Squamous Cell Carcinoma
What is Squamous Cell Carcinoma?
Squamous cell carcinoma (SCC) is the second most common type of skin cancer behind basal cell carcinoma. As its name suggests, it develops in the flat squamous cells that make up the outer layer of the skin (called the epidermis). Until recently, SCC was more often seen in older people, mainly men who worked outdoors. But today, more women and younger people are developing SCC, according to the College of American Pathologists.
Most squamous cell skin cancers appear on sun-exposed areas of the body – the face, neck, ears, back of the hands and scalp. But they can occur in other areas too. For example, SCCs can develop in the mouth or on the genitals. In most cases, SCCs are cured by either removing the cancerous growth and/or using medications applied to the skin. But, if it spreads, it can cause damage and scarring and may even invade nearby tissue or organs.
What Can I Do to Protect Myself?
Fortunately, most SCCs are found early and can be cured. Here are some steps you can take to help protect yourself:
- Pay attention to sun safety. Avoid being in the sun during peak daylight hours, always apply (and reapply) SPF 30 or higher broad-spectrum (UVA/UVB) sunscreen, and wear protective clothing, sunglasses and wide brimmed hats. Don’t skip putting sunscreen on your lips, ears, backs of your hands, neck or the top of the scalp.
- Go to any and all follow-up appointments with your doctor. If you have had a skin cancer, you are more likely to have another. Be sure to get regular skin exams. When found early, skin cancer can be cured.
- Check your skin regularly. Watch for changes in size, color, texture and appearance. If it worries you at all, let your doctor know.
- Tell others. Talk to your family and friends about the importance of skin cancer prevention too.
Symptoms and Diagnosis
Certain people are more likely to develop squamous cell carcinoma (SCC), including:
- Having fair skin, light-colored eyes or blond or red hair
- Spending too much time in the sun (without protection) or using tanning beds
- Frequent sunburns, especially at an early age
- Having had a previous SCC, other skin cancer or certain pre-cancerous conditions such as actinic keratosis, leukoplakia and Bowen’s disease
- Old scars, burns, ulcers or chronic inflammation of the skin
- Certain viruses such as HPV (Human Papillomavirus)
- Exposure to many x-rays or chemicals
- Having had an organ transplantation and on immunosuppressive medications
What Does SCC Look Like?
A change on the skin is the most common sign of skin cancer, including SCC. That’s why it is important to get to know your skin. If you notice a new growth, a sore that isn’t healing or a change in an existing mole or other area of the skin, get it checked out.
SCCs might appear as:
- An elevated wart-like lump that is small, smooth, shiny, pale or waxy
- A flat red spot or rough patch of skin that may become itchy
- A bleeding or crusting sore that doesn’t seem to heal
- A red or brown patch that is rough and scaly
In the majority of cases, squamous cell carcinoma (SCC) is easily cured using local surgery and/or medications applied to the skin (called topical therapies).
Treatment will depend on the size, location and how deep the tumor is in the skin, as well as if it has spread elsewhere.
Treatments usually include:
There are several different types of surgical procedures that can be used:
- Excision – the entire growth is removed along with a surrounding border of normal skin
- Curettage and electrodesiccation – the tumor is scraped down to its base followed by pulses of electrical energy
- Mohs surgery – the goal is to remove skin cancer one layer at a time to spare normal, healthy tissue. After each layer is removed, it is sent to an on-site laboratory to be examined by the surgeon. This allows your dermatologic surgeon to know whether more layers need to be removed in real-time.
SCC can invade nearby tissue. If this happens, several surgeries may be needed to try to remove all of the cancer cells. These procedures can be disfiguring and very upsetting. If nearby lymph nodes are involved, a lymph node dissection may also be required.
If SCC is “superficial” (also called squamous cell carcinoma in-situ, in other words, not very deep in the skin), creams containing chemotherapy medications (imiquimod, 5-Fluorouracil) can be applied to the skin.
Radiation therapy uses high-energy x-rays to target and kill cancer cells. The use of radiation may be considered for patients who have:
- Undergone lymph node dissection
- Remaining SCC cells after surgery (positive margins)
- Evidence that cancer cells are spreading to the space surrounding a nerve (called perineural invasion) on a pathology report
- Other higher risk features, such as larger (>2 cm) tumors. Tumors that invade deeply and pathology results that show that it is likely to grow quickly
For SCC that has spread (metastasized), systemic therapy can be considered which includes chemotherapy, targeted therapy, immunotherapy, and clinical trials. For organ transplant patients who have many SCCs, transplant physicians can consider adjusting the immunosuppressive treatment if appropriate.
Immunotherapy pushes the body’s immune system to work harder to fight the cancer. Immunotherapy has been approved to treat patients with certain types of squamous cell carcinoma who are not candidates for surgery or radiation therapy.