Basal Cell Carcinoma: The Most Common Skin Cancer in Texas

Basal cell carcinoma in New Braunfels, TX is the most frequently diagnosed skin cancer we treat at Elect Dermatology — and the most curable when caught early. Despite how common it is, BCC is consistently underestimated by patients. Most people notice it as a small spot that grows slowly over months or years, easy to dismiss as a blemish or scar that won’t quite heal. Left untreated, however, basal cell carcinoma can destroy significant facial tissue, require complex reconstructive surgery, and in rare cases become life-threatening.

Texas ranks among the highest-UV states in the country, making skin cancer screening in New Braunfels an essential part of preventive healthcare for anyone who spends time outdoors — which, in Comal County, is just about everyone.

What Is Basal Cell Carcinoma?

Basal cell carcinoma originates in basal cells — the cells that line the deepest layer of the outer skin (epidermis). Normally, these cells divide in an orderly way to replace older skin cells as they shed. When ultraviolet radiation damages DNA in these cells, tumor-suppressor mechanisms can fail, causing the damaged cells to divide uncontrollably and form a tumor.

According to the Skin Cancer Foundation, approximately 3.6 million cases of basal cell carcinoma are diagnosed in the United States every year, making it the most common cancer in humans — not just the most common skin cancer. Texas’s intense year-round UV index means residents face above-average lifetime exposure, particularly those working outdoors in agriculture, construction, and ranching.

What Causes Basal Cell Carcinoma?

The primary cause of BCC is cumulative UV radiation exposure. UVB rays directly damage DNA, while UVA rays cause oxidative cellular damage. Both types accelerate the mutations that lead to skin cancer over a lifetime of sun exposure.

Key risk factors include:

• Fair skin (Fitzpatrick types I–II): Less melanin means less natural UV protection.
• Chronic sun exposure and outdoor occupations: Ranchers, farmers, and construction workers in Comal County and the surrounding Hill Country face elevated lifetime UV doses.
• Tanning bed use: Research published in the Journal of the National Cancer Institute found that tanning bed use before age 35 increases melanoma risk by 59% and elevates all skin cancer risk significantly.
• Prior skin cancer history: A first BCC carries a 40% risk of developing a subsequent BCC within five years, according to the American Academy of Dermatology.
• Immunosuppression: Organ transplant recipients face dramatically elevated skin cancer risk due to immunosuppressive medications.
• Radiation therapy history: Prior radiation to the skin increases long-term BCC risk at the treated site.
• Age: Risk increases with age, though BCC is increasingly seen in younger patients due to tanning culture and outdoor recreation.

Basal Cell Carcinoma Symptoms: What to Look For

BCC can look very different depending on its subtype. The classic warning sign across all subtypes is a lesion that doesn’t heal — it bleeds, crusts over, partially heals, then returns. If you have a spot on your skin behaving this way, schedule a skin cancer screening in New Braunfels as soon as possible.

The four main subtypes of basal cell carcinoma:

• Nodular BCC (most common): A pearly or translucent bump with visible blood vessels (telangiectasia) running across its surface. May develop a central ulceration over time. Most often appears on the face, ears, nose, and scalp.
• Superficial BCC: A flat, slightly scaly red or pink patch that can resemble eczema or a patch of dry skin. More commonly found on the trunk and shoulders. Can be easy to overlook.
• Morpheaform BCC (most aggressive): Pale, waxy, and flat with poorly defined borders — it often looks like a small scar. This subtype extends much further under the skin’s surface than it appears, making complete removal significantly more challenging.
• Pigmented BCC: Brown, black, or blue-tinged — can be mistaken for melanoma. Any dark lesion of uncertain origin should be evaluated by a board-certified dermatologist.

Is Basal Cell Carcinoma Dangerous?

Basal cell carcinoma rarely metastasizes (spreads to other organs). However, “rarely metastasizes” does not mean “harmless.” BCC grows locally — and it grows persistently. An untreated BCC invades deeper tissue layers over time, destroying fat, muscle, cartilage, and bone. A neglected facial BCC can destroy the entire nose, invade the orbit of the eye, or penetrate the skull.

Reconstructive surgery for advanced facial BCC can require multiple procedures, skin grafts, and months of recovery. The cure rates available with early treatment — up to 99% with Mohs surgery — drop dramatically once a tumor has grown deep or recurred multiple times. Early detection and treatment are always the right call.

Basal Cell Carcinoma Diagnosis

BCC cannot be diagnosed by appearance alone. A skin biopsy — either a shave biopsy or punch biopsy performed under local anesthesia — is required to confirm the diagnosis and identify the subtype. The biopsy result also guides treatment selection: subtype, depth, and margin status all factor into which treatment is most appropriate.

At Elect Dermatology, biopsies are performed in-office and results are typically returned within one to two weeks.

Basal Cell Carcinoma Treatment in New Braunfels

Treatment depends on the subtype, location, size, and whether the BCC is primary or recurrent. The NCCN Guidelines for Basal Cell Carcinoma stratify tumors into low-risk and high-risk categories, with treatment recommendations based on that classification.

Standard Surgical Excision

The most common treatment. The tumor is removed with a surrounding margin of normal-appearing skin, and the margins are sent to pathology. Cure rates exceed 95% for primary (first-time) BCCs in low-risk locations. Results typically available within one to two weeks.

Mohs Micrographic Surgery

Mohs surgery in New Braunfels is the gold standard for high-risk facial BCCs — particularly those on the nose, eyelids, ears, and lips — and for recurrent tumors. During Mohs surgery, the tumor is removed in thin layers, each processed and examined under a microscope while the patient waits. Layers are removed only until margins are completely clear, achieving up to 99% cure rates while preserving the maximum amount of normal surrounding tissue. This tissue-sparing precision is especially important for facial locations where cosmetic outcome matters.

Electrodesiccation and Curettage (ED&C)

ED&C uses a curette to scrape away the tumor followed by electrosurgery to destroy remaining cancer cells. Appropriate for small, superficial BCCs on the trunk and limbs in low-risk locations. Cure rates range from 90–95% for appropriately selected tumors but are lower for aggressive subtypes or facial locations. Not recommended for the face.

Topical Therapies

Imiquimod cream (Aldara) and 5-fluorouracil cream (Efudex) are FDA-approved for superficial BCC only. They stimulate the immune system or disrupt cell replication to eliminate the tumor. These topicals require weeks of application and are not appropriate for nodular, morpheaform, or facial BCCs.

Radiation Therapy

An option for patients who cannot undergo surgery due to age, health status, or tumor location. Radiation delivers targeted doses to destroy cancer cells. Cure rates are lower than surgical options, and it is generally reserved for non-surgical candidates.

Hedgehog Pathway Inhibitors (Vismodegib, Sonidegib)

For locally advanced or metastatic BCC not amenable to surgery or radiation, vismodegib (Erivedge) and sonidegib (Odomzo) — both FDA-approved hedgehog pathway inhibitors — provide a systemic treatment option. These represent an important advancement for patients with aggressive or recurrent disease.

Basal Cell Carcinoma vs. Squamous Cell Carcinoma: Key Differences

Patients often ask how BCC differs from squamous cell carcinoma (SCC), the second most common skin cancer. While both are caused primarily by UV radiation, SCC arises from keratinocytes higher in the epidermis and carries a meaningfully higher risk of metastasis — approximately 2–5% for SCC versus less than 0.1% for BCC. SCC tends to grow faster and feels rougher or more scaly. Any new or changing skin lesion warrants a professional evaluation rather than self-diagnosis.

After Your First BCC: What Comes Next

A first BCC diagnosis is a significant indicator of future risk. The American Academy of Dermatology recommends follow-up skin exams every 6 to 12 months after a first BCC, given the 40% risk of a subsequent BCC within five years. Sun protection practices — broad-spectrum SPF 30+ sunscreen applied daily, protective clothing, avoiding peak UV hours — remain critical to reducing that risk.

Frequently Asked Questions: Basal Cell Carcinoma

Can basal cell carcinoma go away on its own?

No. BCC does not resolve without treatment. It may appear to stay stable for periods of time, but it will continue to grow and invade deeper tissue. Early treatment results in much simpler procedures and far better cosmetic outcomes than delayed treatment.

Does BCC spread to other parts of the body?

Rarely — fewer than 0.1% of BCCs metastasize. However, BCC aggressively invades local tissue, and untreated lesions can cause serious destruction of underlying structures including cartilage, muscle, and bone.

How long does Mohs surgery take?

Mohs surgery is typically performed as an outpatient procedure. Depending on tumor size and how many layers are required, the procedure can take anywhere from two hours to a full day. Patients remain at the clinic while each layer is processed.

Is BCC covered by insurance?

Yes. Skin cancer removal — including Mohs surgery — is a medical procedure covered by most insurance plans. Our office staff can verify your benefits prior to your procedure.

What does a BCC feel like?

Most BCCs are not painful. Nodular BCCs may feel firm. Superficial BCCs often feel slightly rough or scaly. Morpheaform BCCs feel like a firm, flat scar. Any lesion that persists, bleeds easily, or won’t heal should be evaluated regardless of sensation.

Schedule Your Skin Cancer Screening in New Braunfels

If you have a spot that isn’t healing, a lesion that looks different from your other moles, or simply haven’t had a full-body skin exam — don’t wait. Basal cell carcinoma caught early is highly curable. Basal cell carcinoma left untreated can cause serious, permanent damage.

Dr. Hockley and Dr. Stahr at Elect Dermatology provide comprehensive skin cancer screenings in New Braunfels, expert biopsy evaluation, and the full range of skin cancer removal options including Mohs micrographic surgery.

📞 Call (833) 353-2875 to schedule your appointment.
📍 2154 Gabriels Pl, Ste 103, New Braunfels, TX 78130

Related: Who Is Most at Risk for Skin Cancer in Texas?