Overview

Squamous Cell Carcinoma (SCC) is a common type of skin cancer that begins in the squamous cells, which are thin, flat cells making up the outer layer of your skin. It's primarily caused by long-term exposure to ultraviolet (UV) radiation from the sun or tanning beds, but can also arise from chronic skin inflammation, scars, or certain chemical exposures.

SCC most often affects adults, particularly those over 50, with fair skin, light hair, and blue, green, or gray eyes, as they are more susceptible to sun damage. People with weakened immune systems are also at higher risk. It's important to know that SCC is not contagious; you cannot catch it from someone else. While SCC is usually not life-threatening if caught and treated early, it can sometimes grow deep into the skin or spread to other parts of the body, which can impact your well-being and require more involved care.

Symptoms

You might notice a few different things if SCC is developing. It often appears on sun-exposed areas like your face, ears, neck, lips, and the backs of your hands or forearms.

Here are some common signs to look out for

• A firm, reddish bump or nodule that might feel rough to the touch.
• A flat sore with a scaly, crusted surface.
• A new sore or raised area on an old scar or ulcer.
• A rough, scaly patch on your lip that may evolve into an open sore.
• An open sore that heals and then re-opens, or one that doesn't heal within a few weeks.
• The spot may grow slowly and can sometimes be tender or itchy, though not always.
• In some cases, it might bleed easily if bumped or irritated.
• The appearance can vary significantly, so any new or changing skin lesion warrants attention.

Diagnosis

If you have a spot that concerns you, a doctor, often a dermatologist, will first carefully examine your skin. They'll look at the size, shape, color, and texture of the suspicious area.

To confirm if it's SCC, a skin biopsy is usually needed. This is a simple procedure where a small sample of the affected skin is removed after numbing the area. The sample is then sent to a lab to be examined under a microscope by a specialist called a pathologist. This is the most definitive way to diagnose SCC.

Management & Treatment

Finding out you have Squamous Cell Carcinoma (SCC) can feel overwhelming, but please know that there are very effective treatments available. The main goal of treatment is to completely remove or destroy the cancer, and in most cases, treatment is successful, especially with early detection. Your dermatologist will work with you to choose the best approach based on the size, location, and specific characteristics of the tumor.

Here’s a look at the different ways we can treat SCC:

• Surgical Procedures: Surgery is the most common treatment for SCC and offers a very high cure rate.
  • Excisional Surgery: This is a straightforward procedure where your doctor will numb the area, carefully cut out the tumor along with a small border of healthy skin around it (we call this a "safety margin"), and then close the area with stitches. Taking that extra margin of healthy skin helps us be confident that all the cancer cells have been removed.
  • Mohs Surgery: This is a highly specialized and precise technique that has the best cure rate for SCC. It's often recommended for larger tumors, tumors in cosmetically sensitive areas like your face, or for SCCs that have returned after a previous treatment. During Mohs surgery, the surgeon removes the tumor one thin layer at a time and examines each layer under a microscope right away. They continue this process until no more cancer cells are seen, which allows them to save as much healthy tissue as possible.
  • Curettage and Electrodesiccation: For very small and low-risk SCCs, this two-step procedure can be a good option. First, the cancerous tissue is scraped away with a spoon-shaped instrument called a curette. Then, an electric needle is used to treat the base of the wound to destroy any remaining cancer cells and stop any bleeding.
• Topical Treatments: For SCCs that are confined to the very top layer of the skin (superficial SCC), we sometimes use medicated creams.
  • Topical Chemotherapy (like 5-fluorouracil or 5-FU): This cream is applied directly to the skin to destroy cancer cells.
  • Imiquimod Cream: This cream works by boosting your body's own immune system to fight off the cancerous cells.
  • It's important to understand that these creams can't reach cancer cells that are deeper in the skin, so they are only used for very specific, early-stage situations. Close follow-up with your doctor is a must if you are using a topical treatment.
• Other Local Treatments:
  • Radiation Therapy: This treatment uses focused beams of high-energy X-rays to kill cancer cells. Radiation can be a good option if surgery is not possible or if the cancer has spread to nearby areas like the lymph nodes.
  • Cryotherapy: This involves spraying liquid nitrogen directly onto the tumor to freeze and destroy the cancerous cells. The treated area will then blister and fall off. This is typically only used for very small, early SCCs.
  • Photodynamic Therapy (PDT): This is a two-part treatment. First, a light-sensitizing medication is applied to the skin. After a few hours, the area is exposed to a special light that activates the medication and destroys the cancer cells.

Treating Advanced Squamous Cell Carcinoma

If SCC has spread from the original spot to other parts of the body, it is considered advanced. While this is less common, it is a serious situation that requires a more comprehensive treatment plan, often involving a team of cancer specialists.

• Systemic Medications: These are drugs that travel through the bloodstream to attack cancer cells throughout the body.
  • Immunotherapy: These modern medicines help your own immune system to better recognize and fight cancer cells.
  • Targeted Therapy: These drugs work by targeting specific weaknesses present in the cancer cells.
  • Chemotherapy: These are powerful drugs that kill fast-growing cells, including cancer cells.

What to Do if Treatments Aren't Working

If a treatment doesn't seem to be working, or if the SCC comes back, it's so important to let your doctor know right away. There are usually other treatment options available, and your doctor will work with you to find the best next step.

Lifestyle Changes Are Key

After treatment, one of the most important things you can do is protect your skin from the sun to help prevent new skin cancers from forming.

• Seek shade whenever possible, especially during the sun's peak hours (10 a.m. to 4 p.m.).
• Wear sun-protective clothing, like long-sleeved shirts, pants, a wide-brimmed hat, and UV-blocking sunglasses.
• Use a broad-spectrum sunscreen with an SPF of 30 or higher every single day. Make sure to reapply it every two hours, and more often if you are swimming or sweating.
• Please avoid tanning beds, as they significantly increase your risk of skin cancer.

Your journey with SCC doesn't end after the tumor is removed. It's incredibly important to keep up with your follow-up appointments so your dermatologist can check your skin for any signs of recurrence or new skin cancers. We are here to support you every step of the way.

Duration & Outlook

SCC typically develops slowly over months or even years. It's generally considered a chronic condition in the sense that if you've had one, you're at higher risk for developing others, especially with continued sun exposure. However, an individual SCC lesion, once identified, is often treated as an acute problem to be removed.

The outlook for SCC is generally very good, especially when it's detected and treated early. Most SCCs are cured with relatively minor procedures. However, if left untreated, SCC can grow larger and deeper, potentially damaging surrounding tissues. In a small percentage of cases, particularly with larger or more aggressive tumors, or in individuals with weakened immune systems, SCC can spread to lymph nodes or other organs, which is more serious. Warning signs for complications include rapid growth of the lesion, pain, numbness, or spread to nearby areas.

Prevention

The best way to prevent SCC is to protect your skin from UV radiation. This is something you can take control of every day!

• Seek shade, especially between 10 a.m. and 4 p.m. when UV rays are strongest.
• Wear sun-protective clothing, including a broad-brimmed hat and UV-blocking sunglasses.
• Use a broad-spectrum sunscreen with an SPF of 30 or higher daily, even on cloudy days, and reapply every two hours, or after swimming or sweating.
• Avoid tanning beds and sunlamps completely.
• Examine your skin head-to-toe every month and see your doctor annually for a professional skin exam, or more often if you're at high risk.

Causes & Triggers

The primary cause of most SCCs is long-term exposure to ultraviolet (UV) radiation from sunlight or artificial sources like tanning beds. This UV radiation damages the DNA in your skin cells, leading to mutations that can cause cancer to develop.

Common triggers and risk factors include

• Excessive sun exposure: Especially a history of sunburns, or lots of sun exposure over many years.
• Tanning bed use: Artificial UV radiation is a significant risk factor.
• Fair skin: People who burn easily are more susceptible.
• Older age: The risk increases with age due to accumulated sun exposure.
• Weakened immune system: Due to medical conditions (like HIV) or immunosuppressive medications (e.g., after an organ transplant).
• History of skin cancer: Having had SCC or another type of skin cancer before.
• Precancerous skin lesions: Such as actinic keratoses.
• Chronic skin inflammation or injury: Scars from burns, long-standing sores, or certain inflammatory skin diseases can sometimes develop SCC.
• Exposure to certain chemicals: Such as arsenic.
• Specific genetic syndromes: Though rare, some inherited conditions increase risk.

People most likely to develop SCC are those with significant lifetime sun exposure, fair skin types, and older individuals.

When to see a doctor

It's so important to be proactive about your skin health. You should make an appointment with a doctor or dermatologist if you notice:

• Any new skin growth - that looks unusual or different from your other moles or spots.
• A spot or sore that changes in size, shape, or color.
• A lesion that itches, hurts, bleeds, scabs over, or doesn't heal - within a few weeks.
• A scaly patch that persists despite moisturizing.
• Any spot that you're just worried about – it's always better to get it checked.

Early detection is key for the best outcome with SCC. Trust your instincts; if something on your skin doesn't feel right or look right, please have it evaluated by a healthcare professional.

Frequently Asked Questions (FAQs):

• Q: Is Squamous Cell Carcinoma painful? SCC can sometimes be tender or painful, especially if it's inflamed or growing, but many are not painful at all, particularly in the early stages. Don't rely on pain as the only indicator.
• Q: Can SCC go away on its own? No, SCC does not typically go away on its own. It requires medical evaluation and treatment to prevent it from growing or spreading.
• Q: If I had an SCC removed, can I get another one? Yes, unfortunately. Having one SCC means you have a higher risk of developing another SCC or other types of skin cancer in the future, particularly if you continue to have sun exposure. Regular skin checks are very important.
• Q: Is SCC deadly? Most SCCs are not deadly and are successfully treated, especially when caught early. However, if left untreated, some SCCs can become aggressive, spread to other parts of the body, and, in rare cases, can be fatal. This is why early detection and treatment are so crucial.
• Q: Does SCC spread quickly? SCC usually grows slowly over months or years. However, some can be more aggressive and grow or spread more rapidly, especially in individuals with weakened immune systems or on certain areas like the lip or ear.

References

• The Skin Cancer Foundation. (n.d.). Squamous Cell Carcinoma. Retrieved from https://www.skincancer.org/skin-cancer-information/squamous-cell-carcinoma/
• American Cancer Society. (n.d.). Squamous Cell Carcinoma of the Skin. Retrieved from https://www.cancer.org/cancer/types/basal-and-squamous-cell-skin-cancer/treating/squamousl-cell-carcinoma.html
• National Cancer Institute. (n.d.). Skin Cancer Treatment (PDQ®)–Patient Version. Retrieved from https://www.cancer.gov/types/skin/patient/skin-treatment-pdq
• Mayo Clinic. (2022, August 10). Squamous cell carcinoma of the skin. Retrieved from https://www.mayoclinic.org/diseases-conditions/squamous-cell-carcinoma/symptoms-causes/syc-20352480
• DiMaio, D., & Liau, M. (2019). Cutaneous Squamous Cell Carcinoma. In StatPearls. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK441939/