Squamous Cell Carcinoma of the Skin

This type of cancer is also known as Cutaneous Squamous Cell Carcinoma (cSCC). After Basal Cell Carcinoma, cSCC is the second most common type of skin cancer. It starts in the epidermis from the flat squamous cells that lie on top of the basal layer of the skin. The epidermis is the outer layer of skin on the body that you can see and touch. This cancer usually shows up on sun-exposed areas of the body, like the face, ears, and neck. But it can occur in other areas too. This cancer is usually found early and treated by being removed completely. Sometimes cSCC can grow back, and in rare cases, spread to other parts of the body. 

Known risk factors for squamous cell skin cancer include:  

• Exposure to sunlight or ultraviolet radiation from tanning booths
• Frequent blistering sunburns, especially early in life 
• Having a fair complexion, which includes the following:
  • Fair skin that freckles and burns easily, does not tan, or tans poorly
  • Blue, green, or other light-colored eyes
  • Red or blond hair
• A personal history of skin cancer 
• Having more than 50 moles
• Possible genetic factors (mutations in certain genes or a family history)
• History of radiation therapy, certain conditions that suppress the immune system, or exposure to high levels of arsenic 
• Solid organ transplant recipients are at a very high risk of developing cSCC after transplantation. This is due to the immunosuppressive medication used. Immunosuppressive medication is a drug that suppresses the immune response of an individual.

As always, talk with your health care provider if you notice anything unusual on your skin, or if you have a sore or patch of skin that will not heal. Tell your doctor if you notice changes or anything unusual on your skin. Do monthly skin checks — check all the surfaces of your skin and look closely at your moles so that you can tell if they begin to change in shape, size, or color. Cutaneous squamous cell carcinoma may look like a firm red bump, a scaly red patch, an open sore, or a wart that may crust or bleed easily.

Screening, Diagnosis

Tests that are commonly used to find skin cancer include:

• Skin exams – A dermatologist will check the skin for bumps, moles, or spots that look abnormal in color, size, shape, or texture.
• Skin biopsy – If needed, all or part of an abnormal-looking growth is cut from the skin. A pathologist will look at the sample under a microscope to check for signs of cancer. Different types of biopsies may be used depending on cancer and its location.
  • Shave biopsy: A doctor uses a sterile blade to shave off a growth that looks abnormal.
  • Punch biopsy: A special instrument is used to cut out circular pieces of skin or tissue.
  • Incisional biopsy: The doctor removes part of a growth using a scalpel.
  • Excisional biopsy: The doctor removes the entire growth or abnormal area of skin using a scalpel.

If the disease is more advanced, other diagnostic tests may be added, including CT or PET scans. However, this is done very infrequently.

How is cSCC found? 

Your doctor will examine your skin. He or she may remove the growth or part of it. This is called a skin biopsy. A biopsy is needed to confirm a diagnosis.

To get a sample of the skin/suspicious spot, the area will be numbed with a medication injected into the skin. Then the doctor (often a dermatologist or skin doctor) will cut the skin to get a sample of tissue. A different doctor (called a pathologist or dermatopathologist) will look at this tissue under the microscope to check for cancer cells. There are several types of biopsies.

Ask your doctor when he/she will review the results with you.

Can it spread beyond the skin?

Squamous cell carcinoma usually grows slowly and is contained to the outer layer of the skin. In some cases, especially if it is untreated, it can invade nearby tissue.

If multiple surgeries are needed, it can be disfiguring and may affect function. For example, if squamous cell carcinoma grows deeply on the lower lip, surgeries to remove it may cause cosmetic issues, and also interfere with someone’s ability to smile or close their mouth.

Although rare, it is possible for squamous cell carcinoma to spread (metastasize) to other parts of the body.

Questions to Ask Your Doctor

• What type of biopsy will be done?
• How soon will I know the results?
• What stage is my cancer?
• What treatment is most likely to work?
• Are there side effects I need to be aware of?
• How likely is it that it will return?
• What should I be doing to help protect myself in the future?
• Do you have experience treating this type of cancer, or know someone who does?

Staging

Squamous cell skin cancer is often broken into the following categories:

Local: Tumors that are confined to the original site of disease. Local cSCC is usually curable.

Locally advanced: Tumors that have spread to surrounding skin or lymph nodes. Locally advanced cSCC can be curable by surgery or radiation.

Unresectable: Tumors that can no longer be cured by surgery and/or radiation. Unresectable cSCC cannot be cured but can be controlled by treatments like chemotherapy and immunotherapy.

Metastatic: Tumors that have spread beyond the original area to other parts of the body. Metastatic cSCC cannot be cured but can be controlled by treatments like chemotherapy and immunotherapy. 

Local Versus Advanced cSCC

Your doctor may also use the words “local” and “advanced” to describe your cSCC. Local cSCC is treated very differently than the other categories. Most people who have cSCC have local disease. When you read about cSCC being highly curable, that is for the 95% of people who have local cSCC.

Treatment for cSCC depends on your cancer stage, the size and location of the tumor, your treatment preferences, and overall health. 

Follow-up Care

Because skin cancer can come back, be sure to ask your doctor how often to have your skin checked for signs of cancer. Remember to keep any follow-up visits.