What is basal cell carcinoma, the skin cancer Biden just had

Just over two weeks ago, President Biden had skin cancer, but today, he doesn’t. According to a White House physician’s memo on Friday, doctors at Walter Reed National Military Medical Center removed a lesion off his chest on Feb. 16, treated the area around the tumor site, and that was that. The president’s cancer might be cause for more concern were it not for the type: basal cell carcinoma.

“It’s probably the most common human cancer,” said Ann Silk, a medical oncologist at Dana-Farber Cancer Institute who treats skin cancers. “If you have to get cancer, it’s kind of a good one to have because it’s easy to remove. This is an easily curable cancer that should not impact one’s quality of life, prognosis, or survival.”

Basal cell carcinoma is caused by mutations from ultraviolet damage from the sun or other sources of UV light — like a tanning bed. As one might expect, the people who are at highest risk for the cancer have light skin and are older, presumably because they’ve had more time to soak up UV light from just living on Earth. “Men are at a higher risk — that may be associated with outdoor activities or employment compared to women,” Silk said. “People who are fair-skinned are also at higher risk because melanin gives more protection from burning.”

The United States sees over 4 million cases of basal cell skin cancers each year, according to the American Cancer Society. Some estimates suggest the risk of getting the cancer at least once for a Caucasian man is 33 to 39%, while about a quarter of Caucasian women get it at least once in their life. Given these statistics, it’s not entirely unexpected that Biden, a pale, white man of 80, got it not just once but several times before this last incident.

According to a 2021 medical report from his physician, Kevin O’Connor, Biden had several non-melanoma skin cancers removed with surgery and several pre-cancerous lesions treated before he became president. First Lady Jill Biden also had surgery to remove three skin lesions in January, and one of them was also a basal cell carcinoma.

It’s extremely unlikely for each of these skin cancers to be related to one another, aside from the fact that both Joe and Jill Biden have some risk factors for skin cancer in general. “It is well established that President Biden did spend a good deal of time in the sun in his youth,” his physician wrote in the 2021 report.

It’s also fairly common for people to have more than one non-melanoma skin cancer in their lives. The other common type of non-melanoma skin cancer is squamous cell carcinoma. “It’s actually more common to have multiple over the course of your lifetime than to just have one,” Silk said. “I wouldn’t assume that those lesions are metastases from President Biden’s prior cancer. It’s just that he developed another one.”

Basal cell carcinomas can have some symptoms — like itching, tenderness, or bleeding, but they usually don’t, Silk said. They can appear quite unremarkable as well. “A little pink nodule, a pink spot. Sometimes the appearance is described as pearly looking on the top surface of the tumor that doesn’t go away,” Silk said. “If a spot develops and stays for months and months, it’s probably not a pimple or ingrown hair. It’s probably a basal cell.”

Basal cell carcinomas grow very slowly and are rarely associated with complications. It’s unlikely for them to metastasize or become aggressive. “Something like 0.03% would have metastasis,” Silk said. But older cancers are harder to treat, so she suggests that “anyone who has had a skin cancer or a relative who has had a skin cancer should see a dermatologist at least once a year for a full body skin check.”

The most common treatment is also surgery, although in extremely rare cases, other systemic treatment could be used. There are two types of surgery that are usually used for this. Doctors can just cut an ellipsis around the tumor and take it out, or they perform a Mohs surgery, where the tumor is removed in stages — typically a millimeter at a time. The doctors will examine each stage to see if there are still cancer cells present and stop once all the cancer has been removed. “It’s assessed in real time, and all done as outpatient day surgery. It’s a way to get the bad cells out while leaving the most healthy skin behind and results in smaller scars,” Silk said.

Recovery is also pretty straightforward, too, Silk said. She wouldn’t expect Biden needed any time off from his presidential duties following treatment.

Improving cancer treatment and survival has been one of Biden’s core political priorities since President Obama tapped him as vice-president to lead the national Cancer Moonshot in January 2016. Biden’s son, Beau, died of a brain cancer called glioblastoma in 2015. In recent years, Biden re-launched the Cancer Moonshot with the goal of halving the cancer rate in 25 years by focusing screening, prevention, and addressing racial disparities, but the White House did not expand research funding for the Moonshot.

In a recent update, the White House highlighted several new initiatives targeting cancer, including one on free skin cancer screenings. “I have seen patients who come in with advanced, large basal cell carcinomas due to lack of health insurance — going between jobs or periods of years where they didn’t have good or any health insurance and let it go too long,” Silk said.

But, she added, initiatives to improve skin cancer monitoring for low-income populations should also include assistance for treatment. Other forms of skin cancer, like melanoma, tend to be far more dangerous and aggressive than either basal or squamous cell carcinoma.

Luckily, Silk said, it’s relatively easy to reduce your risk of getting any form of skin cancer in the future by simply wearing UV protective sun screen. “It’s impossible to protect your skin from all UV damage, but avoiding being outside when the sun is strongest — 11 a.m. to 3 p.m. approximately, wearing protective clothing and hats, and wearing sunscreen helps,” Silk said.

That’s not just limited to pale skinned people, too, Silk added. Skin cancer also occurs in darker skinned individuals, if less commonly, so sunscreen is important for everyone, regardless of their skin tone.