Comprehensive Insights Into Basal Cell Carcinoma: Causes, Presentation, Prevention, and Modern Therapeutic Approaches

Basal cell carcinoma (BCC) is the most common skin cancer worldwide, accounting for approximately 80% of all skin cancers. Although more prevalent among Caucasians, BCC affects individuals of all racial and ethnic groups and may present atypically in skin of color, contributing to delayed diagnosis.

This review aims to examine the causes, clinical presentations, prevention strategies, and treatment options for BCC, with an emphasis on recent advancements and ongoing challenges in management.

This review integrates current peer-reviewed literature with clinical insights derived from dermatologic practice, including the evaluation of representative, deidentified patient cases. Observations from clinical experience were incorporated to contextualize diagnostic approaches, management strategies, and treatment outcomes across diverse patient populations. All patient information was anonymized, and no identifiable data were included.

Ultraviolet (UV) radiation remains the leading cause of BCC in fair-skinned populations, whereas genetic predispositions and environmental factors play a larger role in darker-skinned individuals. Diagnostic advances, including dermoscopy and reflectance confocal microscopy, have improved detection, particularly for pigmented lesions that may mimic benign conditions. Preventative strategies include broad-spectrum physical sunscreens, protective clothing, lifestyle modifications, and supplementation such as nicotinamide, which has demonstrated potential in reducing UV-induced skin damage. Treatment options range from Mohs micrographic surgery, considered the gold standard for high-risk and cosmetically sensitive areas, to simple excision, electrodessication and curettage, radiation therapy, and advanced systemic therapies including sonic hedgehog and PD-1 inhibitors for locally advanced or metastatic disease.

Emerging diagnostic tools and expanding therapeutic modalities have enhanced the ability to tailor BCC management to individual patient risk profiles and tumor characteristics. Non-surgical and combination approaches continue to evolve, offering effective alternatives for select cases.

By integrating prevention, early diagnosis, and personalized treatment strategies, modern approaches to BCC management are improving patient outcomes and addressing the complexities of care across diverse populations, underscoring the importance of multidisciplinary and individualized management.