Understanding Squamous Cell Carcinoma

Squamous cell carcinoma (SCC) is a common type of skin cancer that arises from the squamous cells in the outer layer of the skin. It often appears as a firm, red nodule or a flat lesion with a scaly, crusted surface. SCC is primarily caused by prolonged exposure to ultraviolet (UV) radiation from the sun or tanning beds.

Diagnosis:

The diagnosis of SCC typically involves a clinical examination followed by a biopsy. During the biopsy, a small sample of the suspicious lesion is removed and examined under a microscope to confirm the presence of cancer cells.[1] This step is crucial for determining the appropriate treatment plan.

Treatment:

The primary treatment for SCC is surgical excision, where the tumor is removed along with a margin of healthy tissue to ensure complete removal. For low-risk SCC, options include curettage and electrodesiccation, which involve scraping away the tumor and using electrical current to destroy any remaining cancer cells. This method is effective for small, low-risk lesions with cure rates up to 95%.[2]

For high-risk SCC, Mohs micrographic surgery is often recommended. This technique involves removing the tumor layer by layer and examining each layer under a microscope until no cancer cells remain. Mohs surgery offers high cure rates and preserves as much healthy tissue as possible, making it ideal for tumors in sensitive areas.[2][3]

In cases where surgery is not feasible, radiation therapy may be used. This is particularly useful for patients who cannot undergo surgery or have tumors with positive margins after surgery.[2] For advanced SCC that has spread beyond the skin, systemic therapies such as immunotherapy with PD-1 inhibitors (e.g., cemiplimab) have shown promising results, with response rates of up to 50%. (4,2)

Follow-Up:

Regular follow-up is essential to monitor for recurrence. Patients with low-risk SCC should perform monthly skin self-examinations and have full-body skin examinations every 3 to 12 months for the first two years, then less frequently thereafter. High-risk patients require more frequent follow-ups, including clinical nodal examinations.[2]

Prevention:

Preventive measures include minimizing sun exposure, using sunscreen, and avoiding tanning beds. Regular skin checks by a dermatologist can help detect SCC early when it is most treatable.

Understanding the diagnosis and treatment options for SCC can help patients make informed decisions and improve their outcomes. Come to the doctors at Village Dermatology for evaluation of suspicious skin lesions

References

  1. Cutaneous Squamous Cell Carcinoma: State of the Art, Perspectives and Unmet Needs. Heppt MV, Leiter U. Journal Der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG. 2023;21(4):421-424. doi:10.1111/ddg.15052.

  2. Squamous-Cell Carcinoma of the Skin. Wysong A. The New England Journal of Medicine. 2023;388(24):2262-2273. doi:10.1056/NEJMra2206348.

  3. Consensus for Nonmelanoma Skin Cancer Treatment, Part II: Squamous Cell Carcinoma, Including a Cost Analysis of Treatment Methods. Kauvar AN, Arpey CJ, Hruza G, et al. Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [Et Al.]. 2015;41(11):1214-40. doi:10.1097/DSS.0000000000000478.

  4. Medical Treatment of Advanced Cutaneous Squamous-Cell Carcinoma. Gellrich FF, Hüning S, Beissert S, et al. Journal of the European Academy of Dermatology and Venereology : JEADV. 2019;33 Suppl 8:38-43. doi:10.1111/jdv.16024.