Basal cell carcinoma and squamous cell carcinoma are types of skin cancers that form in different layers of your epidermis, the outer layer of your skin. They account for most skin cancers and are highly treatable.

About 1 in every 5 people will receive a skin cancer diagnosis at some point in their life. But skin cancer isn’t just one single kind of cancer. There are several kinds, and it’s important to know the difference.

Basal cell carcinoma (BCC) is the most common type of skin cancer. In fact, it’s the most common kind of cancer, period. It develops in the small cuboidal cells in the lower part of the epidermis, which is the top layer of the skin.

While squamous cell carcinoma (SCC) isn’t as common as BCC, it’s still very common — and the rates are on the rise, with 1.8 million new diagnoses each year. SCC develops in the thin, flat cells known as squamous cells in the epidermis, right above the layer of basal cells.

Where are basal and squamous cells located?

The epidermis, the top layer of your skin, contains several types of cells. Most are keratinocytes, which include squamous and basal cells.

Squamous cells are located in the upper (outer) and middle layers of the epidermis. Basal cells are located at the base of the epidermis.

Other types include melanocytes, Langerhans cells, and Merkel cells.

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BCC can take on various appearances. One person might have a BCC that looks like a shiny bump or growth with a slightly raised edge, while someone else might have a red patch or open sore that just doesn’t seem to heal. Growths or lesions might appear pink on light skin and brown on dark skin.

Like BCC, SCC tends to develop in sun-exposed areas of skin. SCC may look like an open sore or a scaly red patch. It can also resemble a wart or raised growth.

You may be the first person to notice cancer developing on your skin. You might see a scaly patch of skin, a small nodule that wasn’t there before, or a sore that oozes or bleeds on your skin and doesn’t seem to heal.

If you take these concerns to a primary care physician, they may refer you to a dermatologist.

A dermatologist may suspect BCC or SCC after inspecting your skin. They may also consult your medical history and ask if you have a family history of skin cancer.

They will confirm the diagnosis by removing part or all of the affected area for a biopsy. A biopsy shows what kind of cancer cells are present in the sample.

The treatment for BCC depends on how advanced the cancer is. The options are:

  • Surgery: You will likely need surgery to remove BCC. Your doctor can discuss with you which surgical approach is most appropriate for you. Some methods, such as Mohs surgery, are better choices for cancers at higher risk of coming back.
  • Radiation therapy: In some cases, doctors treat BCC in certain areas with radiation therapy. This often includes hard-to-treat areas like the eyelids or ears.
  • Local or topical treatments: If the BCC is superficial, treatment options may include:

The options for treating SCC are similar. They include:

  • Surgery: Many of the same surgical treatments for BCC can also help with SCC.
  • Cryotherapy: Your doctor can freeze and kill the cancerous cells. The American Cancer Society cautions that it’s not usually recommended for large cancers or cancers in certain locations, like the nose, eyelids, and scalp.
  • Radiation therapy: Your doctor might recommend radiation therapy if you have a large SCC, it’s in a hard-to-treat area, or you’re reluctant to try surgery.

If your cancer comes back, your doctor may want to try another treatment option. For example, immunotherapy or systemic chemotherapy might be appropriate for some advanced SCCs.

Survival rates for BCC and SCC are very high, provided you receive prompt diagnosis and treatment.

If you have BCC, your primary concern after treatment may be recurrence. After one BCC, you’re more likely to get more in other places in the future, even if you successfully treat the first one.

SCCs are more likely to grow into deeper layers of your skin, which may affect your outlook. Advanced SCC may have a 5-year survival rate below 40%.

Basal cell carcinoma vs. squamous cell carcinoma vs. melanoma

The overwhelming majority of skin cancers (99%) are nonmelanoma skin cancers, which are typically less serious than melanoma.

BCC and SCC make up 95% of nonmelanoma skin cancers, with BCC outnumbering SCC by a ratio of about 3 to 1. The remainder includes rare skin cancer types like Merkel cell carcinoma.

Melanoma is the most serious type of skin cancer because it’s more likely to spread to other organs. Most skin cancer-related deaths are from melanoma. However, even melanoma has a 99% 5-year relative survival rate if caught and treated early.

Learn more about detecting melanoma.

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Which is more serious, basal cell or squamous cell skin cancer?

Both BCC and SCC are very treatable, especially if caught early. Both are rarely life threatening, but SCCs are more likely to grow into deeper layers of skin and spread, affecting your outlook.

What is the most harmless skin cancer?

Experts generally consider BCC the most harmless type of skin cancer. It rarely spreads beyond the original site. Still, BCC can grow deep into the skin and harm tissue and bone if not treated.

What happens if you pick at a basal cell carcinoma?

If you pick at a BCC, you might make it bleed. Even if you try to scrape away a nodule or sore, it will come back.

How quickly does squamous cell carcinoma spread?

SCC is usually a slow-growing type of cancer. Some recent research suggests that it takes 1 or 2 years for cutaneous SCC to metastasize (spread) locally after diagnosis.

BCC and SCC are different types of skin cancer that affect cells in different layers of the epidermis. Both are very treatable, especially if caught early.

Keep an eye on your skin and schedule a yearly skin check. If you notice any changes in your skin, like nodules or sores that don’t look quite right between visits, contact a doctor and ask for an evaluation.