The most common cancer of all time

Tony Jiang
2 min readOct 23, 2020

I see this all the time. Patient comes in for a skin exam. Maybe they went to a tanning salon a couple times when they were in college. Maybe they forget their sunscreen and had a couple sun burns that were so bad they eventually formed blisters. Maybe they just don’t like using sunscreen. Maybe they’re rather fair skinned. Whatever the case, at least once a week during my skin exams, I’ll find a suspicious looking lesion that looks something like one of the following:

Suspicious looking lesions. Source: DermNet NZ.

The lesion is most likely a basal cell carcinoma — the most common of cancers. We often use buzz words like “pearly” or “translucent” to describe these lesions. If you look at them under a dermatoscope, they look like this:

Basal cell carcinomas under dermoscopy. Source: DermNet NZ.

You can notice prominent blood vessels that are described as arborizing as they resemble the branches of a tree. Basal cell carcinomas can come in my many forms and they can even be pigmented. The cells in the center of the lesion have a tendency to die off, giving what is often called a “rat bitten” appearance.

Regardless of how basal cell carcinomas look, the treatment is the same — removal of the tumor. Interestingly, there are two approaches to excision. The first is called wide local excision, where a certain margin around the tumor is marked, and the tumor along with the margins are removed. The second method is called Mohs microsurgery, where the tumor is removed layer by layer. After each layer is removed, the specimen is looked at under the microscope to determine if any tumor is still at the margins. If there’s tumor remaining, another layer is removed. This provides the highest chances that the tumor will be completely removed.

If i had to choose one tumor to get, it would definitely be a basal cell carcinoma. They (almost) never metastasize and removal is a fairly routine process. Just don’t ignore the basal cell carcinoma or else it can grow to an absurd size.

Absurd size of basal cell carcinoma.



Tony Jiang

Tony is a dermatology resident in PA, here to share some quick stories. When not reading biblical sized textbooks, he enjoys coding and writing apps for iOS.