Are basal cell carcinomas harder to spot in darker skin tones?

Basal cell carcinomas (BCCs) are harder to spot in darker skin tones. This is because they are less common in skin of colour, and when they do occur, they can look different compared to how they appear on lighter skin.

Regardless of your skin tone, it is important to monitor your skin for any new or changing marks and arrange an appointment with a consultant dermatologist if you have any concerns.

Basal cell carcinoma or a rodent ulcer, is a form of non-melanoma skin cancer. It is the most common type of skin cancer and usually develops in areas that have had a lot of sun exposure. BCCs grow slowly and rarely spread to other parts of the body.

Basal cell carcinomas are more common in people with fair skin and light hair, particularly those who have had a lot of sun exposure over their lifetime. These individuals are more likely to experience redness or sunburn with UV exposure and develop DNA mutations that can lead to the development of basal cell carcinomas over time.

Risk factors for basal cell carcinomas include:

• Having fair skin, blue eyes and blonde/red hair
• A significant history of sun exposure
• Use of indoor tanning beds
• Multiple episodes of sunburn
• Having a weakened immune system (due to medications or a disease)
• Exposure to ionizing radiation (e.g, previous radiotherapy treatment)
• Exposure to arsenic
• Rare genetic conditions (e.g, Gorlin syndrome)

Basal cell carcinomas can present in several ways. They often appear as pearly or translucent bumps, particularly on sun exposed areas like the face. They may also look like a flat scaly patch, a persistent sore or an area of skin resembling a scar.

If you are concerned about a mark on your skin, arrange to see your doctor or a consultant dermatologist for further assessment.

Basal cell carcinomas are less common in darker skin tones and are often missed because they can look different from their appearance in lighter skin. They may appear as a dark pearly bump, a shiny patch or a non-healing sore or scab. They are often pigmented appearing brown or black and can be mistaken for moles.

Basal cell skin cancer grows slowly and rarely spreads to other parts of the body, but it can still cause problems if left untreated. Over time, it can grow deeper into the skin and damage nearby tissue, including nerves, muscle or even bone in severe cases. This can lead to a requirement for more complex treatments, with risks of scarring, deformity and local recurrence. Early diagnosis and treatment can prevent these complications from occurring.

Basal cell skin cancer is highly treatable, especially when found early. The most important step is to see a consultant dermatologist if you are concerned about a mark on your skin. During a consultation at OneWelbeck, your dermatologist will ask questions about the mark and assess the area of concern with a special instrument called a dermatoscope. If basal cell skin cancer is suspected, they will arrange a biopsy to confirm the diagnosis.

Surgery is the most common treatment for basal cell carcinoma, with the aim being to remove the cancer completely. In 95% of cases, surgical removal will cure basal cell carcinoma.

Surgical options include:

• Excision – a scalpel is used to cut out the lesion and a small margin of surrounding healthy skin
• Mohs surgery – the cancer is removed layer by layer, with each layer examined under a microscope until no abnormal cells are present. This approach ensures successful removal while preserving as much healthy tissue as possible

Other treatment options available at OneWelbeck include:

• Curettage and cautery
• Cryosurgery
• Radiotherapy
• Topical chemotherapy