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Epidemiology, pathogenesis, and clinical features of basal cell carcinoma

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

INTRODUCTION

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".)

EPIDEMIOLOGY

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 more than two million nonmelanoma skin cancers were treated in the United States in 2006, of which the majority would have been BCC [1]. A population-based study with several methodologic limitations estimated a higher number of lesions, reporting that approximately 3.5 million nonmelanoma skin cancers were treated in the United States during the same year [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 nonmelanoma skin cancer.

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 [5,6]. (See "Treatment and prognosis of basal cell carcinoma at low risk of recurrence", section on 'Prognosis'.)

                                 

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