Squamous Cell Carcinoma vs. Basal Cell Carcinoma: Know the Difference

Finding a new or changing spot on your skin can be unsettling. When you notice an unusual growth, it's natural to wonder what it means and whether it requires medical attention. At MD Vein & Skin Specialists in Columbia, Maryland, our lead specialist, Clement Banda, MD, helps people navigate these concerns every day. 

Basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC) are the two most common types of skin cancer. While both are classified as non-melanoma skin cancers and are primarily caused by ultraviolet (UV) radiation, they behave quite differently. Understanding the key differences between squamous cell carcinoma and basal cell carcinoma can help you protect your health and seek timely care.

What is the difference between basal cell and squamous cell carcinoma?

The main difference between basal cell carcinoma and squamous cell carcinoma is the specific skin cells they originate from and how aggressively they behave. BCC begins in the basal cells at the bottom of the outer skin layer, while cSCC starts in the flat squamous cells that make up the top layer of the skin.

According to the Skin Cancer Foundation (2022), an estimated 3.6 million cases of BCC and 1.8 million cases of cSCC are diagnosed in the US each year. BCC is very common and usually grows slowly, rarely spreading to other parts of the body. It often looks like a pearly, shiny bump or a pinkish patch of skin. 

On the other hand, cSCC is more aggressive and has a higher potential to invade deeper tissues or spread to the lymph nodes. It typically presents as a firm, red nodule or a rough, scaly, flat lesion that may bleed or crust.

How do we detect and treat these skin cancers?

We evaluate suspicious skin growths through clinical examination and, when needed, a skin biopsy. Mole mapping can also help track moles and skin changes over time. Regular self-exams can help you notice changes, but a biopsy may be needed to confirm a skin cancer diagnosis.

When treatment is necessary, Mohs micrographic surgery is often the gold standard for high-risk or cosmetically sensitive areas like the face. This specialized technique lets us examine 100% of the surgical margins under a microscope in real time. We remove additional tissue only where cancer cells remain, helping preserve as much healthy tissue as possible.

A systematic review and meta-analysis published in 2024 found an overall recurrence rate of 3.1% after micrographic surgery compared with 5.3% after conventional surgical excision for the BCC and SCC tumors included in the studies. 

Are you at risk for non-melanoma skin cancer?

Anyone with a history of sun exposure can develop skin cancer, but your risk increases with age, fair skin, and prolonged UV exposure. However, a common misconception is that individuals with darker skin tones are entirely immune to these conditions.

In reality, while the overall incidence is lower in darker skin types, non-melanoma skin cancer absolutely still occurs. When skin cancer develops in people with darker skin tones, it’s often diagnosed at a later stage, which can make treatment more difficult. 

That's why everyone, regardless of skin tone, should know the warning signs and have new or changing skin growths evaluated.

Take control of your skin health

You don't have to navigate skin changes alone. Finding skin cancer early can make it easier to treat successfully. If you have noticed a new, changing, or non-healing spot on your skin, schedule a consultation with Dr. Banda at our Columbia, Maryland, office today. We're here to provide the personalized, expert care you deserve.