BCC vs SCC: what is the difference between these skin cancers?

The short answer: basal cell carcinoma (BCC) is the most common skin cancer. It grows slowly and very rarely spreads, but it needs treating because it keeps growing and can damage the skin around it. Squamous cell carcinoma (SCC) is the second most common. It is more likely than a BCC to spread, so it needs prompt treatment. Both are usually cured with surgery, often under local anaesthetic.

Patients often tell me they were relieved to hear it was “only a BCC”. That is a fair reaction, as BCCs are rarely dangerous, but neither of these should be ignored. Here is how they differ.

What they look like

Every skin cancer is different, and only an examination can tell them apart. But there are typical patterns.

A BCC often looks like a pearly or shiny pink lump, sometimes with small visible blood vessels on the surface. It may have a raised, rolled edge, or form a sore that bleeds, scabs and seems to heal, then comes back. Some are flat, red and scaly. They grow slowly, over months or years.

An SCC often looks like a firm, scaly or crusted lump that may be tender. It can grow more quickly, over weeks to months, and sometimes forms an open sore.

Both are most common on sun-exposed skin: the face, ears, scalp, neck, hands and lower legs.

How serious are they?

BCC very rarely spreads to other parts of the body. The concern is local. Left alone, it slowly grows and can damage the surrounding skin and tissue, which matters a great deal on the face, near the eye, nose or ear.

SCC can spread, most often to nearby lymph nodes, although most are cured by surgery when treated promptly. If it has spread, further treatment is planned with the specialist skin cancer team.

Who is at higher risk?

• People with a lot of sun exposure over their lifetime, especially outdoor workers
• Fair skin that burns easily
• A weakened immune system, for example after an organ transplant
• A personal or family history of skin cancer
• Previous sunbed use

How they are treated

For both, the usual treatment is surgical excision. The cancer is removed with a margin of normal skin, which is then checked in the laboratory to make sure it has all gone. Most are done under local anaesthetic, take 30 to 90 minutes, and you go home the same day. Results usually take two to three weeks.

As a plastic surgeon, I spend as much time thinking about the closure as the removal. On the face especially, I plan the repair carefully, using direct closure, a local flap of nearby skin or a skin graft, so the result looks as natural as possible.

For some BCCs on the face, or with unclear edges, Mohs surgery is the best option. A specialist dermatologist removes the BCC in thin layers and checks each one under the microscope during the procedure. I then reconstruct the area on the same day.

After treatment

Having one BCC or SCC raises the chance of another, so regular skin checks are important. Sun protection matters too: shade, clothing, a hat and a high-factor sunscreen.

When to get checked

See a doctor about any sore or spot that does not heal within a few weeks, a lump that is growing, or a patch of skin that keeps bleeding or scabbing. Treatment for skin cancer is usually covered by private insurance.

You can read more on my BCC treatment and SCC treatment pages, or in my guide to mole checks.