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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'.)

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