to the connective tissue disease scleroderma, morpheaform BCC lesions are characterized by:
Pink-to-ivory colorPoorly defined bordersAreas of induration, which means the tissue has thickened and hardenedLesions that may manifest as a waxy depression in the skin
Morpheaform BCC may look more like a scar than a lesion and is most commonly found around the middle of the face.
Morpheaform BCC is sometimes referred to as infiltrative or infiltrating BCC because the lesion can sometimes penetrate the epidermis and infiltrate the lower layer of skin, called the dermis. Because of this, there’s a higher risk of recurrence compared to the other BCC subtypes.
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