Squamous Cell Carcinoma

Did you know that squamous cell carcinoma (SCC) is the second most commonly diagnosed form of skin cancer? In fact, more than 1 million people will be diagnosed with SCC each year in the U.S.  Each year, roughly 58 million people living in the US will be diagnosed with a precancerous lesion, called an actinic keratosis, which can be a precursor to SCC. Though uncommon, SCC has the potential to spread to lymph nodes, organs, and other tissue, which is why early diagnosis is so important.

What exactly is squamous cell carcinoma?

A SCC is a skin cancer that occurs from damage to a kind of flat, thin skin cell, called a squamous cell, located on the skin (as well as other places on the body). When damage is done to these cells, or these cells become more susceptible to DNA changes due to immune system suppression, the result can be development of a SCC. Typically, ultraviolet (UV) radiation (sunlight) is the major cause for developing this kind of skin cancer, though other factors (discussed below) may play a role in the development of SCCs.

What are the risk factors for developing a SCC?

Though anyone can develop SCC, some people are at higher risk. These factors increase your risk of developing SCC:

• Fair skin
• UV exposure
  • Includes use of tanning beds or spending time in the sun
  • Includes anyone with a job (including previous jobs) working outdoors, or anyone with outdoor hobbies
• Previous history of skin cancer, including basal cell carcinomas, or pre-cancerous growths called actinic keratoses
• Age over 50
• Male gender
• Chronic infections / skin inflammation / skin trauma (burns, scars, etc)
• Immune system suppression, due to illness or certain medications
• People who have received an organ transplant
• History of HPV infection

What does a SCC look like?

There is no “typical” presentation of SCCs – they can vary greatly in appearance. Just like with basal cell carcinomas, SCCs have different subtypes that can look different from one another. Alert your dermatology provider at Pacific Dermatology & Cosmetic Center should you notice any of the following:

• A rough, pink or red scaly patch that may crust or bleed on your skin, inside your mouth, or on your lips
• A non-healing sore that is flat or round
• A firm red nodule that may or may not be painful or sore
• Growths or sores that resemble warts, or are raised at the edges with a depressed center that may itch or bleed
• Irregular or new growths on scars or areas of trauma

Though the above outlines the more common presentations of SCC, remember that SCC can present differently than these descriptions. Typically, SCCs develop on sun-exposed areas, though it is not uncommon to develop SCC in areas that aren’t exposed to sun – including in the mouth and on genitals.

How is SCC treated?

We offer many treatment options here at Pacific Dermatology & Cosmetic Center for SCC. Dr. Reichel and her team will choose the appropriate treatment depending on the subtype, size, and location of the SCC. Some of the treatments options for SCC include:

Excisional Surgery: This treatment method is commonly used for a few different types of SCC. Dr. Reichel or one of her highly trained staff members will remove the SCC with a scalpel, after you have been fully and completely numbed. A small amount of healthy tissue (called a “margin”) will also be excised, to ensure complete removal. That tissue is sent to a laboratory where a dermatopathologist (a dermatologist who specializes in diagnosing disorders of the skin under a microscope) will make sure that all of the SCC has been removed.

Mohs Micrographic Surgery (commonly referred to as “Mohs”): This treatment option is similar to an excisional surgery, with some key differences. Mohs surgery is performed as an outpatient procedure in the surgical suite of Pacific Dermatology & Cosmetic Center, and is performed during a single visit, in stages. Dr. Reichel will excise the SCC along with a small margin of tissue around and beneath the SCC, and will then assess that tissue under the microscope while you wait in our very comfortable & private surgical waiting room. These steps will be repeated until all of the cancerous tissue has been removed, and only healthy tissue remains. Mohs is commonly referred to as the “Gold Standard” because it has the highest cure rate at about 97%, while preserving the most amount of healthy tissue possible, minimizing potential scarring. It is often the treatment of choice for larger SCCs, SCCs with ill-defined borders, or SCCs on sensitive areas, including the face, scalp, hands, feet, and genitals.

Electrodessication & Curettage (ED&C): This procedure is an option for superficial or small SCCs, and is performed by Dr. Reichel or one of her highly trained staff. You will first be numbed completely with a local numbing agent to ensure complete comfort. Then, your provider will scrape the SCC with a sharp metal tool called a curette, and will burn the cancerous tissue with an instrument called electrocautery, or a hyfrecator. This will be repeated until all of the cancerous tissue is destroyed.

Cryosurgery: This treatment option is utilized for small, superficial SCCs. Liquid nitrogen is sprayed on the SCC using a cryogen tank. The area treated will get red, and may get blistered and scab over, eventually falling off and leaving healthy skin to arise. This procedure is quick and has great outcomes, with cure rates between 85-90%.

Treating Advanced SCC: Fortunately, 95% of SCCs remain confined to the skin, and are easily treated. However, 5% of SCC cases become advanced, and spread to surrounding lymph nodes, tissues, or organs. For advanced SCC, radiation may be used after surgery, or in combination with other treatments. In 2018, a new immunotherapy medication called Libtayo® was FDA approved for the treatment of advanced SCCs.

What to know after a SCC diagnosis:

Once you have developed one SCC, you are at higher risk for developing another. It is important to have regular check-ups at Pacific Dermatology & Cosmetic Center, as well as doing your own monthly at-home skin check. Alert your dermatology provider at Pacific Dermatology & Cosmetic Center should you be concerned about any new or changing growths.

The best protection against developing SCC is photoprotection – simply using sunscreen appropriately will drastically decrease your risk of developing this skin cancer. Let us help you explore our large selection of medical-grade sunscreen we have here at Pacific Dermatology & Cosmetic Center – we have sunscreens for all skin types and skin concerns, from sensitive skin to acne-prone skin to skin prone to hyperpigmentation.