Squamous Cell Carcinoma

Squamous cell carcinoma is the second most common cancer of the skin. More than 250,000 new squamous cell carcinomas are diagnosed every year in the United States

The cancer develops in the outer layer of the skin (the epithelium). Some squamous cell carcinomas arise from small sandpaper-like lesions called solar (sun) or actinic keratosis.

It is possible for squamous cell carcinoma to spread to other areas of the body so early treatment is important.

What does squamous cell carcinoma look like and where does it appear?

Squamous cell carcinomas usually appear as crusted or scaly patches on the skin with a red, inflamed base, a growing tumor, or a non-healing ulcer. They are generally found in sun-exposed areas like the face, neck, arms, scalp, backs of the hands, and ears.

The cancer also can occur on the lips, inside the mouth, on the genitalia, or anywhere on the body.

Note: Any lesion, especially those that do not heal, grow, bleed, or change in appearance, should be evaluated.

What are factors that cause squamous cell carcinoma?

Ultraviolet light exposure (from the sun or indoor tanning devices) greatly increases the chance of developing skin cancer. Although anyone can get squamous cell carcinoma, people with light skin who sunburn easily are at the highest risk. The chance of developing skin cancer increases with age and a history of severe sunburns as a child.

How serious is squamous cell carcinoma?

These skin cancers are usually locally destructive. Untreated squamous cell carcinoma can destroy much of the tissue surrounding the tumor and may result in the loss of a nose or ear, for example.

Aggressive types of squamous cell carcinomas, especially those on the lips and ears, or untreated cancers, can spread to the lymph nodes and other organs which can become fatal.

How is Squamous Cell Carcinoma treated?

A skin biopsy for microscopic examination may be done to confirm the diagnosis. A variety of different treatment options are available in our office:

MOHS MICROGRAPHIC SURGERY

Using local anesthesia, the tumor is removed with a very thin layer of tissue around it. The layer is immediately checked under a microscope thoroughly. If tumor is still present in the depths or peripheries of this surrounding tissue, the procedure is repeated until the last layer examined under the microscope is tumor-free.

This technique saves the greatest amount of healthy tissue and has the highest cure rate, generally 98 percent or better. It is frequently used for tumors that have recurred, are poorly demarcated, or are in critical areas around the eyes, nose, lips, and ears. After removal of the skin cancer, the wound may be allowed to heal naturally or be reconstructed using cosmetic surgery methods.

EXCISIONAL SURGERY

After numbing the area with local anesthesia, we remove the entire growth along with a surrounding border of normal skin as a safety margin. The skin around the surgical site is then closed with stitches, and the excised tissue is sent to the laboratory for microscopic examination to verify that all malignant cells have been removed.

The effectiveness of the technique does not match that of Mohs, but is highly effective.

CURETTAGE AND ELECTRODESICCATION

Using local anesthesia, the physician scrapes off the cancerous growth with a curette (a sharp, ring-shaped instrument). The heat produced by an electrocautery needle destroys residual tumor and controls bleeding. This technique may be repeated twice or more to ensure that all cancer cells are eliminated. It can produce cure rates approaching those of surgical excision, but may not be as useful for aggressive basal cell carcinomas or those in high-risk or difficult sites.

CRYOSURGERY

Tumor tissue may be destroyed by freezing with liquid nitrogen, without the need for cutting or anesthesia. The procedure may be repeated at the same session to ensure total destruction of malignant cells.

The growth becomes crusted and scabbed, and usually falls off within weeks. Cryosurgery is effective for the most common tumors and is the treatment of choice for patients with bleeding disorders or an intolerance to anesthesia.

PHOTODYNAMIC THERAPY