Identifying Squamous Cell Carcinoma

Defining Squamous Cell Carcinoma (Skin Cancer):

Squamous cell carcinoma (SCC) is an uncontrolled growth of abnormal cells arising in the squamous cells, which compose most of the skin’s upper layers (the epidermis). This type of cancer may present itself as open sores, growths with a central depression, or warts. The lesions may crust or bleed.  The risk of death is present and can cause permanent disfigurations. More than 1 million cases of squamous cell carcinoma are diagnosed each year in the U.S., and (depending on different estimates) as many as 8,800 people die from the disease. The cancer is caused and aggravated 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 Squamous Cell Carcinoma.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. Often the skin in these areas reveals telltale signs of sun damage, including wrinkles, pigment changes, freckles, “age spots,” loss of elasticity, and broken blood vessels.

NOTE: People who use tanning beds have a much higher risk of getting SCC. They also tend to get SCC earlier in life.

Identifying SCC:This skin cancer often develops on skin that has soaked up the sun for years. The face, ears, lips, backs of the hands, arms, and legs are common places for squamous cell carcinoma (SCC) to form. Signs include: 

• A bump or lump on the skin that can feel rough.
• As the bump or lump grows, it may become dome-shaped or crusty and can bleed.
• A sore that doesn’t heal, or heals and returns.
• Flat, reddish, scaly patch that grows slowly (Bowen’s disease).
• In rare cases, SCC begins under a nail, which can grow and destroy the nail.

Treatments for Squamous Cell Skin Cancer:

Mohs Surgery

Using a scalpel or curette (a sharp, ring-shaped instrument), a physician trained in Mohs surgery removes the visible tumor with a very thin layer of tissue around it. While the patient waits, this layer is sectioned, frozen, stained and mapped in detail, then checked under a microscope thoroughly. If cancer is still present in the depths or peripheries of this excised surrounding tissue, the procedure is repeated on the corresponding area of the body still containing tumor cells until the last layer viewed under the microscope is cancer-free. Mohs surgery spares the greatest amount of healthy tissue, reduces the rate of local recurrence, and has the highest overall cure rate — about 94-99 percent — of any treatment for SCC. It is often used on tumors that have recurred, are poorly demarcated, or are in hard-to-treat, critical areas around the eyes, nose, lips, ears, neck, hands and feet. After tumor removal,, the wound may be allowed to heal naturally or may be reconstructed immediately; the cosmetic outcome is usually excellent.

Excisional Surgery

The physician uses a scalpel to remove the entire growth, along with a surrounding border of apparently normal skin as a safety margin. The wound around the surgical site is then closed with sutures (stitches). The excised tissue specimen is then sent to the laboratory for microscopic examination to verify that all cancerous cells have been removed. A repeat excision may be necessary on a subsequent occasion if evidence of skin cancer is found in the specimen. The accepted cure rate for primary tumors with this technique is about 92 percent. This rate drops to 77 percent for recurrent squamous cell carcinomas.

Radiation

The physician destroys the tumor tissue by freezing it with liquid nitrogen, using a cotton-tipped applicator or spray device. There is no cutting or bleeding, and no anesthesia is required. The procedure may be repeated several times at the same session to help ensure destruction of all malignant cells. The growth becomes crusted and scabbed, and usually falls off within weeks. Redness, swelling, blistering and crusting can occur following treatment, and in dark-skinned patients, some pigment may be lost. Inexpensive and easy to administer, cryosurgery may be the treatment of choice for patients with bleeding disorders or intolerance to anesthesia. However, it has a lower overall cure rate than the surgical methods. Depending on the physician’s expertise, the 5-year cure rate can be quite  high with selected, generally superficial squamous cell carcinoma; but cryosurgery is not often used today for invasive SCC  because deeper portions of the tumor may be missed and because scar tissue at the cryotherapy site might obscure a recurrence.

If you believe you are in need of a skin cancer screening or have been diagnosed and require treatment, please contact the Orlando Dermatology Center at your earliest convenience.