Squamous Cell Carcinoma

Squamous cell carcinoma (SCC) is a type of skin cancer that arises from the squamous cells of the skin, which compose most of the skin’s upper layer. When squamous cells become cancerous, they will divide without stopping, create rough bumps that may turn into sores, and start to invade deeper tissues.

UV radiation is the primary risk factor for development of squamous cell carcinomas, especially chronic, daily, cumulative sun exposure. Those who work in the sun experience a higher incidence of SCC. Most SCCs appear on the head and neck, hands and forearms, and lower legs.

Other risk factors for SCC include chronic arsenic exposure, radiation therapy, long-term immunosuppression, chronic inflammation, and a number of rare genetic syndromes.

SCCs can present in chronic wounds or scars, a condition referred as Marjolin’s ulcer. They may occur in any site of chronic inflammation, such as burn scars, stasis ulcers, osteomyelitis, and are often on the extremities. These SCCs have an aggressive course with higher rates of recurrence and metastasis. A malignancy should be suspected in cases of chronic, non-healing wounds on a scar or ulcer.

SCCs usually present as scaly red patches, open sores, elevated growths with a central depression, or warts. They may crust or bleed. They are often tender, non-healing lesions. SCCs often appear on the temples, ears, and lips, and they tend to be aggressive with higher rates of recurrence and metastasis.

Squamous cell carcinomas may be treated with surgical or nonsurgical techniques, depending on the size and location. Surgical treatments include cryotherapy (freezing superficial small SCCs with liquid nitrogen), electrodissection and curettage (ED&C, also known as scraping and burning), excision, or Mohs micrographic surgery.

Nonsurgical techniques may include topical treatments and radiation therapy. Small and superficial SCCs may be treated with topical creams. Radiation is often reserved for cancers that cannot be treated surgically.

An excision is when the area around the skin cancer is cleaned and numbed, and the tumor is surgically removed with margins. The site is then immediately sutured. The specimen is sent to the lab and processed, which takes several days. A dermatopathologist then reads the slides under the microscope and determines if the cancer was fully removed. Many squamous cell carcinomas can be treated effectively with an excision.

Mohs micrographic surgery is a procedure in which the tumor is removed and the margins are evaluated on the same day. The area is cleaned and numbed, and the tumor is surgically removed with margins. The Mohs surgeon evaluates the tissue and 100% of the margin is examined as the patient waits in the procedure room.

If a residual tumor is found, additional tissue is removed until it is all clear. Because the margins are narrower, Mohs often results in smaller scars.

Mohs is only indicated in certain circumstances, such as in cases of tumors on critical areas (such as the face, hands, genitalia), or for aggressive subtypes or larger cancers.

Most squamous cell carcinomas are treatable and curable. Better outcomes are always achieved when SCCs are diagnosed and treated early. If left untreated, they will continue to grow, progressing to a lesion that bleeds, ulcerates, and never heals. They are often painful.

Eventually, the tumor starts to invade underlying tissue and may spread to other parts of the body. In contrast to basal cell carcinoma (BCC), which rarely metastasizes, around 2 to 5 percent of SCCs spread to regional lymph nodes or more distant sites. Early treatment provides the best opportunity to cure SCC.

Call us at one of our offices to schedule an appointment with a dermatology provider, or request an appointment online.

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