Squamous Cell Carcinoma
Squamous cell carcinoma (SCC) is an uncontrolled growth of abnormal cells arising in the squamous cells, which compose most of the skin’s epidermis. The lesions typically appear as persistent, thick, rough, scaly patches that can bleed if bumped, scratched or scraped. They often look like warts and sometimes appear as open sores with a raised border and a crusted surface.
SCC is mainly caused by cumulative ultraviolet (UV) exposure over the course of a lifetime; daily year-round exposure to the sun’s UV light, intense exposure in the summer months, and the UV produced by tanning beds all add to the damage that can lead to a SCC.
SCCs may occur on all areas of the body including the mucous membranes and genitals, but are most common in areas frequently exposed to the sun, such as the rim of the ear, lower lip, face, balding scalp, neck, hands, arms and legs.
Squamous cell carcinomas detected at an early stage and removed promptly are almost always curable and cause minimal damage. A small percentage metastasize to local lymph nodes, distant tissues, and organs and can become fatal. Any change in a preexisting skin growth, such as an open sore that fails to heal, or the development of a new growth, should prompt an immediate visit to your Dermatologist, who will biopsy the tissue to determine if there are cancerous cells present.
Treatment can almost always be performed in-office, common approaches include:
· Curettage and Electrodessication - this technique is typically only an option for the smallest of lesions. The affected skin will be scraped off with a curette, next the tumor site is burned with an electrocautery needle.
· Mohs Micrographic Surgery – Mohs surgery has the highest cure rate (99% or better) and can be done in our office (link to landing page about the Mohs Surgery under “Surgical” section) by Dr. Mraz Robinson who is a fellowship trained Mohs physician. The procedure first removes a thin layer of the affected tissue, and then while the patient waits the tissue is examined under a microscope. If cancer is present in the tissue being examined, the procedure is repeated until the last excised layer is cancer-free.
· Excisional Surgery – using a scalpel, the physician removes the entire growth along with a surrounding border of skin. The skin is closed with sutures, and the tissue is sent to a laboratory to verify that all cancerous cells have been removed. A repeat excision is rarely necessary but will be performed if pathology shows any skin cancer cells in the margins of the excised tissue.
· Radiation – for tumors that are difficult to manage surgically due to size and/or placement, radiation can be used. During radiation, x-ray beams are directed through the skin at the tumor. Typically several sessions are required over few weeks.
· Cryosurgery – with cryosurgery the cancerous tissue is destroyed by freezing with liquid nitrogen. The growth will then blister or become crusted and then fall off within a few weeks. This is rarely used for SCCs.
· Photodynamic Therapy (PDT) – PDT is an FDA-approved treatment for superficial cases of BCC and rarely used for SCCs. The affected area will be medicated with a topical acid and then activated by a strong blue light.
· Topical chemotherapy drug Imiquimod (5-FU) is applied to the tumor five times a week for up to 6 weeks or longer, it causes the body to produce interferon, a chemical that attacks cancer.
· Oral chemotherapeutic agents may be used for some cases of advanced SCC in collaboration with a medical oncologist.