Squamous cell carcinoma (SCC) is a type of cancer that originates in the squamous cells present in the middle and outer layers of the skin. Read about its causes, symptoms, diagnosis, treatment, and prognosis.
Squamous cell carcinoma is a type of skin cancer that develops in the squamous cells, which are thin and flat cells that make up the outermost layer of the skin (epidermis). All places in the body that contain squamous cells can get affected by this cancer. It is the second most common type of skin cancer, is relatively slow-growing, and does not usually result in fatal complications if treated in early stages. Prolonged sun or UV radiation exposure (tanning beds or lamps) is the most common cause of this type of skin cancer.
If left untreated, this cancer can affect a large part of the skin and can also spread to other body parts, such as tissues, bones, and lymph nodes. When this happens, it can cause severe complications. The skin in the face, neck, chest, back, lips, hands and legs are more susceptible to sun exposure. SCC results in scaly and red patches or open sores on the skin. The other factors that increase the risk of you getting SCC are old age, fair skin, exposure to chemicals like arsenic, and changes in the DNA of squamous cells. It is most common in males and elderly people (more than 64 years).
Squamous cell carcinoma commonly affects the scalp, face, ears, lips, and hands, as these places are most often exposed to sun rays. But it can also develop inside the mouth, genitals, and feet. The signs and symptoms of SCC are:
Red and firm nodules on the affected area.
Open sore with a scaly crust.
Rough and scaly patch on the skin that develops into an open sore.
An old scar gets a raised area.
Wart-like growth on the anus or genitals.
A red rough patch inside the mouth.
Consult a doctor immediately if you have a skin sore or lesion that does not heal even after two months.
When the squamous cells present in the epidermis undergo DNA mutations, they multiply uncontrollably and form SCC. The DNA contains information and instructions for the cell. But when they get mutated, these cells start growing out of control and form abnormal cancer cells. These cancer cells do not die like normal skin cells.
This DNA mutation is caused by exposure to ultraviolet radiation. Ultraviolet radiation is found in sun rays and commercial tanning lamps and beds. But this theory does not support skin cancers that develop in places hardly exposed to the sun. So it is right to believe that other factors also contribute to the development of SCC. The risk factors that appear to increase the incidence of squamous cell carcinoma are:
It is most common in elderly people (more than 64years of age).
Males are more commonly affected than females.
People who have blond or red hair are more susceptible.
The same goes for people with blue, green, or grey eyes.
Although anyone can get SCC, fair-skinned individuals are more susceptible. This is because they have less melanin in the skin, which are the pigments that protect your skin from the harmful radiation of the sun.
People who get sunburnt easily or have freckles.
People who tan their skin using indoor tanning beds.
Spending the majority of the day under the sun without proper protective clothing.
Individuals with immunocompromised conditions, such as leukemia, lymphoma, AIDS, etc.
Organ transplant patients who take immunosuppressants.
The presence of precancerous skin conditions, such as actinic keratosis or Bowen's disease.
Exposure to chemicals like arsenic.
A history of skin cancer.
Rare genetic conditions like xeroderma pigmentosum, which results in extreme sensitivity to sunlight.
The doctor will examine the skin lesion and note its size, shape, color, and texture. He or she will also check your lymph nodes and other body parts for a similar skin lesion. They will take a detailed medical history to understand if you have any risk factors for SCC or other skin cancer.
If the doctor suspects it to be SCC, then a biopsy or sample of the affected skin is taken and sent for lab testing. The presence of cancerous or abnormal squamous cells are detected under the microscope in the lab. There are four types of skin biopsy, which are:
Shave biopsy - The doctor will shave the top layer of your skin (dermis) using a sharp blade.
Punch biopsy - Here, a sharp and hollow surgical tool is used to punch out a circle of skin.
Incisional biopsy - Part of the skin lesion is removed using a scalpel.
Excisional biopsy - The entire skin lesion along with some surrounding tissue is cut using a scalpel.
If needed, your doctor might also suggest you get the following imaging tests like X-rays, CT scans, MRI scans, and positron emission tomography (PET) scans to see if cancer has metastasized or spread.
Treatment and prognosis of SCC depend on its extent and severity, patient’s overall health, and its location. The prognosis is excellent if detected and treated early. The treatment options include:
Mohs’ micrographic surgery - The doctor removes the abnormal skin along with some of the surrounding tissue using a scalpel. The cutout skin is examined under the microscope for cancer cells. If cancer cells are present, then the procedure is repeated until the sample is free of cancer cells.
Excisional surgery - Here, the surgeon removes cancer cells along with a thin layer of surrounding healthy skin. Then the wound is closed with stitches.
Electrosurgery - Otherwise called curettage or electrodesiccation, it is the method where the lesion is scraped and the surrounding skin is burned off to kill cancer cells.
Cryosurgery - Here, liquid nitrogen is used to freeze and destroy cancer cells.
Radiation therapy - High-energy X-rays are used to kill cancer cells.
Photodynamic therapy (PDT) - A photosensitizing substance is applied to the cancerous areas, after which the area is exposed to strong light for a few minutes.
Laser surgery - Laser is used to remove skin cancer.
Topical medicines - 5-fluorouracil and Imiquimod.
With prompt diagnosis and treatment, SCC can be cured without any complications. But in some aggressive type, cancer cells can migrate to other organs and lymph nodes, which can be fatal.
SCC usually is aggressive if it involves a larger or deeper skin area, if the mucous membrane is involved (like the lips), or if the patient has a week immune system.
Try to follow the following tips to reduce the risk of SCC:
Avoid going out in the sun between 10 AM and 3 PM.
Use sunscreen of at least 30 SPF every day, even during winters.
Wear clothes that cover your hands and legs, and hats to protect your face and head if you go out in the sun.
Do not use tanning beds.
Check your body regularly for abnormal skin growths or lesions.
For more information on squamous cell carcinoma, consult a dermatologist online.
Squamous cell carcinoma is one of the tumors that occurs in the skin. It can be an aggressive condition, but the survival rate is higher. If it is detected early, then it is very easy to cure. It can occur on the skin as a large lesion and spread to different parts of the body.
The treatment for squamous cell carcinoma involves the following:
- The topical application of Fluorouracil and Imiquimod for approximately three to six weeks will help.
- Surgical excision of the tumor, along with the safety margin, will help.
Laser surgery and cryosurgery are also recommended.
- After the surgical procedure, radiation therapy is recommended in a few patients.
Squamous cell carcinoma might appear as a brownish patch or a flat red area of the skin. It is scaly, rough, or crusted. The growth of squamous cell carcinoma is very slow. It is known to occur only in the areas of the skin that are exposed to sunlight. It might include the ears, face, lips, neck, and backs of the hands.
The life expectancy of a patient with squamous cell carcinoma depends on the time taken for diagnosis. In the majority of cases, early detection has helped in faster recovery. An average of less than five percent of the patients are known to suffer severe complications if the carcinoma has spread beyond the skin. In such patients, even aggressive treatment is not known to be helpful.
No, squamous cell carcinoma does not spread fast. Only in some patients, squamous cell carcinoma is known to spread to other parts of the body. It might include the neck, ears, lips, face, and backs of the hands.
The treatment of chemotherapy helps in destroying the cancer cells. This method uses drugs that are very powerful. If squamous cell carcinoma is known to spread to the body's lymph nodes, then chemotherapy is the treatment of choice. It is used together with other forms of treatment, such as radiation therapy.
The following procedures can remove squamous cell carcinoma:
- Mohs surgery.
- Excisional surgery.
- Curettage and electrodesiccation (electrosurgery).
- Laser surgery.
- Topical medications.
- Photodynamic therapy (PDT).
In stage 2, the squamous cell carcinoma is bigger than 2 cm. At this stage, the tumor has not spread to adjacent organs or lymph nodes. If the tumor is larger than two centimeters, then it is considered a high-risk lesion.
All the types of squamous cell carcinoma do not appear suddenly. A variant of squamous cell carcinoma called the keratoacanthoma is a tumor that is known to appear suddenly. It might reach a considerable size. The shape of the lesion is dome-shaped. It is often seen with a keratin plug formation.
Squamous cell carcinoma is more severe and complicated than basal cell carcinoma. The condition of squamous cell carcinoma can spread to other regions. But, basal cell carcinoma does not spread commonly. Squamous cell carcinoma is a malleable condition. It might occur in one region. In the later stages, it can spread cancer to other cells. It can be an aggressive condition.
Squamous cell carcinoma is a malignant condition. It is known to affect the cells by spreading to other parts of the body. It is not a very complicated condition, as the rate of survival is higher.
There are five stages of squamous cell carcinoma. They are:
- Stage 0: Superficial cancer.
- Stage 1: Cancer present on the deeper layers of the skin. It has not spread to the lymph nodes.
- Stage 2: Cancer present on the deeper layers of the skin. It has not spread to the lymph nodes, but it exhibits a higher risk than stage 2.
- Stage 3: Cancer can occur on the lymph nodes along with skin involvement.
- Stage 4: Cancer has spread to other regions such as the liver, lungs, brain, and parts of the skin.
According to the National Comprehensive Cancer Network (NCCN) reports, approximately 70-80 % of squamous cell carcinoma develops within two initial therapy years. A regular follow up with the doctor is necessary after the treatment.
Yes, squamous cell carcinoma can make you feel tired. It can make a person feel weak and exhausted. During the treatment procedures of squamous cell carcinoma, the patient tends to feel more tired. These types of fatigue that are related to cancer are known as cancer-related fatigue (CRF).
Skin cancers like squamous cell carcinoma can hurt a patient. It is often seen along with itching sensation and bleeding. The patient will experience a higher degree of discomfort when the lesion begins to develop in size.
If the squamous cell carcinoma begins to spread, then there would be enlargement of the lymph nodes. It will make the condition worse. The percentage of recurrence is also high in the case of the involvement of lymph nodes.
In the majority of the patients, the time taken for recovery from squamous cell carcinoma surgery is around one or two months to heal. If it is seen along with infection and bleeding, then the time taken to heal prolongs accordingly.
Last reviewed at:
09 Jan 2020 - 5 min read
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