Squamous Cell Carcinoma
What Is Squamous Cell Carcinoma?
Squamous cell carcinoma is a common type of skin cancer that develops from squamous cells in the outermost layer of the skin. It most frequently appears on areas with significant ultraviolet exposure, including the face, ears, scalp, neck, forearms, and backs of the hands. It may also develop within an actinic keratosis, chronic wound, scar, or previously irradiated area.
Most squamous cell carcinomas are highly treatable when identified early. However, some tumors can grow quickly, invade deeply, return after treatment, or spread to nearby lymph nodes or other areas of the body. Early diagnosis and complete treatment are particularly important for tumors with high-risk features.
What Does Squamous Cell Carcinoma Look Like?
Squamous cell carcinoma can have several different appearances. It may look like:
A rough, scaly, or crusted patch
A firm pink, red, brown, or skin-colored bump
A rapidly growing dome-shaped growth
A sore that does not heal or repeatedly returns
A tender or painful spot that bleeds easily
A wart-like growth or thickened area of skin
A change developing within a scar or chronic wound
Squamous cell carcinoma can occur in people of every skin tone. Any new, changing, painful, rapidly growing, bleeding, or non-healing lesion should be evaluated by a dermatologist.
Diagnosis and Risk Assessment
Diagnosis usually begins with a careful examination followed by a skin biopsy. The biopsy confirms the diagnosis and helps determine whether the tumor has microscopic features associated with a greater risk of recurrence or spread.
Treatment planning considers the tumor’s size, location, depth, borders, microscopic appearance, growth rate, and whether it has been treated previously. The patient’s immune status is also important because squamous cell carcinoma may behave more aggressively in organ transplant recipients and other immunosuppressed patients.
Tumors involving the lips, ears, face, scalp, hands, feet, or genital skin may require a more specialized approach. Additional examination of nearby lymph nodes, imaging, or coordinated cancer care may be recommended for selected high-risk or advanced tumors.
Treatment Options
Treatment is individualized to completely remove or destroy the cancer while preserving healthy tissue and achieving the best possible functional and cosmetic result.
Mohs micrographic surgery is often recommended for squamous cell carcinomas located on the face or other tissue-sensitive areas, tumors with aggressive microscopic features, recurrent cancers, poorly defined tumors, and cancers with a higher risk of returning or spreading. During Mohs surgery, the tumor is removed in stages and the complete surgical margin is examined microscopically. This allows the surgeon to remove the cancer while conserving as much unaffected tissue as possible.
Standard surgical excision may be appropriate for many well-defined tumors. The cancer and a measured margin of surrounding skin are removed and sent to a laboratory for examination.
Curettage and electrodesiccation may be used for selected small, low-risk tumors in appropriate locations. The cancerous tissue is removed with a specialized instrument, and the base is treated with controlled electrical energy.
Nonsurgical treatments may be considered for selected cases of squamous cell carcinoma in situ, the earliest form of the disease that remains confined to the outermost layer of skin. Options may include topical medications or other localized treatments. These approaches are generally not appropriate for invasive squamous cell carcinoma.
Radiation therapy or systemic immunotherapy may be considered when surgery is not appropriate or when a tumor is locally advanced, recurrent, or has spread beyond its original location. Complex cases may be managed collaboratively with radiation oncology, medical oncology, or other specialists.
Follow-Up and Prevention
Having one squamous cell carcinoma increases the likelihood of developing another skin cancer in the future. Continued dermatologic surveillance is therefore an important part of care.
Follow-up recommendations are individualized based on the tumor’s risk factors and your medical history. Patients with high-risk tumors or immune suppression may require more frequent examinations. Regular skin checks, monthly self-examinations, protective clothing, broad-spectrum sunscreen, and avoidance of tanning beds can help identify future skin cancers earlier and reduce additional ultraviolet damage.
If you notice a new growth, a rapidly changing spot, or a sore that repeatedly bleeds or does not heal, schedule a dermatologic evaluation.
