Squamous Cell Carcinoma: From Diagnosis to Prognosis

Early signs of squamous cell carcinoma include dome-shaped growths, scaly red patches, or rough, raised areas on the skin. These lesions may bleed easily, itch, or become painful—especially as they grow.

Some SCCs appear within scars or slow-healing sores. Although they’re most common on sun-exposed areas such as the face, ears, neck, or scalp, SCC can develop anywhere on the body. Any changes in the size, shape, color, or texture of skin lesions should be checked by a healthcare provider.

Dermatologists perform examinations of possible SCCs, checking their color, shape, texture, and size. They may order skin biopsies if they suspect a malignant growth, which requires removing a small tissue sample to send to a laboratory for tests. During examinations, dermatologists may use a dermatoscope to inspect the lesion more closely. More advanced SCCs can sometimes be identified without a biopsy.

Risk factors for SCC include

• Fair skin, blue eyes, or blond hair
• Excessive exposure to sunlight (UV radiation)
• Using tanning beds
• A history of serious sunburns
• Past diagnoses of precancerous skin lesions, such as actinic keratosis
• An immune system compromised by chronic disease or disorders
• Age over 50
• History of human papilloma virus

Xeroderma pigmentosum is a rare genetic disorder that makes people extremely sensitive to UV radiation. People who carry this gene have a greatly increased risk of developing SCC, basal cell carcinoma, or melanoma. Squamous cell carcinoma is also more common in males.

When caught in its early stages, squamous cell carcinoma is treatable with minor surgery a dermatologist can perform in their clinic. The doctor may use a number of common techniques to remove noninvasive SCCs

• Excision (simply cutting out the lesion)
• Mohs surgery (removing layers of the lesion until the cancer cells are completely eliminated)
• Dermabrasion (sanding SCC lesions to expose cancer-free layers of skin)
• Liquid nitrogen (freezes and destroys the spot)
• Cream or gel chemotherapy (treats non-melanomas only)
• Superficial radiation therapy (SRT)

The best treatment will depend on the size, location, and depth of the SCC, as well as how aggressive the cancer is.

Left untreated, SCC may spread and infiltrate nearby skin tissues. Invasive SCC means cancer has spread to lymph nodes or internal organs. Although rarely fatal, the cancer can cause serious health problems and disfigurement. Aggressive SCC is associated with how deep or large the lesion is, whether lesions form on mucous membranes (lips or eyes), and the overall health of the person at the time of diagnosis.

The most common reason for the development of squamous cell carcinoma is ultraviolet radiation. Both types of UV radiation promote SCC. The sun, tanning beds, and sun lamps emit UVA, which is responsible for the tanning the color of the skin. UVB causes sunburns and is mostly responsible for SCC and melanoma. Fair-skinned individuals with a history of severe sunburns, sun poisoning, and blisters are at a high risk for SCC.

Dermatologists diagnose low-risk SCC if bumps or lesions are small, superficial, and have well-defined edges. Removal of these growths typically involves topical chemotherapy or excisions performed in-office. High-risk SCC lesions exceed two centimeters and affect the ears, lips, nose, or eyelids. They have a higher potential for spreading (metastasizing) than low-risk SCC. Lesions that extend deeper into the skin (more than 4 mm), those that invade the underlying nerves, and ones located near the parotid gland are also often classified as high risk. People who have a suppressed immune system are also at higher risk of the tumor spreading.

In some cases, squamous cell carcinoma may emerge from a precancerous condition called actinic or solar keratosis. Beginning as pink, flat, rough lesions on the skin, actinic keratosis areas may rise above the skin and become hard. Skin cancer screenings are vital for detecting actinic keratosis and other precancerous skin lesions. When caught early, they are usually easy to treat with photodynamic therapy or topical chemotherapy.

Basal cell carcinoma (BCC) differs from SCC because it affects basal cells only. Basal cells produce new skin cells as old cells die. However, both basal cell and squamous cell carcinoma are caused primarily by long-term exposure to sunlight and tanning beds. Basal cell carcinoma spots tend to look like open sores or patches of eczema or psoriasis. Treatment for BCC involves the same techniques used to treat SCC: excision, Mohs surgery, and topical chemotherapy.

The survival rate for squamous cell carcinoma is quite high, thanks largely to the success of treatment. Even when the cancer has metastasized into the lymph nodes or other nearby structures, many individuals benefit from surgery and radiation. However, there is always a chance that SCC will recur, so regular checkups are vital for individuals in remission.