Basal Cell Carcinoma (BCC): Complete Guide by Barnett Dermatology
We are a dermatologist in Delray Beach, Florida.
Being that we’re located in sunny Florida, we see a lot of skin cancer patients.
One question we get is if skin cancer produces pus.
In this guide, we’ll walk you through the details.
Introduction
When patients notice a new or changing spot on their skin, one of the most common questions they ask is: could this be cancer? A frequent source of confusion is when a lesion produces fluid, drainage, or pus. People are used to seeing pus with infections like acne or cysts, but it can be frightening when something that looks like an infection does not heal.
This article answers the question, does skin cancer have pus? The short answer is that cancer itself does not directly produce pus, but skin cancers can ulcerate, bleed, and become secondarily infected, which may result in pus-like drainage. We will break this down in detail, review medical research, and help you understand when to see a dermatologist.
What Is Pus?
Pus is a thick fluid made up of white blood cells, bacteria, and tissue debris. It forms when the body mounts an immune response against infection. Common causes of pus on the skin include acne, abscesses, and infected cysts.
Skin cancer, on the other hand, is caused by the uncontrolled growth of abnormal cells. Because cancer is not an infection, it does not naturally create pus. However, once a tumor breaks the skin barrier or ulcerates, bacteria can enter, leading to secondary infection. That is when pus may appear.
The Three Main Types of Skin Cancer
1.Basal Cell Carcinoma (BCC)
The most common type of skin cancer.
Appears as pearly bumps, open sores, or shiny pink patches.
Grows slowly but can cause local tissue damage.
2.Squamous Cell Carcinoma (SCC)
Appears as scaly patches, warty growths, or sores that may crust or bleed.
Can spread to lymph nodes if untreated.
3.Melanoma
The most dangerous type.
Often looks like an irregular or changing mole.
Can spread rapidly and become life-threatening.
Each of these cancers can ulcerate and sometimes drain, but pus is usually only present if bacteria infect the lesion.
Can Skin Cancer Produce Pus on Its Own?
Skin cancer cells do not secrete pus. Instead, two scenarios explain why pus may appear:
Secondary infection. A tumor breaks the skin, bacteria colonize the wound, and pus forms.
Tissue death (necrosis). Advanced cancers can damage surrounding tissue, leaving areas that may resemble pus.
A study in the Journal of the American Academy of Dermatology examined malignant ulcers and found that bacterial colonization was extremely common. Researchers noted that infection can change the appearance of a cancerous lesion, making it look more like a boil or abscess. For patients, this means that if a sore produces pus, it should not automatically be assumed to be “just an infection.”
How Infections and Cancers Overlap
The National Cancer Institute explains that one hallmark warning sign of skin cancer is a wound that does not heal. Unfortunately, infections and cancers can share similar symptoms:
Redness and swelling
Drainage of fluid or pus
Crusting or scabbing
Pain or tenderness
The key difference is that infections usually improve with antibiotics, while cancers persist or return.
ABritish Journal of Dermatology study followed patients who were originally treated for “chronic skin infections.” Researchers discovered that many of these cases were actually undiagnosed cancers. Because treatment was delayed, the lesions grew larger and more complicated. The takeaway is clear: if a lesion that looks infected does not respond to standard treatment, it should be evaluated for skin cancer.
Basal Cell Carcinoma and Pus
Basal cell carcinoma is not known for producing pus, but it can present as an open sore that bleeds or crusts. When these ulcers are present for a long time, bacteria may settle in the area, leading to infection and pus formation.
TheAmerican Cancer Society notes that basal cell carcinoma often appears as a sore that heals and then returns. If pus develops in such a lesion, it may be due to a superimposed infection, not the cancer itself.
Squamous Cell Carcinoma and Pus
Squamous cell carcinoma is somewhat more likely to produce discharge. Lesions often crust, bleed, and develop central ulcers. These ulcers can become infected.
A study published in the Journal of Cutaneous Pathology looked at squamous cell carcinomas that had ulcerated and found that bacterial infection was present in a significant percentage of cases. Patients often presented thinking they had chronic “infected wounds” rather than cancer. The study highlights why persistent pus-draining sores should always be biopsied.
Melanoma and Pus
Melanomas typically do not produce pus. Instead, they may ooze clear fluid or blood. However, ulcerated melanomas can become infected.
Astudy in The Lancet Oncology examined ulcerated melanomas and found that ulceration is associated with a poorer prognosis. Infections complicate healing and may mask the true nature of the lesion. For patients, any mole that bleeds, drains, or looks different from the rest should be checked promptly.
Other Skin Conditions That Mimic Cancer
Not all pus-producing lesions are cancer. Some benign conditions look similar:
Infected cysts
Acne nodules
Abscesses
Pyogenic granulomas
Areview in the International Journal of Dermatology analyzed cases of non-healing ulcers and found that both malignant and benign conditions can look nearly identical. The authors stressed that biopsy is essential when a lesion does not respond to standard treatments.
What the Research Shows About Infections in Skin Cancer
Several key studies shed light on the relationship between infection and cancerous wounds:
Malignant ulcers frequently colonized by bacteria. The JAAD study found that infections are common in malignant ulcers and can complicate both appearance and management.
Misdiagnosis delays treatment. The BJD study revealed that many cancers are mistaken for chronic infections, causing dangerous delays.
Ulcerated melanomas carry worse outcomes. The Lancet Oncology analysis showed that ulceration, often accompanied by infection, predicts poorer survival rates.
Biopsy remains essential. A systematic review in JAMA Dermatology concluded that despite advanced imaging, biopsy is still the gold standard to distinguish infection from malignancy.
Non-healing wounds often malignant. A study in Acta Dermato-Venereologica confirmed that many chronic ulcers initially thought to be “infected wounds” were actually squamous cell carcinomas.
Skin cancer and wound bacteria linked to delayed healing. Research in the International Wound Journal found that bacterial infection in malignant wounds increases pain, odor, and drainage, complicating treatment.
Together, these studies show that pus in a skin lesion is often a sign of infection on top of cancer, not cancer alone.
How Dermatologists Diagnose the Difference
If a patient presents with a pus-producing lesion, dermatologists take a stepwise approach:
History. How long has the lesion been present? Has it responded to antibiotics?
Exam. Is the lesion irregular, growing, or changing color?
Dermatoscopy. Special magnification may reveal cancer-specific patterns.
Biopsy. A small tissue sample provides the definitive answer.
Biopsy is particularly important when pus or drainage is present, because infection can obscure the true diagnosis.
Treatment Approaches
Treatment depends on the cancer type:
Basal cell carcinoma. Excision, Mohs surgery, topical medications.
Squamous cell carcinoma. Excision, Mohs surgery, radiation therapy in select cases.
Melanoma. Wide excision, lymph node biopsy, systemic therapy if advanced.
When infection is present, dermatologists may prescribe antibiotics or recommend wound care while also addressing the cancer itself.
Living With a Cancerous Lesion That Drains
Patients with ulcerated or infected cancers often need special wound care:
Clean gently with mild soap and water.
Use non-stick dressings.
Monitor for foul odor or spreading redness.
Avoid self-treating with harsh chemicals or over-the-counter creams.
Dermatologists provide personalized wound care plans to minimize infection while preparing for definitive cancer treatment.
Prevention and Early Detection
Preventing complications starts with early detection:
Perform monthly skin checks.
See a dermatologist yearly for a professional exam.
Protect skin with sunscreen and clothing.
Avoid tanning beds.
TheSkin Cancer Foundation emphasizes that early treatment reduces the chance of ulceration, infection, and scarring.
Treatment Options for Basal Cell Carcinoma
Treatment for BCC depends on several factors: the size, depth, and location of the tumor, whether it is primary or recurrent, and the patient’s overall health.
1. Surgical Excision
This is the most common treatment. The dermatologist removes the tumor along with a margin of surrounding healthy tissue. The tissue is sent to a lab to ensure all cancerous cells have been removed.
Effectiveness: Cure rates exceed 95% for small BCCs.
Best for: Isolated lesions on the trunk or limbs.
Recovery: Sutures are removed within one to two weeks, and scars fade gradually.
2. Mohs Micrographic Surgery
Mohs surgery offers the highest precision and cure rate. Thin layers of tissue are removed and examined under a microscope in real time until no cancer cells remain.
It is ideal for:
BCCs on the face, scalp, ears, or other cosmetically sensitive areas
Recurrent tumors
Large or ill-defined lesions
A 2021 study in Dermatologic Surgery confirmed that Mohs surgery achieves 99% clearance for primary BCC and 94% for recurrent BCC. Because only cancerous tissue is removed, it also provides the best cosmetic outcome.
3. Curettage and Electrodessication
A quick outpatient procedure often used for small, superficial BCCs. The lesion is scraped away with a curette, and an electric current destroys remaining cancer cells.
Advantages: Fast and inexpensive.
Limitations: Slightly higher recurrence risk and mild scarring.
4. Topical Medications
Topical creams can treat superficial BCCs without surgery.
Imiquimod: Stimulates the immune system to attack cancer cells.
5-Fluorouracil (5-FU): Interferes with DNA synthesis in abnormal cells.
These are typically used for early or multiple shallow lesions. According to a study in The Lancet, imiquimod cured 83% of superficial BCCs at five years, providing a valuable alternative for non-surgical candidates.
5. Photodynamic Therapy (PDT)
PDT combines a photosensitizing drug with specific light wavelengths to destroy cancerous cells while sparing healthy tissue.
Best for: Superficial or multiple small BCCs on the face or scalp.
Recovery: Minimal downtime, mild redness or peeling for a few days.
A 2020 meta-analysis in Lasers in Surgery and Medicine reported overall cure rates of 87% for superficial lesions, highlighting PDT’s role as a non-invasive therapy for appropriate patients.
6. Radiation Therapy
Radiation is used when surgery is not possible, such as for very elderly patients or those with health limitations.
It is effective but may require multiple sessions over several weeks. Side effects can include temporary skin irritation or pigment changes.
7. Targeted Therapy and Immunotherapy
For advanced or inoperable BCC, new drugs offer promising outcomes.
Vismodegib (Erivedge) and Sonidegib (Odomzo) block the Hedgehog signaling pathway, which drives abnormal cell growth.
These oral therapies can shrink tumors and reduce symptoms.
A trial published in The New England Journal of Medicine showed that vismodegib achieved significant tumor regression in 43% of patients with locally advanced BCC.
Immunotherapies such as cemiplimab (a PD-1 inhibitor) are also showing effectiveness in difficult-to-treat cases.
Post-Treatment Care and Monitoring
After BCC removal, proper care ensures optimal healing and lowers recurrence risk.
Keep the area clean with gentle, fragrance-free cleansers.
Use non-stick dressings and avoid picking at scabs.
Apply silicone gel or scar-reduction cream after the wound has closed.
Continue daily sunscreen use to prevent future lesions.
Regular follow-up is essential. TheSkin Cancer Foundation recommends dermatology visits every 6 to 12 months for at least five years after treatment.
What the Research Shows About Infections in Skin Cancer
Several key studies shed light on the relationship between infection and cancerous wounds:
Malignant ulcers frequently colonized by bacteria. The JAAD study found that infections are common in malignant ulcers and can complicate both appearance and management.
Misdiagnosis delays treatment. The BJD study revealed that many cancers are mistaken for chronic infections, causing dangerous delays.
Ulcerated melanomas carry worse outcomes. The Lancet Oncology analysis showed that ulceration, often accompanied by infection, predicts poorer survival rates.
Biopsy remains essential. A systematic review in JAMA Dermatology concluded that despite advanced imaging, biopsy is still the gold standard to distinguish infection from malignancy.
Non-healing wounds often malignant. A study in Acta Dermato-Venereologica confirmed that many chronic ulcers initially thought to be “infected wounds” were actually squamous cell carcinomas.
Skin cancer and wound bacteria linked to delayed healing. Research in the International Wound Journal found that bacterial infection in malignant wounds increases pain, odor, and drainage, complicating treatment.
Together, these studies show that pus in a skin lesion is often a sign of infection on top of cancer, not cancer alone.
How Dermatologists Diagnose the Difference
If a patient presents with a pus-producing lesion, dermatologists take a stepwise approach:
History. How long has the lesion been present? Has it responded to antibiotics?
Exam. Is the lesion irregular, growing, or changing color?
Dermatoscopy. Special magnification may reveal cancer-specific patterns.
Biopsy. A small tissue sample provides the definitive answer.
Biopsy is particularly important when pus or drainage is present, because infection can obscure the true diagnosis.
Treatment Approaches
Treatment depends on the cancer type:
Basal cell carcinoma. Excision, Mohs surgery, topical medications.
Squamous cell carcinoma. Excision, Mohs surgery, radiation therapy in select cases.
Melanoma. Wide excision, lymph node biopsy, systemic therapy if advanced.
When infection is present, dermatologists may prescribe antibiotics or recommend wound care while also addressing the cancer itself.
Living With a Cancerous Lesion That Drains
Patients with ulcerated or infected cancers often need special wound care:
Clean gently with mild soap and water.
Use non-stick dressings.
Monitor for foul odor or spreading redness.
Avoid self-treating with harsh chemicals or over-the-counter creams.
Dermatologists provide personalized wound care plans to minimize infection while preparing for definitive cancer treatment.
Prevention and Early Detection
Preventing complications starts with early detection:
Perform monthly skin checks.
See a dermatologist yearly for a professional exam.
Protect skin with sunscreen and clothing.
Avoid tanning beds.
The Skin Cancer Foundation emphasizes that early treatment reduces the chance of ulceration, infection, and scarring.
Frequently Asked Questions
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No, cancer cells do not make pus. Pus usually means there is an infection in or around the cancer.
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Yes, but if a mole changes in appearance, ulcerates, or produces drainage, it should always be evaluated for cancer.
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Infections often improve with antibiotics, while cancers persist or recur. A biopsy is the only way to know for sure.
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Not always, but ulcerated or infected cancers are usually more serious. Ulceration in melanoma, for example, is linked with worse outcomes.
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Not necessarily. Even if infection resolves, the underlying lesion may still be cancer.
Conclusion
Skin cancer does not directly create pus, but when lesions ulcerate and bacteria invade, pus can appear. Research confirms that infections are common in malignant ulcers and can confuse both patients and doctors. The safest approach is to treat any non-healing, draining sore as suspicious until proven otherwise.
At Barnett Dermatology, we stress that patients should not wait to see if a “pus-producing sore” gets better on its own. Biopsy and early diagnosis are the keys to effective treatment and prevention of complications.
