Difference Between Basal Cell and Squamous Cell Carcinoma

Cancer is a complex and deadly disease that affects millions of people worldwide. Skin cancer is one of the most common types of cancer, with two main types: basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Both of these types of skin cancer originate from cells in the epidermis, the outermost layer of the skin. Although both types are similar in many ways, there are some key differences that set them apart.

What is Basal Cell Carcinoma?

Of the nonmelanoma skin cancers, more than 75% are basal cell carcinomas. Basal cell carcinomas are known to be one of the most malignant diseases that humans acquire in their lifetime. Basal cell carcinomas occur in a type of cell in the skin that produces new skin cells when other, older skin cells die.

In a clinical setting, it has been found that more than 99% of people who are diagnosed with basal cell carcinomas are white, usually between the ages of 40 and 79 years. In addition, more than half of these diagnoses are men.

When analyzing the histology of these cancers, the structure of these carcinomas can be broken down into the following sub-types: 50-54% nodular (solid tissue just under the skin), 9-11% superficial (in region around the dermal papillae), 4-8% cystic (growth of cysts), 1-7% adenoid (in glands), 6% pigmented (colored), 2% morpheaform (white plaques present), and 1% metatypical (a greater chance of metastasis).

The risk for recurrence of basal cell carcinomas depends on the location, type as determined by histology, and size of the tumor reported. For instance, basal cell carcinomas that occur on the nose or ear are more likely to recur, including morpheaform and metatypical tumors. Morpheaform tumors have certain characteristics about their biology that allows for more aggressive tumor formation and stability, including increased actin filaments, decreased amyloid formation (thus making it harder for tumors to be broken down), and increased collagen synthesis.

Clinical and biological markers of basal cell carcinomas are defined as −

• Occurring in the basal cells of the epidermis

• More invasive basal cell carcinomas have increased production of type IV collagenase, actin microfilaments, and tetraploid DNA, among other characteristics

• Slow growing, averaging cell cycles around 217 hours

• Slight aneuploidy of DNA in cells (~19% of samples)

• Rare metastatic incidence

What is Squamous Cell Carcinoma?

Squamous cell carcinomas are a cancer of the skin (and other parts of the body) that are characterized by malignant tumors that develop in epithelial keratinocytes, or the cells that produce keratin. It is the second most common skin cancer within the white population, with basal cell carcinoma being the first most common skin cancer.

Squamous cell carcinoma incidence has grown by 50 to 200% over the past 10 to 30 years, based on various studies. Squamous cell carcinomas are also geographically-dependent in populations of which it affects: for instance, there is a 50-fold increase in rates when comparing Northern Europe to Australia.

Squamous cell carcinomas are similar to basal cell carcinomas in that they are both cancers of the skin. However, squamous cell carcinomas can occur in other parts of the body and organs. Both carcinomas are characterized by their presence in specific skin cells, though they do occur at different layers of the skin: basal cells are in the lower part of the epidermis, whereas squamous cells are closer to the surface of the epidermis.

Squamous cell carcinoma-diagnosed patients usually have tumors on sun-exposed areas that are often in the form of firm nodules, which can be small. Squamous cell carcinomas lack translucence, unlike basal cell carcinoma tumors.

Clinical and biological markers of squamous cell carcinomas are defined as −

• Occurring in the squamous (surface) keratinocytes of the epidermis

• Inactivation of multiple tumor suppressor genes and activation of proto-oncogenes which leads to a higher incidence of tumors

• Slow growing

• Invasive tumors result in firm papules or plaques that are pink or skin-colored

• More likely than basal cell carcinomas to metastasize, but still rare.

Differences: Basal Cell and Squamous Cell Carcinoma

Although BCC and SCC are similar in many ways, there are some key differences that set them apart.

• Origin − BCC originates from the basal cells in the epidermis, while SCC originates from the squamous cells in the epidermis.

• Appearance − BCC usually appears as a small, shiny, pearly bump on the skin, while SCC usually appears as a scaly, red patch of skin that may bleed or crust over.

• Growth rate − BCC usually grows slowly and is not aggressive, while SCC can grow quickly and can spread to other parts of the body if left untreated.

• Metastasis − BCC rarely metastasizes (spreads to other parts of the body), while SCC can metastasize if left untreated.

• Treatment − Both BCC and SCC are usually treated with surgical removal of the tumor. However, in some cases, radiation therapy or topical chemotherapy may also be used.

The following table highlights the major differences between Basal Cell Carcinoma and Squamous Cell Carcinoma −

Conclusion

In conclusion, basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are two of the most common types of skin cancer. Both types originate from cells in the epidermis, the outermost layer of the skin, and are usually caused by prolonged exposure to the sun.

Although both types are similar in many ways, there are some key differences that set them apart. BCC usually grows slowly and is not aggressive, while SCC can grow quickly.

Vineet Nanda

Updated on: 25-Apr-2023

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