Squamous Cell Cancer

Squamous cell carcinoma (SCC) is the second most common type of skin cancer in the United States. Clinically, it presents as a pink, scaly, crusted lesion on sun exposed areas such as the head, face, neck, and extremities. However, SCC can also affect mouth, genital skin, and other non-exposed areas of the body. SCC has a risk of spreading to lymph nodes and other internal organs.

Risk factors for squamous cell carcinoma include:

• light complexion
• excessive sun exposure
• weakened immune system
• increased age (> 50)
• tobacco use (smoking, chewing)
• UV radiation exposure as from tanning beds
• infection from oncogenic strains of Human Papilloma Virus (HPV)

A skin biopsy is necessary confirm a diagnosis of SCC. Knowledge of the size, biological behavior of cancer, location, duration, as well as presence of any metastasis can help in determining treatment options as well as risk stratification for patients. Generally, the larger the lesion and the longer it has been present, the higher the risk of metastasis. Treatment options for SCC include:

• Electrodessication & Curettage (ED&C): ED&C is known as the “scrape and burn” technique. In this method, the cancer is scraped with a curette and burned with an electrical needle called hyfrecator. This wound heals on its own in a few weeks and no sutures are needed.
• Surgical Excision: The skin cancer is surgically excised with appropriate margins to remove the entire skin cancer, and the resulting skin defect is sutured in layers. The internal stiches dissolve on their own in a few weeks to a few months, and the top stiches are left in skin for 5-14 days, depending on the type of repair, location of surgery on the body, and types of sutures used. The lesion removed is sent to a dermatopathologist to confirm negative margins.
• Mohs Micrographic Surgery: This is a tissue-sparing procedure in which the cancer is excised in layers to confirm negative margins. A Mohs surgeon has the necessary equipment to process the tissue and confirm negative margins prior to closing the wound. The patient will have confirmation the entire skin cancer has been removed before the surgeon begins to close the wound with sutures, repairs it with a skin graft or flap, or allows the wound to heal on its own through second intention. This is the preferred method of treatment for large cancers or tumors on cosmetically sensitive areas like face, ears, scalp, fingers, toes and sometimes neck.
• Topical Chemotherapy: This is a non-surgical treatment option that can be used for superficial SCCs (squamous cell carcinoma in-situ); these are squamous cell skin cancers that are limited to the top layer of the skin. This treatment requires precise application of a prescription chemotherapy cream or solution on the skin cancer for several days to several weeks as directed by your dermatologist.
• Radiation Therapy: This is an option for difficult to treat tumors, very large tumors spanning over multiple cosmetic units on face and ears, or for patients, usually elderly, who are not candidates for surgical excision.

Patients who develop any suspicious lesions that are changing, growing, bleeding, or not healing should consult a dermatologist for evaluation. Patients with a history of sun damage, precancerous lesions, or skin cancers need routine skin examinations. Our dermatologists can help determine the right treatment plan for you.