Basal cell carcinoma – what does it look like? Symptoms and treatment

Content author: MD. Piotr Rak, surgeon · Editorial work: Editorial team of Wyspa Medycyny Przyjaznej · Medical review: lek. Piotr Rak · Date of creation: 07.08.2026 · Date of review: 07.08.2026 · Updated: 07.08.2026

The article is of educational nature and is not intended for self-assessment of skin lesions. The diagnosis is not made based on photos or description - it requires a dermatoscopic examination and, ultimately, a histopathological examination. A lesion that does not heal for several weeks, is bleeding, enlarges or ulcerates requires urgent consultation, regardless of whether it hurts.

The most important information at a glance

• Basal cell carcinoma is the most common skin cancer and originates from the cells of the basal layer of the epidermis.
• It practically does not cause distant metastases - this is the main reason for the good prognosis.
• However, it has the ability to locally infiltrate and destroy surrounding tissues, including cartilage and bones.
• It develops slowly, over months and years, and usually does not hurt - which is why it is often neglected.
• The most characteristic image is a morning that does not heal or a "pimple" that returns in the same place.
• Typical features include a pearly shine, a raised, scalloped edge and visible, dilated blood vessels.
• More than half of the cases occur in the head and neck area, especially the nose, eyelids, forehead and ears.
• The main cause is the dose of ultraviolet radiation accumulated over the years.
• The basic method of treatment is surgical excision with a margin and histopathological examination.
• After treatment, follow-up is required - the risk of another outbreak elsewhere on the skin is clearly increased.

Find out more about the specialist

Doctor. Piotr Rak is a surgeon at the Island of Friendly Medicine in Gdańsk. He deals with surgical procedures, including the assessment and removal of skin lesions. In basal cell carcinoma, two things are crucial: early diagnosis and complete excision with an adequate margin, confirmed by histopathological examination.

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What is basal cell carcinoma

The name comes from the place where the cancer originates - the basal layer of the epidermis, i.e. the deepest layer of cells from which the epidermis is renewed. Damage to the genetic material of these cells, accumulated over the years under the influence of ultraviolet radiation, leads to uncontrolled growth.

This is a cancer with unique characteristics that are worth understanding because it explains the entire procedure. On the one hand, practically does not cause distant metastases - the described cases are rare. This results in a very good prognosis and this is information that is worth hearing at the beginning.

On the other hand it is locally malignant: as it grows, it infiltrates and destroys surrounding tissues. If left untreated for years, it can affect not only the skin, but also subcutaneous tissue, cartilage, and in extreme cases, bone. This is particularly important in areas where there is no room for such growth - near the eye, on the nose or on the auricle.

So the practical consequence is this: delay is not usually life-threatening, but changes the scope of the procedure. A lesion removed early means a small scar. The same change after five years may require extensive surgery and reconstruction in a visible part of the face.

What does it look like? Characteristic features

There is no single appearance, but several features are repeated often enough that it is worth knowing them.

• Pearl shine. The surface of the lesion appears slightly transparent, waxy, as if translucent. This is the most characteristic feature.
• Raised, ridged edge. The lesion has a clearly defined, harder labrum, often with a depression in the center.
• Visible blood vessels. Small, dilated blood vessels running through the surface of the lesion.
• Non-healing morning. A superficial sore or scab that comes off and comes back in the same place.
• Bleeding tendency. The lesion bleeds after minor trauma, shaving or washing, and takes a long time to heal.
• Slow growth. The lesion takes months or years to grow, not weeks.
• No pain. This is the rule, not the exception - and the main reason for the delay.

The most common scenario that patients report is: "I have a pimple that hasn't gone away for a year." The lesion will heal once, the scab will fall off, then it will bleed again. It is this cycle – healing, relapse, healing – that is most suspect. Ordinary morning sickness heals once and does not come back.

Clinical forms

Scleroderma-like form deserves a separate opinion because it is sometimes the most difficult. It looks inconspicuous - like a small scar, although there was no trauma in this place. There are no clear boundaries and the actual extent of infiltration is usually greater than what can be seen with the naked eye. It is in such cases that adequate margin and histopathological control are particularly important.

The superficial form, on the other hand, is treated for months with anti-inflammatory ointments as "persistent eczema". A warning sign is a lesion that does not respond to such treatment or returns in the same place after its completion.

Where does it appear and who is at risk

The location is very characteristic and results directly from the mechanism of formation. More than half of the changes concern the head and neck area - i.e. places exposed to the sun throughout life, regardless of whether someone has sunbathed.

• nose, especially its wings and back,
• eyelids and around the corners of the eyes,
• forehead and temples,
• cheeks and ear area,
• auricles, especially in men,
• scalp in balding people,
• neck and neckline,
• torso - more often superficial form,
• forearms and backs of hands.

Risk factors include: fair skin with a tendency to sunburn, age over fifty, many years of work or outdoor activity, sunburn in the past, use of tanning beds, reduced immunity and immunosuppressive treatment, previous radiotherapy of the area and previous skin cancer.

It is worth emphasizing the thing that surprises patients: it decides sum of lifetime exposures, not a single holiday. Everyday, seemingly harmless doses - commuting to work, gardening, taking a walk - add up over decades. That's why changes appear in people who have never considered themselves tanners.

What is it sometimes confused with?

The basis of diagnosis is a clinical examination with dermatoscopic evaluation - under magnification, characteristic vascular systems, invisible to the naked eye, become visible. The final decision is made by histopathological examination, performed after taking a specimen or after removing the lesion.

Treatment methods

The choice of method depends on the form, size and location of the lesion, the risk of recurrence, the patient's age and comorbidities. In most cases, surgical treatment is the treatment of choice.

The key concept is margin. The lesion is excised with an envelope of healthy tissue because cancer cells can reach further than the visible border. Histopathological examination then assesses whether the margins are free from infiltration. If they are not, it may be necessary to widen the cutout - and this is not an error, just a standard part of the procedure.

Tissue-destroying methods, such as cryotherapy or laser, have a significant limitation: they do not leave material for histopathological examination. Therefore, they are only used when the diagnosis has been previously confirmed and the lesion falls into the low-risk category. Removing a change of an undetermined nature in this way is incorrect.

After treatment: scar, control and risk of further changes

After excision, a scar remains - this is an inevitable consequence of every incision. Its appearance depends on the location, size of the lesion, skin tension and individual predispositions. In areas of great aesthetic importance, such as the nose or eyelid, planning the incision and the method of closing the wound is particularly important, and sometimes reconstructive surgery is necessary.

Follow-up is mandatory after treatment and has two purposes. The first is to assess the site after the procedure for local recurrence. The second, equally important, is whole skin inspection - because a patient who has had one basal cell carcinoma has a clearly increased risk of another outbreak occurring elsewhere.

This is very practical information. The diagnosis means that the patient's skin has received a significant, cumulative dose of ultraviolet radiation - and this applies to the entire surface of the body, not just the place where the lesion appeared. Therefore, one detected change should lead to an examination of the entire skin, not just its removal.

The frequency of inspections is determined by the doctor individually, depending on the form, location, completeness of excision and risk factors.

Prevention

Removing the lesion does not remove the cause. Protection from ultraviolet radiation remains the only real way to reduce the risk of further outbreaks.

• cream with a high filter every day on exposed areas, all year round,
• re-application when staying outdoors for a long time, after sweating and swimming,
• wide-brimmed headgear, also covering the ears and neck,
• long-sleeved clothing when working outdoors,
• avoiding the sun during peak sun hours,
• completely avoiding the solarium,
• protecting the lips with lipstick with a filter,
• self-observation of the skin and reporting changes that do not heal for more than a few weeks,
• regular check-ups with a doctor, especially after skin cancer.

The simplest rule to remember: any skin lesion that doesn't heal for several weeks needs to be seen by a doctor - whether it hurts or not. The lack of pain is not an argument for waiting, but a typical feature of this cancer.

The most common myths

• "Skin cancer must hurt." No. Basal cell carcinoma usually does not hurt and is the main cause of delay.
• "If it doesn't metastasize, you can wait." No. Delay changes the scope of the procedure from a minor excision to extensive surgery.
• "It's just a pimple that won't heal." Ordinary morning heals once. A lesion that recurs at the same site requires evaluation.
• "Skin cancer is always a dark lesion." No. Basal cell carcinoma most often has a skin-colored or pearly sheen.
• "Only applies to people who have sunbathed." NO. It is the sum of exposures throughout one's life, including everyday exposure, that decides.
• "It can be removed with a laser." Not in the case of an undetermined change - there is no material left for testing.
• "After deletion, case closed." No. The risk of another outbreak elsewhere is increased; inspections are needed.
• "The filter only needs to be used in summer." No. UVA radiation is active all year round, even when it is cloudy.

Do you have a lesion that hasn't healed for weeks?

Dermatoscopic assessment takes a few minutes and is painless. With basal cell carcinoma, earlier diagnosis means less surgery and less scarring.

Diagnostics and removal of skin lesions in the Island of Friendly Medicine in Gdańsk

In the Island of Friendly Medicine doctor. Piotr Rak consults patients with skin lesions that cause concern. The visit includes an interview, dermatoscopic assessment and a decision on further proceedings: observation, taking a biopsy or removing the lesion with histopathological examination.

Suspicious lesions are removed surgically, with margins assessed in histopathological examination. In case of extensive, recurrent lesions or those requiring specialist treatment, the patient is referred to the appropriate center. The current scope of treatments, availability of dates and prices should be confirmed during registration.

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What to ask the doctor?

• Does this lesion raise suspicion under dermatoscopy?
• What is the proposed method and why this one?
• Will the lesion be sent for histopathological examination?
• How much margin will be needed and where will the cut be?
• What will the scar look like and is reconstruction needed?
• When will I know the test result?
• What happens if the margins are not free from infiltration?
• What is the risk of recurrence at this site?
• Do I have other changes worth watching?
• How often should I check my skin?
• How to protect scar and skin from the sun?
• What should I worry about between visits?

FAQ - Basal cell carcinoma

What does basal cell carcinoma look like?

Most often as a pearly, slightly transparent nodule with visible small blood vessels and a raised edge, often with a depression or scab in the middle. It can also be a flat, pink spot or a scar-like lesion.

Does basal cell carcinoma hurt?

Usually no. Absence of pain is the rule and the main reason for delaying the visit. Pain is not a condition that should prompt consultation.

Does it metastasize?

Practically not - reported cases are rare. However, it is locally malignant: it infiltrates and destroys surrounding tissues, including cartilage and bone.

If it doesn't metastasize, can I wait?

Not worth it. Delay is usually not life-threatening, but it changes the scope of the procedure - from a small excision with a small scar to extensive surgery, sometimes requiring reconstruction.

How to distinguish it from an ordinary morning?

Ordinary morning sickness heals once and does not come back. Basal cell carcinoma has a characteristic cycle: healing, the scab falling off, bleeding again in the same place.

Where is it most common?

More than half of the cases concern the head and neck: nose, eyelids, forehead, cheeks, earlobes and scalp in balding people. The superficial form appears more often on the trunk.

How is it treated?

The basis is surgical excision with a margin and histopathological examination. In selected situations, micrographic surgery, curettage, cryotherapy, local treatment, photodynamic therapy or radiotherapy are used.

What does margin mean in the result?

This is a shell of healthy tissue excised together with the lesion. Histopathological examination assesses whether it is free from infiltration. If it is not, it may be necessary to widen the cutout - this is a standard part of the procedure, not an error.

Can it be removed with a laser?

Not for changes of an undetermined nature. Methods that destroy tissue do not leave material for histopathological examination, so they make it impossible to confirm the diagnosis and assess its completeness.

Can another treatment occur after treatment?

Yes. A patient who has had basal cell carcinoma has a clearly increased risk of another outbreak occurring elsewhere on the skin. Therefore, regular checks of the entire skin are needed.

When to see a doctor?

When any skin lesion does not heal for several weeks, bleeds after a minor injury, gets larger or recurs in the same place - regardless of whether it hurts.

Who assesses skin lesions in WMP?

On the WMP website, MD. Piotr Rak is described as a surgeon who performs surgical procedures, including the evaluation and removal of skin lesions. The scope of treatments and availability of dates are confirmed by registration.

Sources

• DermNet, Basal cell carcinoma: https://dermnetnz.org/topics/basal-cell-carcinoma
• DermNet, Cutaneous squamous cell carcinoma: https://dermnetnz.org/topics/squamous-cell-carcinoma
• DermNet, Actinic keratosis: https://dermnetnz.org/topics/actinic-keratosis
• DermNet, Dermatoscopy: https://dermnetnz.org/topics/dermatoscopy
• NHS, Skin cancer (non-melanoma): https://www.nhs.uk/conditions/non-melanoma-skin-cancer/
• NHS, Sunscreen and sun safety: https://www.nhs.uk/live-well/seasonal-health/sunscreen-and-sun-safety/
• NICE, Improving outcomes for people with skin tumors including melanoma (CSG8): https://www.nice.org.uk/guidance/csg8
• NICE, Suspected cancer: recognition and referral (NG12): https://www.nice.org.uk/guidance/ng12
• British Association of Dermatologists, information for patients: https://www.bad.org.uk/patient-information-leaflets/
• World Health Organization, Ultraviolet radiation: https://www.who.int/news-room/questions-and-answers/item/radiation-ultraviolet-(uv)