Nonmelanoma Skin Cancer: Basal vs. Squamous Cell Carcinoma Explained

More than 5.4 million cases of nonmelanoma skin cancer are diagnosed in the U.S. every year. Two types make up nearly all of them: basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). They’re not the same. One grows slowly and rarely spreads. The other grows faster and can turn deadly if ignored. Knowing the difference isn’t just helpful-it can save your life.

Where They Come From

Your skin has layers. The top layer, the epidermis, is made of cells that constantly renew themselves. At the very bottom are basal cells the lowest layer of skin cells that divide to create new skin cells. As these cells move up, they flatten out and become squamous cells flattened skin cells that form the outermost layer of the epidermis. BCC starts in the basal layer. SCC starts in the squamous layer. That tiny difference in origin leads to big differences in how they behave.

What They Look Like

It’s hard to tell them apart just by glancing. But there are patterns.

Basal cell carcinoma often shows up as a shiny, pearly bump-like a tiny pearl under the skin. About 70% of cases look like this. Other common signs include open sores that won’t heal, even after weeks, or flat, scar-like patches that feel firm. These usually appear on the face, ears, or neck. They don’t always hurt. Many people ignore them because they don’t bleed much or itch.

Squamous cell carcinoma looks different. It often appears as a rough, scaly red patch that might flake or crust. About 45% of cases are firm, dome-shaped bumps. Others look like warts or persistent sores that bleed easily. Unlike BCC, SCC lesions often feel tender or sore. They’re more likely to grow quickly and change shape over weeks, not months.

Who Gets Them

Most cases happen after age 50. In fact, 85% of all nonmelanoma skin cancers are found in people over 50. But that doesn’t mean younger people are safe. Fair skin, frequent sunburns, and years of sun exposure raise your risk. People with blue eyes, red or blond hair, and who burn easily are at highest risk.

There’s a gender difference, too. BCC affects men and women almost equally-about 55% male, 45% female. But SCC? Around 65% of cases are in men. Why? More men work outdoors-construction, farming, roofing-leading to decades of UV exposure. Women are more likely to get BCC on the face from casual sun exposure, like walking the dog or sitting by a window.

How Fast They Grow

BCC is slow. Really slow. On average, it grows about 0.5 to 1.0 cm per year. It might take two years before it starts to damage deeper tissue. That’s why people often delay seeing a doctor.

SCC? It’s faster. It grows 1.5 to 2.0 cm per year. Aggressive forms can double in size in just 4 to 6 weeks. If you notice a spot changing quickly-getting thicker, bleeding, or forming a crust-it’s not something to wait on.

How Dangerous They Are

Here’s the big difference: BCC almost never spreads. Fewer than 0.1% of cases metastasize. That’s why doctors call it "the least dangerous" skin cancer. But don’t mistake that for harmless. Left untreated, BCC can eat through skin, cartilage, and even bone. On the nose or ear, it can destroy structure. Cosmetic damage is common.

SCC is more serious. About 2% to 5% of cases spread to lymph nodes or other organs. That number jumps to 14% if it’s on the lip, 9% on the ear, or 7% on the genitals. When SCC spreads, survival rates drop from 95% to under 30%. That’s why doctors treat it more aggressively.

Treatment Differences

Both can be cured if caught early. But how they’re treated isn’t the same.

BCC often responds to simple methods. Topical creams like imiquimod or 5-fluorouracil work for small, shallow lesions-clearing up to 70% of cases. For deeper or larger spots, doctors use curettage and electrodesiccation (scraping and burning) or standard surgical removal. Mohs surgery-a precise technique that removes layers one at a time-has a 99% success rate for BCC.

SCC rarely responds to creams. Topical treatments clear only about 45% of cases. Surgery is almost always needed. Mohs surgery works here too, but with a 97% success rate-slightly lower than for BCC. Why? SCC tends to grow deeper and has more unpredictable borders. Surgeons often need wider margins. In high-risk cases, radiation or immunotherapy (like cemiplimab) may be used. In 2018, the FDA approved cemiplimab for advanced SCC, a major breakthrough.

Prevention and Monitoring

Both cancers are caused by UV exposure. But they respond differently to protection.

Daily sunscreen reduces BCC risk by 40%. For SCC? It cuts risk by 50%. That’s because SCC is more tied to lifelong, cumulative sun exposure. BCC is more linked to intense, occasional burns-like a bad day at the beach.

If you’ve had one skin cancer, you’re at higher risk for another. BCC patients usually need checkups every 12 to 18 months. SCC patients? Every 6 to 12 months. Why? 73% of recurrent SCC cases show up within a year. For BCC, it’s usually 18 months.

People with weakened immune systems-like organ transplant recipients-are at extreme risk. They’re 250 times more likely to get SCC than the average person. For BCC? Only 10 times higher. That’s why transplant patients often get skin exams every 3 months.

What Patients Say

Real-world experiences back up the data.

On patient forums, BCC users often say, "I didn’t think it was serious." Many describe their lesions as "annoying" or "ugly," but not painful. Treatment is usually quick and simple.

SCC patients report more anxiety. One Reddit user wrote, "It grew so fast I was terrified it was going to spread." Another said, "They took out half my ear. I didn’t know it could do that." SCC patients are more likely to need reconstructive surgery and more follow-up visits. On average, they have 2.3 times more doctor appointments than BCC patients.

What’s New in 2026

Research is moving fast. In 2023, scientists found that 90% of SCCs have a mutation in the TP53 gene-called the "guardian of the genome." BCCs have it too, but only about half. This explains why SCC is more aggressive.

AI tools are now helping dermatologists spot the difference. New dermoscopy apps can distinguish BCC from SCC with 94% accuracy-better than most human eyes. That means earlier detection.

And there’s hope for advanced cases. Immunotherapy, once only for melanoma, is now helping SCC patients. Clinical trials are testing vaccines and targeted drugs for SCC. BCC has hedgehog inhibitors like vismodegib. SCC doesn’t have an equivalent yet-but researchers are working on it.

Bottom Line

BCC is common. SCC is dangerous. Both are preventable. Both are curable-if you catch them early.

If you see a spot that:

• doesn’t heal after 4 weeks
• bleeds easily
• grows fast
• looks scaly or crusty

Don’t wait. See a dermatologist. Don’t assume it’s just a pimple or a scar. Skin cancer doesn’t always look scary. Sometimes, it looks like nothing at all.

Remember: skin cancer doesn’t always hurt. It doesn’t always look scary. But it can be deadly if you ignore it. Check your skin. Know the signs. Protect yourself. And if something looks off-get it checked.