Squamous Cell Carcinoma

The primary cause of skin cancer is frequent and prolonged exposure to UV radiation from the sun that accumulates over years, damaging the skin’s DNA.  When caught early and treated appropriately, SCC is curable in most cases.

What is squamous cell carcinoma?

Cutaneous squamous cell carcinoma is the second most frequent cancer in humans and the second most common type of skin cancer after basal cell carcinoma. It accounts for 20% of skin cancer cases, but it is on the rise due to an aging population.

SCC is commonly found on skin that has been exposed to intense, long-term ultraviolet radiation from the sun and tanning beds. However, SCC can also develop on areas not typically exposed to the sun.

It is more dangerous than basal cell carcinoma due to its ability to metastasize locally and to other parts of the body, causing disfigurement and death.  Every year more than 15,000 Americans die from SCC.

Who is at risk for SCC?

The most significant risk factors include individuals with fair skin, older age, those who have chronic exposure to sunlight or other ultraviolet radiation, and patients who have a suppressed immune system. While, SCC is more common in fair skinned patients, it is the most common type of skin cancer in patients of color.

Other risk factors include:

• A prior BCC or SCC
• A family history of SCC
• A family history of melanoma
• Men are more frequently diagnosed with SCC than women. The majority of diagnoses are made in people over the age of 50. However, women under 40 are diagnosed more often than in the past, likely due to the use of tanning beds.
• Patients who have an organ transplant or suppressed immune systems

SCC is typically found on areas that are aesthetically and functionally important like the face, ears, eyes, lips, nose, and hands. A standard excision often results in a larger surgical defect and scar. Consequently, Mohs micrographic surgery is the option of choice to spare healthy tissues, provide a cosmetically acceptable result, and reduce the risk of recurrence. Dr. Michael Sotiriou is one of the first dermatologists in Utah to be board-certified by the American Board of Dermatology in Mohs micrographic dermatologic surgery.

What are the symptoms of SCC?

Squamous Cell skin cancers appear as firm, red bumps or scaly patches, or sores that won’t heal. SCC can also develop in scars and chronic skin sores.

How is SCC diagnosed?

Dr. Michael Sotiriou is an expert and may suspect SCC merely by its appearance. However, a skin biopsy is necessary to confirm the diagnosis. He will conduct an examination noting the size, appearance, and symptoms of the lesion. He will review the patient’s health history including family history of skin cancer, and whether the individual has previously had skin cancer.

A skin biopsy is the definitive tool to diagnose SCC. It is a simple procedure where the area is numbed with a local anesthetic and part, or all the lesion is removed and examined under a microscope.

What are the treatment options?

Treatment options depend upon the size, location, and depth of the tumor, plus your overall health, age, and the impact of treatment on your appearance. Most SCCs are successfully eliminated by surgical excision, but there is a subset of SCC that have a higher likelihood of recurrence, metastasis and death which will determine the best treatment option.

Treatment options for early stage localized, and low risk SCCs include:

• Surgical excision is the gold standard treatment for localized basal cell and squamous cell carcinoma. It is an in-office procedure performed under local anesthetic. The tumor is cut out along with a wide margin of healthy tissue to ensure all the cancer cells have been removed. The wound in closed with stitches. There will be a scar. The removed tissue is examined in a lab by a pathologist to confirm that all the cancer has been removed. Though rare, if cancer cells are found at the edge of the specimen upon microscopic examination the surgery must be repeated. Cure rates are about 90-94%.
• Mohs Micrographic surgery – Mohs surgery is recommended for SCCs when there is a significant risk of spread or recurrence or when surgical excision would cause disfigurement. Cure rates are about 97-99%.
• Cryotherapy or freezing – this is useful for small and superficial tumors. Liquid nitrogen freezes the cancer cells, and the dead cells fall off. However, it has disadvantages include the potential need for repeated freezing, and side effects including pain, blistering, hypopigmentation, and scarring. This treatment carries a much higher risk of recurrence.
• Electrodessication and Curettage – this involves scraping the growth off and then burning the area with an electric tipped needle. This treatment is repeated several times in one sitting to minimize risk of recurrence.  The advantage to this treatment is it does not require stitches. The disadvantage is it results in a more noticeable scar. Topical therapies – there are several options including topical chemotherapy drugs. This approach is reserved for low-risk superficial tumors. These treatments generally do not cause scarring, but the risk of recurrence is much higher.

Treatment options for recurrent local SCCs include:

• Surgical excision
• Mohs surgery
• Radiation therapy

Treatment for advanced metastatic SCC includes:

• Surgical excision
• Debulking
• Chemotherapy
• Retinoid therapy
• Immunotherapy
• Clinical trials.

When you are concerned about a skin lesion don’t wait! Schedule a consultation with Dr. Michael Sotiriou at Salt Lake Dermatology & Aesthetics to receive the correct diagnosis and treatment.