Understanding the Types of Basal Cell Carcinoma

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Nodular BCC represents around 60% of all BCCs. It’s common among older males with light skin and a history of extensive sun exposure.

It appears as a pearly, translucent bump, often on sun-exposed areas like the face, chest, and back. It may have visible blood vessels that may ulcerate or bleed in larger lesions.

This type of carcinoma often grows slowly and can spread to other body parts if untreated. Possible treatment options may include:

• surgical excision
• Mohs surgery
• topical therapies
• radiation (in specific cases)

Superficial BCC is a less aggressive form of skin cancer characterized by well-defined flat, waxy, or scaly spots or reddish patches resembling other skin conditions like eczema or psoriasis. It’s commonly found on the chest, back, or shoulders.

Superficial BCC often grows slowly and is typically less aggressive, making it less likely than other types to invade surrounding tissues.

Due to its superficial nature, treatment options may include:

• topical creams like imiquimod (Aldara, Zyclara) or 5-fluorouracil (Efudex)
• cryotherapy
• photodynamic therapy
• surgical excision

Morpheaform BCC (aka sclerosing BCC) is an invasive subtype that accounts for about 5% to 10% of all BCCs. It’s characterized by white or flesh-colored plaques on the skin that can be mistaken for scars. Its borders are often poorly defined, making it difficult to determine the extent of the cancer.

This subtype often occurs on the face and neck, and its treatment typically involves surgical procedures like Mohs surgery to ensure complete removal. This is important due to its invasiveness and recurrence rate after treatment.

Pigmented BCC is more common in people with darker skin tones. It may have irregular borders and appear as a dark, shiny bump or nodule, often resembling a melanoma due to melanin within the tumor cells.

This form of skin cancer can sometimes be more challenging to diagnose as it may resemble other pigmented lesions. Treatment options may include surgical excision or Mohs surgery.

Scientists can also classify BCC according to the way the cancerous cells look under a microscope. These are known as histological subtypes and may present with different appearances, locations, and severity. These subtypes may include:

• Micronodular BCC: This type is similar to nodular BCC but with smaller nodules. It’s often found on the back as light yellowish lesions that do not ulcerate. Treatment may include Mohs surgery due to its precision in removal.
• Infiltrating BCC: Often occurring in the face and upper trunk, this type may appear as a white plaque. It’s more aggressive than other forms of BCC. Treatment typically involves surgical removal or radiation therapy if surgery isn’t suitable.
• Infundibulocystic BCC: This type typically presents as small, multiple cyst-like lesions that often appear on the face. Since it progresses slowly, treatment options may include excision or Mohs surgery to less aggressive treatments like topical therapies.
• Basosquamous BCC: Also known as metatypical BCC, this is the most aggressive subtype of BCC, often showing features of both basal and squamous cell carcinomas (SCC). It’s more likely to spread to other body parts and recur.
• Fibroepithelioma of Pinkus: This slow-growing tumor is more common in females with light skin. It typically appears as a small, pink, or skin-colored growth on the lower back but may occur anywhere on the skin. Surgical excision is the primary treatment.
• BCC with sarcomatoid differentiation: This is an aggressive form of skin cancer in which cancerous basal cells are part of a sarcoma, a cancer that affects soft tissue. Treatment may involve surgical excision and additional therapies like radiation or targeted therapy.
• BCC with adnexal differentiation: This type is often found in the skin around the eyes and may have features similar to the usual structures around hair follicles and sweat glands, complicating diagnosis.
• BCC with sebaceous differentiation: This type may appear as nodular lesions characterized by mature sebaceous cells, sebaceous ducts, or sebum within the tumor, resembling other sebaceous tumors.

Doctors determine the different types of BCC based on a combination of visual examination and biopsy. They’ll examine the lesion’s size, shape, and color, including its borders and surrounding skin.

A skin biopsy may help healthcare professionals confirm the diagnosis and identify the specific BCC type. This procedure involves removing a small sample of the affected skin and examining it under a microscope.

Based on the results, they can classify the type of BCC and develop an appropriate treatment plan.

BCC types include nodular, superficial, morpheaform, and pigmented, each with different characteristics.

Early detection may increase the chance of curing the condition, and treatment options may vary from surgical excision to topical therapies.