Can Basal Cell Carcinoma Bleed?
Yes, basal cell carcinoma (BCC) can bleed, and bleeding is a recognized clinical feature that may indicate ulceration or erosion of the tumor.
Clinical Presentation of Bleeding in BCC
Bleeding in BCC occurs through several mechanisms related to the tumor's growth pattern and tissue involvement:
- Ulceration and erosion are common features of BCC that lead to bleeding, particularly in nodular and infiltrative subtypes 1
- The British Journal of Dermatology describes BCC as a slow-growing, locally invasive lesion that may ulcerate centrally, which inherently involves bleeding 1
- Bleeding is documented as an application site reaction in clinical trials, occurring in 7 of 215 patients (3%) treated for actinic keratosis and 4 of 185 patients (2%) treated for superficial BCC 2
When Bleeding Signals Aggressive Behavior
Bleeding should raise concern in specific clinical contexts:
- Rapid growth with bleeding is identified by the American Academy of Dermatology as a warning sign of aggressive BCC behavior 1
- Lesions in high-risk locations (central face, eyelids, eyebrows, periorbital skin, nose, lips, chin, mandible, ears) that bleed warrant heightened concern 1
- Recurrent lesions in previously treated areas that present with bleeding are associated with aggressive behavior 1
Bleeding as Part of the Diagnostic Workup
When evaluating a bleeding lesion suspicious for BCC:
- Perform a skin biopsy that includes deep reticular dermis if the lesion is suspected to be more than a superficial process, as infiltrative histology may be present only at deeper margins 3
- Consider patient-specific factors such as bleeding diatheses when selecting the biopsy technique 3
- Maintain a low threshold for performing skin biopsies in high-risk populations, as skin lesions may be difficult to assess clinically 3
Clinical Significance of Bleeding
The presence of bleeding in BCC has important implications:
- Bleeding indicates tissue destruction and ulceration, which are features of locally invasive disease 4, 5
- In advanced cases, BCC can cause significant soft tissue destruction with ulceration, exudation, and bleeding, particularly when diagnosis or treatment is delayed 4, 5
- While BCC metastasizes extremely rarely (0.0028% to 0.55%), morbidity results primarily from local tissue invasion and destruction, which manifests as bleeding and ulceration 6
Common Pitfalls to Avoid
- Do not dismiss a bleeding skin lesion as benign trauma without proper evaluation, especially in sun-exposed areas or high-risk anatomic locations 3, 1
- Do not perform only superficial biopsies on bleeding lesions, as this may miss infiltrative components at deeper margins 3
- Do not delay definitive treatment in patients with bleeding BCC, as locally invasive disease can result in severe tissue destruction affecting muscle, cartilage, and bone 4, 5