Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

Epidemiology, pathogenesis, and clinical features of basal cell carcinoma

Peggy A Wu, MD
Section Editors
Robert S Stern, MD
June K Robinson, MD
Deputy Editor
Rosamaria Corona, MD, DSc


Basal cell carcinoma (BCC) is a common skin cancer arising from the basal layer of epidermis and its appendages. These tumors have been referred to as "epitheliomas" because of their low metastatic potential. However, the term carcinoma is appropriate, since they are locally invasive, aggressive, and destructive of skin and the surrounding structures including bone (picture 1A-B).

The epidemiology, pathogenesis, clinical presentation, and differential diagnosis of BCC will be reviewed here. The treatment and prognosis of BCC are discussed separately. (See "Treatment and prognosis of basal cell carcinoma at low risk of recurrence" and "Treatment of basal cell carcinomas at high risk for recurrence".)


Estimates of the incidence of BCC are imprecise since there is no cancer registry that collects data on BCC. The American Cancer society estimates that in 2012, 5.4 million cases of nonmelanoma skin cancers (NMSCs) were diagnosed in 3.3 million people, of which approximately 8 in 10 cases would have been BCC [1]. A population-based study with several methodologic limitations estimated that 3.5 million NMSCs were treated in the United States in 2006 [2]. One study using data from a commercially insured population in the Unites States estimated an age-adjusted prevalence and incidence of BCC of 226 and 343 per 100,000 persons per year, respectively [3].

In addition, an incidence-based mathematical model supports a high prevalence of nonmelanoma skin cancer in the United States [4]. According to the model, approximately 13 million white non-Hispanic individuals living in the United States in 2007 may have had a personal history of at least one NMSC.

Individuals with a history of BCC are at increased risk for subsequent lesions. Approximately 40 percent of patients who have had one BCC will develop another lesion within five years, although the probability of developing a subsequent BCC following a first BCC is significantly less than after a non-first BCC (12.8 versus 33.9 percent at one year; 20 versus 51.8 percent at two years; and 34.6 versus 75 percent at five years) [5-7]. (See "Treatment and prognosis of basal cell carcinoma at low risk of recurrence", section on 'Prognosis'.)


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Jan 2017. | This topic last updated: Fri Feb 17 00:00:00 GMT+00:00 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. www.cancer.org/acs/groups/content/@research/documents/document/acspc-047079.pdf (Accessed on December 29, 2016).
  2. Rogers HW, Weinstock MA, Harris AR, et al. Incidence estimate of nonmelanoma skin cancer in the United States, 2006. Arch Dermatol 2010; 146:283.
  3. Goldenberg G, Karagiannis T, Palmer JB, et al. Incidence and prevalence of basal cell carcinoma (BCC) and locally advanced BCC (LABCC) in a large commercially insured population in the United States: A retrospective cohort study. J Am Acad Dermatol 2016; 75:957.
  4. Stern RS. Prevalence of a history of skin cancer in 2007: results of an incidence-based model. Arch Dermatol 2010; 146:279.
  5. Robinson JK. Risk of developing another basal cell carcinoma. A 5-year prospective study. Cancer 1987; 60:118.
  6. Karagas MR, Stukel TA, Greenberg ER, et al. Risk of subsequent basal cell carcinoma and squamous cell carcinoma of the skin among patients with prior skin cancer. Skin Cancer Prevention Study Group. JAMA 1992; 267:3305.
  7. Wehner MR, Linos E, Parvataneni R, et al. Timing of subsequent new tumors in patients who present with basal cell carcinoma or cutaneous squamous cell carcinoma. JAMA Dermatol 2015; 151:382.
  8. American Cancer Society. Cancer facts and figures 2000. www.cancer.org.2001 (Accessed on March 08, 2005).
  9. Hannuksela-Svahn A, Pukkala E, Karvonen J. Basal cell skin carcinoma and other nonmelanoma skin cancers in Finland from 1956 through 1995. Arch Dermatol 1999; 135:781.
  10. Marks R, Staples M, Giles GG. Trends in non-melanocytic skin cancer treated in Australia: the second national survey. Int J Cancer 1993; 53:585.
  11. Demers AA, Nugent Z, Mihalcioiu C, et al. Trends of nonmelanoma skin cancer from 1960 through 2000 in a Canadian population. J Am Acad Dermatol 2005; 53:320.
  12. Wrone DA, Swetter SM, Egbert BM, et al. Increased proportion of aggressive-growth basal cell carcinoma in the Veterans Affairs population of Palo Alto, California. J Am Acad Dermatol 1996; 35:907.
  13. Green A, Battistutta D, Hart V, et al. Skin cancer in a subtropical Australian population: incidence and lack of association with occupation. The Nambour Study Group. Am J Epidemiol 1996; 144:1034.
  14. Chuang TY, Popescu A, Su WP, Chute CG. Basal cell carcinoma. A population-based incidence study in Rochester, Minnesota. J Am Acad Dermatol 1990; 22:413.
  15. Reizner GT, Chuang TY, Elpern DJ, et al. Basal cell carcinoma in Kauai, Hawaii: the highest documented incidence in the United States. J Am Acad Dermatol 1993; 29:184.
  16. Scotto J, Fears TR, Fraumeni JF Jr, et al. Incidence of nonmelanoma skin cancer in the United States in collaboration with Fred Hutchinson Cancer Research Center. NIH publication No. 83-2433, U.S. Dept. of Health and Human Services, Public Health Service, National Institutes of Health, National Cancer Institute, Bethesda, MD 1983:xv. p.113.
  17. Christenson LJ, Borrowman TA, Vachon CM, et al. Incidence of basal cell and squamous cell carcinomas in a population younger than 40 years. JAMA 2005; 294:681.
  18. Vitasa BC, Taylor HR, Strickland PT, et al. Association of nonmelanoma skin cancer and actinic keratosis with cumulative solar ultraviolet exposure in Maryland watermen. Cancer 1990; 65:2811.
  19. van Dam RM, Huang Z, Rimm EB, et al. Risk factors for basal cell carcinoma of the skin in men: results from the health professionals follow-up study. Am J Epidemiol 1999; 150:459.
  20. Zanetti R, Rosso S, Martinez C, et al. Comparison of risk patterns in carcinoma and melanoma of the skin in men: a multi-centre case-case-control study. Br J Cancer 2006; 94:743.
  21. Gallagher RP, Hill GB, Bajdik CD, et al. Sunlight exposure, pigmentary factors, and risk of nonmelanocytic skin cancer. I. Basal cell carcinoma. Arch Dermatol 1995; 131:157.
  22. Boyd AS, Shyr Y, King LE Jr. Basal cell carcinoma in young women: an evaluation of the association of tanning bed use and smoking. J Am Acad Dermatol 2002; 46:706.
  23. Kricker A, Armstrong BK, English DR, Heenan PJ. Does intermittent sun exposure cause basal cell carcinoma? a case-control study in Western Australia. Int J Cancer 1995; 60:489.
  24. Ramsay HM, Fryer AA, Hawley CM, et al. Factors associated with nonmelanoma skin cancer following renal transplantation in Queensland, Australia. J Am Acad Dermatol 2003; 49:397.
  25. Liang G, Nan H, Qureshi AA, Han J. Pre-diagnostic plasma 25-hydroxyvitamin D levels and risk of non-melanoma skin cancer in women. PLoS One 2012; 7:e35211.
  26. Wu S, Han J, Laden F, Qureshi AA. Long-term ultraviolet flux, other potential risk factors, and skin cancer risk: a cohort study. Cancer Epidemiol Biomarkers Prev 2014; 23:1080.
  27. Stern RS, Weinstein MC, Baker SG. Risk reduction for nonmelanoma skin cancer with childhood sunscreen use. Arch Dermatol 1986; 122:537.
  28. Green A, Williams G, Neale R, et al. Daily sunscreen application and betacarotene supplementation in prevention of basal-cell and squamous-cell carcinomas of the skin: a randomised controlled trial. Lancet 1999; 354:723.
  29. Naylor MF, Boyd A, Smith DW, et al. High sun protection factor sunscreens in the suppression of actinic neoplasia. Arch Dermatol 1995; 131:170.
  30. Dennis LK, Beane Freeman LE, VanBeek MJ. Sunscreen use and the risk for melanoma: a quantitative review. Ann Intern Med 2003; 139:966.
  31. Ferrucci LM, Cartmel B, Molinaro AM, et al. Indoor tanning and risk of early-onset basal cell carcinoma. J Am Acad Dermatol 2012; 67:552.
  32. Karagas MR, Zens MS, Li Z, et al. Early-onset basal cell carcinoma and indoor tanning: a population-based study. Pediatrics 2014; 134:e4.
  33. Zhang M, Qureshi AA, Geller AC, et al. Use of tanning beds and incidence of skin cancer. J Clin Oncol 2012; 30:1588.
  34. Wehner MR, Shive ML, Chren MM, et al. Indoor tanning and non-melanoma skin cancer: systematic review and meta-analysis. BMJ 2012; 345:e5909.
  35. Schneider S, Krämer H. Who uses sunbeds? A systematic literature review of risk groups in developed countries. J Eur Acad Dermatol Venereol 2010; 24:639.
  36. Ezzedine K, Malvy D, Mauger E, et al. Artificial and natural ultraviolet radiation exposure: beliefs and behaviour of 7200 French adults. J Eur Acad Dermatol Venereol 2008; 22:186.
  37. Stern RS, Liebman EJ, Väkevä L. Oral psoralen and ultraviolet-A light (PUVA) treatment of psoriasis and persistent risk of nonmelanoma skin cancer. PUVA Follow-up Study. J Natl Cancer Inst 1998; 90:1278.
  38. Stern RS, PUVA Follow-Up Study. The risk of squamous cell and basal cell cancer associated with psoralen and ultraviolet A therapy: a 30-year prospective study. J Am Acad Dermatol 2012; 66:553.
  39. Patel RV, Clark LN, Lebwohl M, Weinberg JM. Treatments for psoriasis and the risk of malignancy. J Am Acad Dermatol 2009; 60:1001.
  40. Lim JL, Stern RS. High levels of ultraviolet B exposure increase the risk of non-melanoma skin cancer in psoralen and ultraviolet A-treated patients. J Invest Dermatol 2005; 124:505.
  41. Black RJ, Gavin AT. Photocarcinogenic risk of narrowband ultraviolet B (TL-01) phototherapy: early follow-up data. Br J Dermatol 2006; 154:566.
  42. Hearn RM, Kerr AC, Rahim KF, et al. Incidence of skin cancers in 3867 patients treated with narrow-band ultraviolet B phototherapy. Br J Dermatol 2008; 159:931.
  43. Weischer M, Blum A, Eberhard F, et al. No evidence for increased skin cancer risk in psoriasis patients treated with broadband or narrowband UVB phototherapy: a first retrospective study. Acta Derm Venereol 2004; 84:370.
  44. Stern RS, Laird N. The carcinogenic risk of treatments for severe psoriasis. Photochemotherapy Follow-up Study. Cancer 1994; 73:2759.
  45. Lee E, Koo J, Berger T. UVB phototherapy and skin cancer risk: a review of the literature. Int J Dermatol 2005; 44:355.
  46. Robinson SN, Zens MS, Perry AE, et al. Photosensitizing agents and the risk of non-melanoma skin cancer: a population-based case-control study. J Invest Dermatol 2013; 133:1950.
  47. Ruiter R, Visser LE, Eijgelsheim M, et al. High-ceiling diuretics are associated with an increased risk of basal cell carcinoma in a population-based follow-up study. Eur J Cancer 2010; 46:2467.
  48. Kaae J, Boyd HA, Hansen AV, et al. Photosensitizing medication use and risk of skin cancer. Cancer Epidemiol Biomarkers Prev 2010; 19:2942.
  49. Karagas MR, Tosteson TD, Blum J, et al. Design of an epidemiologic study of drinking water arsenic exposure and skin and bladder cancer risk in a U.S. population. Environ Health Perspect 1998; 106 Suppl 4:1047.
  50. Tao SS, Bolger PM. Dietary arsenic intakes in the United States: FDA Total Diet Study, September 1991-December 1996. Food Addit Contam 1999; 16:465.
  51. Boonchai W, Green A, Ng J, et al. Basal cell carcinoma in chronic arsenicism occurring in Queensland, Australia, after ingestion of an asthma medication. J Am Acad Dermatol 2000; 43:664.
  52. Karagas MR, McDonald JA, Greenberg ER, et al. Risk of basal cell and squamous cell skin cancers after ionizing radiation therapy. For The Skin Cancer Prevention Study Group. J Natl Cancer Inst 1996; 88:1848.
  53. Lichter MD, Karagas MR, Mott LA, et al. Therapeutic ionizing radiation and the incidence of basal cell carcinoma and squamous cell carcinoma. The New Hampshire Skin Cancer Study Group. Arch Dermatol 2000; 136:1007.
  54. Ron E, Modan B, Preston D, et al. Radiation-induced skin carcinomas of the head and neck. Radiat Res 1991; 125:318.
  55. Levi F, Moeckli R, Randimbison L, et al. Skin cancer in survivors of childhood and adolescent cancer. Eur J Cancer 2006; 42:656.
  56. Watt TC, Inskip PD, Stratton K, et al. Radiation-related risk of basal cell carcinoma: a report from the Childhood Cancer Survivor Study. J Natl Cancer Inst 2012; 104:1240.
  57. Hildreth NG, Shore RE, Hempelmann LH, Rosenstein M. Risk of extrathyroid tumors following radiation treatment in infancy for thymic enlargement. Radiat Res 1985; 102:378.
  58. Schwartz JL, Kopecky KJ, Mathes RW, et al. Basal cell skin cancer after total-body irradiation and hematopoietic cell transplantation. Radiat Res 2009; 171:155.
  59. Naruke Y, Nakashima M, Suzuki K, et al. Genomic instability in the epidermis induced by atomic bomb (A-bomb) radiation: a long-lasting health effect in A-bomb survivors. Cancer 2009; 115:3782.
  60. Sadamori N, Mine M, Honda T. Incidence of skin cancer among Nagasaki atomic bomb survivors. J Radiat Res 1991; 32 Suppl 2:217.
  61. Preston DL, Ron E, Tokuoka S, et al. Solid cancer incidence in atomic bomb survivors: 1958-1998. Radiat Res 2007; 168:1.
  62. Ron E, Preston DL, Kishikawa M, et al. Skin tumor risk among atomic-bomb survivors in Japan. Cancer Causes Control 1998; 9:393.
  63. Euvrard S, Kanitakis J, Claudy A. Skin cancers after organ transplantation. N Engl J Med 2003; 348:1681.
  64. Silverberg MJ, Leyden W, Warton EM, et al. HIV infection status, immunodeficiency, and the incidence of non-melanoma skin cancer. J Natl Cancer Inst 2013; 105:350.
  65. Dantal J, Hourmant M, Cantarovich D, et al. Effect of long-term immunosuppression in kidney-graft recipients on cancer incidence: randomised comparison of two cyclosporin regimens. Lancet 1998; 351:623.
  66. Otley CC, Coldiron BM, Stasko T, Goldman GD. Decreased skin cancer after cessation of therapy with transplant-associated immunosuppressants. Arch Dermatol 2001; 137:459.
  67. Baibergenova AT, Weinstock MA, VATTC Trial Group. Oral prednisone use and risk of keratinocyte carcinoma in non-transplant population. The VATTC trial. J Eur Acad Dermatol Venereol 2012; 26:1109.
  68. Karagas MR, Cushing GL Jr, Greenberg ER, et al. Non-melanoma skin cancers and glucocorticoid therapy. Br J Cancer 2001; 85:683.
  69. Jensen AØ, Thomsen HF, Engebjerg MC, et al. Use of oral glucocorticoids and risk of skin cancer and non-Hodgkin's lymphoma: a population-based case-control study. Br J Cancer 2009; 100:200.
  70. Sørensen HT, Mellemkjaer L, Nielsen GL, et al. Skin cancers and non-hodgkin lymphoma among users of systemic glucocorticoids: a population-based cohort study. J Natl Cancer Inst 2004; 96:709.
  71. Omland SH, Gniadecki R, Hædersdal M, et al. Skin Cancer Risk in Hematopoietic Stem-Cell Transplant Recipients Compared With Background Population and Renal Transplant Recipients: A Population-Based Cohort Study. JAMA Dermatol 2016; 152:177.
  72. DePry JL, Vyas R, Lazarus HM, et al. Cutaneous Malignant Neoplasms in Hematopoietic Cell Transplant Recipients: A Systematic Review. JAMA Dermatol 2015; 151:775.
  73. Lange E, Blizzard L, Venn A, et al. Disease-modifying anti-rheumatic drugs and non-melanoma skin cancer in inflammatory arthritis patients: a retrospective cohort study. Rheumatology (Oxford) 2016; 55:1594.
  74. Gudbjartsson DF, Sulem P, Stacey SN, et al. ASIP and TYR pigmentation variants associate with cutaneous melanoma and basal cell carcinoma. Nat Genet 2008; 40:886.
  75. Berlin NL, Cartmel B, Leffell DJ, et al. Family history of skin cancer is associated with early-onset basal cell carcinoma independent of MC1R genotype. Cancer Epidemiol 2015; 39:1078.
  76. Stacey SN, Gudbjartsson DF, Sulem P, et al. Common variants on 1p36 and 1q42 are associated with cutaneous basal cell carcinoma but not with melanoma or pigmentation traits. Nat Genet 2008; 40:1313.
  77. Rafnar T, Sulem P, Stacey SN, et al. Sequence variants at the TERT-CLPTM1L locus associate with many cancer types. Nat Genet 2009; 41:221.
  78. Stacey SN, Sulem P, Masson G, et al. New common variants affecting susceptibility to basal cell carcinoma. Nat Genet 2009; 41:909.
  79. Stacey SN, Sulem P, Jonasdottir A, et al. A germline variant in the TP53 polyadenylation signal confers cancer susceptibility. Nat Genet 2011; 43:1098.
  80. Welsh MM, Applebaum KM, Spencer SK, et al. CTLA4 variants, UV-induced tolerance, and risk of non-melanoma skin cancer. Cancer Res 2009; 69:6158.
  81. Fine JD, Johnson LB, Weiner M, et al. Epidermolysis bullosa and the risk of life-threatening cancers: the National EB Registry experience, 1986-2006. J Am Acad Dermatol 2009; 60:203.
  82. Cribier B, Scrivener Y, Grosshans E. Tumors arising in nevus sebaceus: A study of 596 cases. J Am Acad Dermatol 2000; 42:263.
  83. Rosen H, Schmidt B, Lam HP, et al. Management of nevus sebaceous and the risk of Basal cell carcinoma: an 18-year review. Pediatr Dermatol 2009; 26:676.
  84. Marks R, Rennie G, Selwood TS. Malignant transformation of solar keratoses to squamous cell carcinoma. Lancet 1988; 1:795.
  85. Criscione VD, Weinstock MA, Naylor MF, et al. Actinic keratoses: Natural history and risk of malignant transformation in the Veterans Affairs Topical Tretinoin Chemoprevention Trial. Cancer 2009; 115:2523.
  86. Milán T, Verkasalo PK, Kaprio J, Koskenvuo M. Lifestyle differences in twin pairs discordant for basal cell carcinoma of the skin. Br J Dermatol 2003; 149:115.
  87. Leonardi-Bee J, Ellison T, Bath-Hextall F. Smoking and the risk of nonmelanoma skin cancer: systematic review and meta-analysis. Arch Dermatol 2012; 148:939.
  88. Reinau D, Surber C, Jick SS, Meier CR. Epidemiology of basal cell carcinoma in the United Kingdom: incidence, lifestyle factors, and comorbidities. Br J Cancer 2014; 111:203.
  89. Ferrucci LM, Cartmel B, Molinaro AM, et al. Tea, coffee, and caffeine and early-onset basal cell carcinoma in a case-control study. Eur J Cancer Prev 2014; 23:296.
  90. Dyer RK, Weinstock MA, Cohen TS, et al. Predictors of basal cell carcinoma in high-risk patients in the VATTC (VA Topical Tretinoin Chemoprevention) trial. J Invest Dermatol 2012; 132:2544.
  91. Olesen AB, Engholm G, Storm HH, Thestrup-Pedersen K. The risk of cancer among patients previously hospitalized for atopic dermatitis. J Invest Dermatol 2005; 125:445.
  92. Ming ME, Levy R, Hoffstad O, et al. The lack of a relationship between atopic dermatitis and nonmelanoma skin cancers. J Am Acad Dermatol 2004; 50:357.
  93. Hagströmer L, Ye W, Nyrén O, Emtestam L. Incidence of cancer among patients with atopic dermatitis. Arch Dermatol 2005; 141:1123.
  94. Genders RE, Mazlom H, Michel A, et al. The presence of betapapillomavirus antibodies around transplantation predicts the development of keratinocyte carcinoma in organ transplant recipients: a cohort study. J Invest Dermatol 2015; 135:1275.
  95. Wu PA, Chen CA, Stern RS. Presence of Hand Warts Is Associated with Subsequent Development of Cutaneous Squamous Cell Carcinoma in Psoriasis Patients Treated with Psoralen UVA (PUVA). J Invest Dermatol 2016; 136:2317.
  96. Torti DC, Christensen BC, Storm CA, et al. Analgesic and nonsteroidal anti-inflammatory use in relation to nonmelanoma skin cancer: a population-based case-control study. J Am Acad Dermatol 2011; 65:304.
  97. Nunes AP, Lapane KL, Weinstock MA, VATTC Trial Group. Association between non-steroidal anti-inflammatory drugs and keratinocyte carcinomas of the skin among participants in the Veterans Affairs Topical Tretinoin Chemoprevention Trial. Pharmacoepidemiol Drug Saf 2011; 20:922.
  98. Grau MV, Baron JA, Langholz B, et al. Effect of NSAIDs on the recurrence of nonmelanoma skin cancer. Int J Cancer 2006; 119:682.
  99. Butler GJ, Neale R, Green AC, et al. Nonsteroidal anti-inflammatory drugs and the risk of actinic keratoses and squamous cell cancers of the skin. J Am Acad Dermatol 2005; 53:966.
  100. Elmets CA, Viner JL, Pentland AP, et al. Chemoprevention of nonmelanoma skin cancer with celecoxib: a randomized, double-blind, placebo-controlled trial. J Natl Cancer Inst 2010; 102:1835.
  101. Johannesdottir SA, Chang ET, Mehnert F, et al. Nonsteroidal anti-inflammatory drugs and the risk of skin cancer: a population-based case-control study. Cancer 2012; 118:4768.
  102. Reinau D, Surber C, Jick SS, Meier CR. Nonsteroidal anti-inflammatory drugs and the risk of nonmelanoma skin cancer. Int J Cancer 2015; 137:144.
  103. Chen AC, Martin AJ, Choy B, et al. A Phase 3 Randomized Trial of Nicotinamide for Skin-Cancer Chemoprevention. N Engl J Med 2015; 373:1618.
  104. Hruza LL, Pentland AP. Mechanisms of UV-induced inflammation. J Invest Dermatol 1993; 100:35S.
  105. Buckman SY, Gresham A, Hale P, et al. COX-2 expression is induced by UVB exposure in human skin: implications for the development of skin cancer. Carcinogenesis 1998; 19:723.
  106. Smith WL, Garavito RM, DeWitt DL. Prostaglandin endoperoxide H synthases (cyclooxygenases)-1 and -2. J Biol Chem 1996; 271:33157.
  107. Pentland AP, Schoggins JW, Scott GA, et al. Reduction of UV-induced skin tumors in hairless mice by selective COX-2 inhibition. Carcinogenesis 1999; 20:1939.
  108. Orengo IF, Gerguis J, Phillips R, et al. Celecoxib, a cyclooxygenase 2 inhibitor as a potential chemopreventive to UV-induced skin cancer: a study in the hairless mouse model. Arch Dermatol 2002; 138:751.
  109. Fischer SM, Lo HH, Gordon GB, et al. Chemopreventive activity of celecoxib, a specific cyclooxygenase-2 inhibitor, and indomethacin against ultraviolet light-induced skin carcinogenesis. Mol Carcinog 1999; 25:231.
  110. Wikonkal NM, Berg RJ, van Haselen CW, et al. bcl-2 vs p53 protein expression and apoptotic rate in human nonmelanoma skin cancers. Arch Dermatol 1997; 133:599.
  111. Gailani MR, Leffell DJ, Ziegler A, et al. Relationship between sunlight exposure and a key genetic alteration in basal cell carcinoma. J Natl Cancer Inst 1996; 88:349.
  112. Ouhtit A, Nakazawa H, Armstrong BK, et al. UV-radiation-specific p53 mutation frequency in normal skin as a predictor of risk of basal cell carcinoma. J Natl Cancer Inst 1998; 90:523.
  113. Nangia R, Sait SN, Block AW, Zhang PJ. Trisomy 6 in basal cell carcinomas correlates with metastatic potential: a dual color fluorescence in situ hybridization study on paraffin sections. Cancer 2001; 91:1927.
  114. Ramachandran S, Fryer AA, Smith A, et al. Cutaneous basal cell carcinomas: distinct host factors are associated with the development of tumors on the trunk and on the head and neck. Cancer 2001; 92:354.
  115. Ramachandran S, Lear JT, Ramsay H, et al. Presentation with multiple cutaneous basal cell carcinomas: association of glutathione S-transferase and cytochrome P450 genotypes with clinical phenotype. Cancer Epidemiol Biomarkers Prev 1999; 8:61.
  116. Yengi L, Inskip A, Gilford J, et al. Polymorphism at the glutathione S-transferase locus GSTM3: interactions with cytochrome P450 and glutathione S-transferase genotypes as risk factors for multiple cutaneous basal cell carcinoma. Cancer Res 1996; 56:1974.
  117. Hajeer AH, Lear JT, Ollier WE, et al. Preliminary evidence of an association of tumour necrosis factor microsatellites with increased risk of multiple basal cell carcinomas. Br J Dermatol 2000; 142:441.
  118. Ramachandran S, Fryer AA, Lovatt TJ, et al. Combined effects of gender, skin type and polymorphic genes on clinical phenotype: use of rate of increase in numbers of basal cell carcinomas as a model system. Cancer Lett 2003; 189:175.
  119. Goeteyn M, Geerts ML, Kint A, De Weert J. The Bazex-Dupré-Christol syndrome. Arch Dermatol 1994; 130:337.
  120. Castori M, Morrone A, Kanitakis J, Grammatico P. Genetic skin diseases predisposing to basal cell carcinoma. Eur J Dermatol 2012; 22:299.
  121. Wolberink EA, Pasch MC, Zeiler M, et al. High discordance between punch biopsy and excision in establishing basal cell carcinoma subtype: analysis of 500 cases. J Eur Acad Dermatol Venereol 2013; 27:985.
  122. Roozeboom MH, Mosterd K, Winnepenninckx VJ, et al. Agreement between histological subtype on punch biopsy and surgical excision in primary basal cell carcinoma. J Eur Acad Dermatol Venereol 2013; 27:894.
  123. Mosterd K, Thissen MR, van Marion AM, et al. Correlation between histologic findings on punch biopsy specimens and subsequent excision specimens in recurrent basal cell carcinoma. J Am Acad Dermatol 2011; 64:323.
  124. Haws AL, Rojano R, Tahan SR, Phung TL. Accuracy of biopsy sampling for subtyping basal cell carcinoma. J Am Acad Dermatol 2012; 66:106.
  125. Russell EB, Carrington PR, Smoller BR. Basal cell carcinoma: a comparison of shave biopsy versus punch biopsy techniques in subtype diagnosis. J Am Acad Dermatol 1999; 41:69.
  126. Altamura D, Menzies SW, Argenziano G, et al. Dermatoscopy of basal cell carcinoma: morphologic variability of global and local features and accuracy of diagnosis. J Am Acad Dermatol 2010; 62:67.
  127. Zalaudek I, Kreusch J, Giacomel J, et al. How to diagnose nonpigmented skin tumors: a review of vascular structures seen with dermoscopy: part II. Nonmelanocytic skin tumors. J Am Acad Dermatol 2010; 63:377.
  128. Johr R, Soyer HP, Argenziano G, et al. Dermoscopy - The essentials, Mosby, Philadelphia 2004.
  129. Sariya D, Ruth K, Adams-McDonnell R, et al. Clinicopathologic correlation of cutaneous metastases: experience from a cancer center. Arch Dermatol 2007; 143:613.