Basal cell vs squamous cell carcinoma: both are common skin cancers that form in the outer layer of the skin and are largely caused by UV exposure, but they differ in where they start, how they look and how quickly they grow. Basal cell carcinoma (BCC) is the most common type of skin cancer and usually grows slowly. Squamous cell carcinoma (SCC) is the second most common and can grow faster.
Melanomas often gets the most attention because of how serious it can be, but it accounts for only about 1% of skin cancer cases. Together, basal cell and squamous cell carcinoma account for roughly 5.4 million diagnoses each year in the United States.
Basal Cell vs Squamous Cell Carcinoma at a Glance
| Basal cell carcinoma (BCC) | Squamous cell carcinoma (SCC) | |
|---|---|---|
| Where it starts | Basal cells, in the lower part of the epidermis | Squamous cells, in the top layer of the epidermis |
| How common | Most common type of skin cancer | Second most common type |
| How it often looks | A pearly or shiny bump, which can be pearly-white, pink or reddish; a sore that won’t heal; a patch that crusts or scabs repeatedly | A rough, scaly patch; a crusted or scabbed sore; a sore that bleeds or doesn’t heal |
| How fast it grows | Usually slowly | Can grow more quickly |
| Risk of spreading | Rarely spreads, but can grow deeper and damage surrounding tissue | Higher chance of spreading, including to nearby lymph nodes, if untreated |
| Precancer to watch | — | Most SCCs begin as actinic keratoses |
| Where it appears | Sun-exposed areas | Sun-exposed areas |
How These Cancers Form in Our Skin
While both basal cell and squamous cell carcinomas form in the outermost later of the skin and are largely caused by direct UV exposure, the ways in which they form present different characteristics.
Squamous cells comprise the top layer of the epidermis. Typically, these cells are shed to make room for new cells. When these cells grow out of control, however, carcinoma can develop. Squamous cell carcinoma is usually scaly and rough to the touch due to a build-up of hard, dead skin.
Basal cells, on the other hand, make up the lower part of the epidermis. Basal cells constantly divide within the skin and move up the epidermis to turn into squamous cells, thereby replacing dead cells at the skin’s surface. Basal cell carcinoma most commonly presents as a pearly-white lesion, although they can be pink or reddish in color.
How to Tell Them Apart
Basal cell carcinoma most often looks like a pearly or shiny bump, usually pearly-white but sometimes pink or reddish. It can also show up as a sore that won’t heal or a patch that crusts or scabs again and again.
Squamous cell carcinoma often looks like a rough, scaly patch, a crusted or scabbed sore, or a sore that bleeds or doesn’t heal. Many SCCs begin as actinic keratoses, precancerous spots caused mainly by long-term sun exposure. Only about 10% of AKs become cancer, but most SCCs start as one.
Skin cancer doesn’t always look the way you’d expect. A non-pigmented melanoma, called amelanotic melanoma, can even resemble BCC or SCC. Learn more in When Skin Cancer Doesn’t Look Like Skin Cancer and When a Melanoma Does Not Look Like a Melanoma.
Which Is More Serious: Basal Cell or Squamous Cell Carcinoma?
Squamous cell carcinoma is generally more aggressive. It can grow more quickly and has a higher chance of spreading to nearby lymph nodes if left untreated. Basal cell carcinoma rarely spreads, but without treatment it can grow deeper and cause significant damage to surrounding tissue.
Both are very treatable when caught early. That’s why it matters to have any new or changing spot checked.
Risks associated with Basal Cell and Squamous Cell Carcinomas
Although fatalities due to carcinomas are uncommon (2,000 people per year die from these cancers) they do pose some serious risks to patients. One of the greatest risks of these cancers is that, if left undiagnosed and untreated, they can damage nearby healthy tissue and spread to other areas of the body such as organs and lymph nodes.
Who Is at Risk?
While anyone can develop either basal cell or squamous cell carcinoma, there are some risk factors that make people more susceptible to these cancers. These include:
- Unprotected sun exposure or tanning bed use
- Having lighter-colored skin
- Exposure to radiation treatments
- A history of severe burns and/or prolonged skin inflammation
- A weakened immune system
- Having HPV (human papillomavirus infection)
Additionally, being older and male makes patients statistically more likely to develop carcinoma in their lifetime.
When to Get a Spot Checked
Landon Barton, PA-C is a dermatology physician assistant at Vanguard who specializes in medical dermatology and the diagnosis of skin cancer.
Landon advises paying close attention to “any lesion that grows, changes in appearance, bleeds, or does not heal in about three weeks.” If you notice a spot like that, don’t wait. With our WOW Promise, we’ll see you within one week. And if it’s been more than a year since your last total body skin exam, now is a great time to schedule one.
Advice on Treatment Options for Skin Cancers
When seeking treatment options for skin cancer, Landon advises that “the recommended treatment options for skin cancer may vary depending on the type, size, and location of the skin cancer. Once you receive your diagnosis, your dermatologic provider will be happy to discuss all recommended treatment options with you.”
Landon goes on to say that “while surgical removal of a skin cancer commonly has the highest cure rate, it may not always be indicated. In many cases, a less invasive treatment option may be considered.”
When performing at-home examinations, Landon advises that patients be especially diligent when evaluating “any lesion that grows, changes in appearance, bleeds, or does not heal in about three weeks.”
Your provider will walk you through the options that fit your diagnosis. Learn more about basal and squamous cell carcinoma treatment at Vanguard, Mohs surgery and chemo cream for skin cancer.
Schedule Your Annual Skin Exam
If you have any concerns about a bump, lesion, or area of discoloration on your skin, or if it has been over a year since your last skin exam, contact Vanguard Skin Specialists today at 719-355-1585 to schedule your annual skin exam.
Frequently Asked Questions
What is the main difference between basal cell and squamous cell carcinoma
Basal cell carcinoma starts in the basal cells in the lower part of the epidermis and usually grows slowly. Squamous cell carcinoma starts in the squamous cells in the top layer of the epidermis, can grow more quickly and has a higher chance of spreading.
Which is worse, basal cell or squamous cell carcinoma?
Squamous cell carcinoma is generally more aggressive and more likely to spread. Basal cell carcinoma rarely spreads but can damage surrounding tissue if left untreated. Both are very treatable when caught early.
What does basal cell carcinoma look like?
Most often a pearly or shiny bump, usually pearly-white but sometimes pink or reddish. It can also look like a sore that won’t heal or a patch that crusts or scabs repeatedly.
What does squamous cell carcinoma look like?
Often a rough, scaly patch, a crusted or scabbed sore, or a sore that bleeds or doesn’t heal.
When should I see a dermatologist about a spot?
If a spot grows, changes in appearance, bleeds or doesn’t heal in about three weeks, have it checked.
Questions about a spot? Call 719-355-1585 or schedule online.
