What is basal cell carcinoma?
Basal cell carcinoma is the most common skin cancer. It arises from the basal cells of the epidermis and is directly related to cumulative lifetime sun exposure. That is why it appears mainly where the sun lands year after year: the nose, eyelids, cheeks, ears, forehead, scalp, upper lip, neck and back of the hands.
The good news first: it has an excellent prognosis and virtually never metastasises. The part that gets underestimated: it is locally destructive. Left to advance for years it infiltrates deeply and consumes neighbouring structures —the nasal ala, the eyelid margin, the ear cartilage— and then the surgery needed to cure it is no longer small. It is a cancer that almost never kills, but that can disfigure. Treat it early.
It is commoner after 50, in fair skin, in people with a history of sunburn or outdoor work, and in anyone who has already had a skin cancer: having had one is the best predictor of having another.
What does it look like? The signs that matter
Basal cell carcinoma is a master of disguise: many patients mistake it for a pimple that will not close or a wound that never quite heals. The practical rule is simple: a skin lesion that has not healed in a month should be seen by a doctor.
- A pearly or shiny bump, translucent, with fine blood vessels visible on the surface.
- A sore that bleeds, crusts, seems to heal and opens again — over and over.
- A pink, red or brown patch with a slightly raised border and a sunken centre.
- A flat, whitish or waxy plaque, like a scar nobody remembers acquiring (the morphoeic variant — the most treacherous).
- Any lesion that changes in size, colour or shape, or that starts to hurt, itch or bleed.
How are diagnosis and surgery performed?
The process has three stages, and none is skipped.
1. Diagnosis. The lesion is examined —with dermoscopy when indicated— and confirmed by biopsy. Skin cancer is confirmed under the microscope, never by eye. The biopsy also identifies the subtype, and the subtype changes how aggressive the surgery must be: a nodular BCC is not treated like a morphoeic or a recurrent one.
2. Margin-controlled excision. Surgery removes the tumour together with a margin of healthy skin around it and in depth. That margin is what determines cure: you do not operate to remove what is visible, you operate to remove what is visible and its microscopic periphery. The whole specimen goes to histopathology to confirm the margins are clear of tumour. If a margin comes back involved, you re-operate: uncomfortable to say, and correct.
3. Reconstruction. Closing the resulting defect is the plastic surgeon’s work, and on the face everything is at stake. Depending on size and site: direct closure, a local flap (neighbouring tissue mobilised to fill the defect, preserving colour and texture), a skin graft, or specific techniques for eyelid, nose and ear reconstruction, where you must restore not only skin but the function and form of structures that do not forgive millimetre errors.
See the full guide: Post-surgical recovery and care.
Technique and reconstruction: why the surgeon matters
A basal cell carcinoma on the back is a simple excision. A basal cell carcinoma on the nasal ala, the free margin of the eyelid or the helix of the ear is an entirely different problem: it must be excised with adequate margins —no negotiating with cancer to “save skin”— and then a three-dimensional structure must be rebuilt that the patient will carry on their face for life.
That double demand —oncological and reconstructive— is precisely the territory of plastic and reconstructive surgery. The temptation to excise with a short margin to make closure easier is the classic error: it produces involved margins, recurrences and, in the end, a second operation bigger than the first.
- Excision with margins defined by subtype, size and location.
- Histopathological confirmation of clear margins — the criterion of cure.
- Local flaps to restore colour, thickness and texture with neighbouring tissue.
- Skin grafts when the defect does not allow local closure.
- Eyelid, nose and ear reconstruction: preserving function (closing the eye, breathing) and form.
- When site or subtype indicate it, micrographic (Mohs) surgery is an option that is assessed and coordinated with the corresponding specialist.
Who should get checked?
Anyone with a lesion that has not closed in a month, that bleeds repeatedly, that changes, or that simply was not there last year. And periodically: fair-skinned people, over 50, with intense or cumulative sun exposure, with a family or personal history of skin cancer, or immunosuppressed.
Early detection turns a large operation and a complex reconstruction into a small excision with a discreet scar. In skin cancer, time is on nobody’s side. All surgery carries risk and requires a prior medical assessment. Results may vary according to each patient, their anatomy and their individual healing process.
Dermatology and plastic surgery under one roof since 1971
The clinic was founded in 1971 by Dr. Francisco Arellano Ocampo, a dermatologist. Skin-cancer diagnosis and surgery are in the roots of this house: the second generation added plastic and reconstructive surgery — which is exactly what is needed when the tumour is on the face and the defect has to be rebuilt.
Dr. Arístides Arellano is a plastic surgeon holding a specialty licence: he practises under a Mexican medical licence (D.G.P. 1125959) and a specialty licence in Plastic & Reconstructive Surgery (0002008), both issued by the Directorate General of Professions (DGP), which reissued his certificate of professional standing in 2025. His career began before Mexico’s present-day specialty-board system existed: he belongs to the founding generation of plastic surgery in Puebla, the second generation of a surgical tradition started in 1971 by Dr. Francisco Arellano Ocampo. Trust is verified, not promised: both licences are public and anyone can look them up in the DGP’s National Registry of Professionals.
Is basal cell carcinoma benign? The short answer is no
It is one of the most frequent questions and deserves an unambiguous answer: basal cell carcinoma is a skin cancer. What confuses people is that it almost never metastasizes — spread to other organs is exceptional — and from that comes the popular idea that "it is not serious".
But it is locally invasive: left alone it grows sideways and downwards and destroys what it meets. On the face that means cartilage, eyelid, nasal ala, even bone. A tumour that would have been removed with a small excision ends up demanding a complex reconstruction.
The correct way to put it is this: a cancer with an excellent prognosis when treated early, and a serious reconstructive problem when left for years. It is not benign, and calling it benign delays consultations.
The types: nodular, superficial and morphoeic
They do not all behave the same, and the type changes the surgical plan. The three seen most often:
- Nodular — the commonest. A pearly, raised lesion with fine surface vessels and sometimes a central crust that bleeds and returns. Borders are usually well defined.
- Superficial — a pink, flat, slightly scaly patch, mistaken for eczema or psoriasis for years because it does not hurt and grows very slowly. It can be considerably wider than it looks.
- Morphoeic or sclerosing — the most treacherous. It looks like a whitish, poorly defined scar and extends beneath the surface far past what is visible. It is the one that recurs most when operated without margin control.
Why the margin matters more than the size
What decides whether a basal cell carcinoma comes back is not how much was removed, but whether it was removed completely. A small tumour with subclinical extension can recur, and a large but well-defined one can be cured in a single operation.
That is why the specimen always goes for histopathology. If the pathologist reports clear margins, treatment is finished. If a margin is involved, it must be widened — and it is far better to learn that from a report than from a recurrence three years later.
It is also why destroying a suspicious lesion without analysing it is a bad trade: burning it with laser or cautery leaves no tissue to examine, so nobody can confirm it was complete. Where there is suspicion, it is excised and analysed.
When it appears on the nose, the eyelid or the ear
These are the commonest sites, because they take the most sun, and also the least forgiving of an excision done without a reconstructive plan. On the nasal ala, the eyelid or the rim of the ear there is no spare skin: closing under tension distorts, retracts the eyelid or notches the ear.
This is where plastic surgery changes the outcome. The same excision is closed with a local flap designed to respect the aesthetic unit, or with a graft taken from a site matching colour and thickness. The priority remains oncological — remove it completely — but the reconstruction is planned before cutting, not afterwards.
Before and after
Most patients want to see before-and-after photographs before deciding. Out of respect for each person’s privacy, Dr. Arístides Arellano shows real cases —always with documented consent— during your in-person consultation, where you can review results from patients with a starting point similar to yours. Results may vary from patient to patient.
Approximate price in Puebla
Cost depends on the size and location of the tumour, the type of reconstruction the defect requires (direct closure, flap or graft) and the histopathology. It is defined at the consultation, where a clear quote is provided. Approximate price — the definitive cost is set at your private consultation with Dr. Arístides Arellano.
Educational content. Basal cell carcinoma requires individual medical diagnosis; this page does not replace a consultation.
Documented training in skin-cancer surgery and reconstruction
In a facial carcinoma, excision is half the job; the other half is reconstructing the defect — and that is plastic surgery. Dr. Arístides Arellano was invited to teach the reconstructive surgery course for skin cancer of the Argentine Society of Dermatologic Surgery. He is a plastic surgeon holding a specialty licence (cédula de especialidad) issued by the DGP:
- Speaker invitation — Argentine Society of Dermatologic Surgery — Curso: cirugía reparadora en cáncer de piel · Buenos Aires, 2020
- Speaker: surgical treatment of skin tumors — Jornada de Alergia, Dermatología y Cirugía Estética · BUAP, noviembre de 1996
- Fellow — International Society for Dermatologic Surgery — Nueva York · abril de 1991
- Symposium: cutaneous substance loss — Instituto Marcelo J. Fitte · Buenos Aires
Trust is verified, not promised. All 210 scanned documents —degree, licences, diplomas, publications and certificates, from 1977 to 2025— are open in Dr. Arístides Arellano’s credential archive, alongside an explanation of the difference between a specialty licence and a board certification.
Recovery · step by step
- Days 1–3Wound care, dressing and simple analgesia. Relative rest; strict sun avoidance.
- Days 5–10Sutures removed depending on the area (earlier on the face). The histopathology result is delivered and margins confirmed.
- Weeks 2–4Return to normal life. Scar care: silicone and rigorous sun protection (high SPF, every day).
- Months 3–12The scar and flap mature, lighten and blend with the surrounding skin.
- Annual follow-upPeriodic full-skin review: anyone who has had one skin cancer is at higher risk of another.
Frequently asked questions
Is basal cell carcinoma serious?
It is the most common skin cancer and the one with the best prognosis: it virtually never metastasises. But it is locally destructive: left to grow for years it can infiltrate and damage neighbouring structures such as the nose, eyelid or ear. Treated early and with adequate surgery, the outlook is excellent.
What does a basal cell carcinoma look like?
It often presents as a pearly, shiny bump with fine vessels on the surface, or as a sore that bleeds, crusts, seems to heal and reopens. It can also look like a pink patch with a raised border or a whitish, scar-like plaque. A skin lesion that has not healed in a month should be assessed by a doctor.
Can skin cancer be removed without surgery?
Non-surgical treatments exist for very selected superficial cases, prescribed by the doctor after biopsy. However, surgical excision with margins and histopathological confirmation of clear borders remains the reference treatment, especially on the face and in aggressive or recurrent subtypes.
What is margin-controlled excision?
It means removing the tumour together with a border of healthy skin around it and in depth, and sending the whole specimen for histopathology to confirm the margins are free of tumour. That margin is what determines cure. If the report shows an involved margin, re-excision is required.
Will I be left with a hole in my face?
No. The defect left by excision is reconstructed in the same operation: with direct closure, a flap of neighbouring tissue or a skin graft, depending on size and location. On the eyelid, nose and ear, specific techniques restore both form and function.
Can skin cancer come back after surgery?
If it is excised with confirmed clear margins, recurrence at the same site is unlikely. However, anyone who has had a skin cancer is at higher risk of developing another on any sun-exposed area, so periodic full-skin review and lifelong sun protection are advised.
What is the difference between basal cell carcinoma and melanoma?
They are different cancers. Basal cell carcinoma is the commonest, grows locally and almost never metastasises. Melanoma is less common but far more aggressive and can spread, so early detection is critical. Any mole that changes in size, colour, shape or border should be assessed without delay.
How much does basal cell carcinoma surgery cost in Puebla?
Cost depends on the size and location of the tumour, the type of reconstruction the defect requires (direct closure, flap or graft) and the histopathology. It is defined at the consultation, where a clear quote is provided.
Every case is different. Discuss yours in a personal consultation.
Book a consultation on WhatsAppEvery figure published on this site is approximate and is not a quote. Any procedure or treatment first requires a private assessment consultation with Dr. Arístides Arellano —$800 MXN, charged separately— and it is at that consultation that the definitive cost of your case is determined.
Educational content; it does not replace a medical consultation. Results may vary from person to person.