Basal Cell Carcinoma

Basal cell carcinoma is the most common cancer in the United States, with several million tumors diagnosed each year according to the American Cancer Society (opens in new tab). It arises from basal keratinocytes in the epidermis, the thin outermost layer of the skin, and is driven primarily by cumulative ultraviolet exposure over a lifetime.

If you have just been diagnosed, the most important thing to understand is that basal cell carcinoma is not melanoma. It behaves very differently. Basal cell carcinoma almost never spreads to distant parts of the body, and it is usually cured with a single surgical procedure performed under local anesthesia in one day, rarely requiring chemotherapy or radiation. Many patients arrive at our office worried they have a life-threatening cancer; for the large majority of basal cell carcinomas, that is not the situation.

That said, basal cell carcinoma should not be ignored. Untreated tumors continue to grow, often spreading further beneath the skin than the visible surface suggests, and can invade cartilage, muscle, and bone. A tumor that could have been removed in a single stage may eventually require a far more involved reconstruction. Very rarely, basal cell carcinoma spreads to lymph nodes or lungs.

Basal cell carcinoma most often develops on sun-exposed skin: the nose, cheeks, forehead, ears, eyelids, lips, scalp, neck, and the backs of the hands. The nose is the single most common location.

Common presentations include:

• A pearly or translucent bump, sometimes with small visible blood vessels crossing the surface
• A sore that bleeds, scabs over, appears to heal, and then returns in the same spot
• A flat, scaly, reddish patch that slowly enlarges
• A pale, waxy, scar-like area with poorly defined borders, which can indicate a more infiltrative subtype

A lesion that will not heal is the pattern most worth acting on. Basal cell carcinoma grows slowly, so a spot that has been present and changing for months is still worth evaluating.

Your biopsy report will name a growth pattern, and that pattern influences the recommended treatment. Nodular and superficial basal cell carcinomas tend to be well defined and lower risk. Infiltrative, micronodular, morpheaform, and sclerosing subtypes send irregular finger-like extensions outward beneath intact-looking skin, which is why the true extent of these tumors is regularly larger than what is visible.

This is the central reason margin-controlled surgery matters. When a tumor's borders cannot be reliably judged by eye, examining the actual margin under a microscope is the only way to confirm complete removal without taking an unnecessarily wide margin of healthy tissue on the face.

Mohs micrographic surgery offers the highest cure rate available for basal cell carcinoma, up to 99 percent for previously untreated tumors, per the American College of Mohs Surgery (opens in new tab). It is also the only technique that examines 100 percent of the surgical margin rather than sampling a small fraction of it.

The visible tumor and a thin margin are removed under local anesthesia. Dr. Lopez then processes and reads the tissue himself under a microscope while you wait. If cancer remains at a specific point on the margin, only that area is taken in the next stage, sparing the surrounding healthy skin. Stages repeat until the margins are clear. Dr. Lopez averages 1.4 stages per case on head and neck sites, and most basal cell carcinomas are cleared in one or two stages.

Once margins are clear, reconstruction is performed the same day, in the same visit. Dr. Lopez performs 99 percent of his own reconstructions, selecting the simplest repair that restores function and appearance.

Mohs is not required for every basal cell carcinoma. It is most valuable for tumors on the face and other cosmetically or functionally sensitive sites, tumors with aggressive growth patterns, large tumors, recurrent tumors, and tumors in immunosuppressed patients. For small, thin, low-risk tumors on the trunk or extremities, standard excision, electrodessication and curettage, or topical therapy may be entirely appropriate. Dr. Lopez will tell you directly when a less involved option is the better choice.

Dr. Lopez has personally performed over 10,000 Mohs micrographic surgery procedures since completing his Mayo Clinic fellowship in 2018, with 1,757 cases in 2025. Basal cell carcinoma is the single most common tumor type he treats. In 2025, 1,288 of his cases (73 percent) were on the head, neck, or other anatomically sensitive sites.

He accepts basal cell carcinoma referrals from dermatologists, primary care physicians, plastic surgeons, oculoplastic surgeons, facial plastic surgeons, and radiation oncologists across Tampa Bay, including Wesley Chapel and Land O' Lakes.

Patients diagnosed with basal cell carcinoma frequently have coexisting squamous cell carcinoma or precancerous actinic keratoses from the same lifetime sun exposure, and a history of one basal cell carcinoma meaningfully raises the odds of developing another. Ongoing full-skin surveillance with your dermatologist matters as much as treating the tumor in front of you.