Alternative Name

Cancer - skin - squamous cell; Skin cancer - squamous cell; Nonmelanoma skin cancer - squamous cell; NMSC - squamous cell

Overview

Squamous cell carcinomas are the second most common skin cancer. These can occur anywhere, but are found most frequently on chronically sun exposed skin. The metastatic potential of Squamous cell carcinomas are higher than that of Basal cell carcinomas and so early detection is important.

Actinic keratoses are felt by most to be pre-cancerous areas on chronically sun exposed areas. A portion of these if left alone may progress to Squamous cell carcinoma and so it is best to treat these as well.

Review Date: 5/12/2011

Reviewed By: Sandra Osswald, MD

Risk Factors

There are many factors that may increase your risk. These are some factors to consider:

Sun exposure is a very important risk factor.  Chronic sun exposure, history of sunburns and indoor tanning may increase your risk of skin cancer.

Having fair skin and light hair/eyes such as blond or red hair and blue or green eyes may increase your risk.

Family history of skin cancer

Personal history of a previous skin cancer

Males over 50 years of age

History of radiation treatments or chemical carcinogens

History of immunosuppression, such as organ transplant patients requiring chronic medications to weaken their immune system

Chronic wounds/scarring conditions

Certain subtypes of Human papillomavirus

Inherited syndromes such as Xeroderma pigmentosa

Signs/Symptoms

Fortunately, the skin is part of our body that we can examine every day. Squamous cell carcinoma can occur anywhere, but is often related to sun exposure so it often occurs on areas exposed to the sun, particularly the face, upper body, arms and lower legs. Particularly critical areas are the ears and lesions on the lips.  A skin growth that is new or changing should alert you to it.  A spot that is painful, itches, erodes or bleeds, or scabs over are potential signs.  Pay attention as well to a sore that does not seem to heal. 

Squamous carcinomas have varying appearances.  Common appearances are a scaly or crusted, pink or red, firm nodule.  These can also appear as a chronic sore or ulceration that does not heal or bleeds easily.

Actinic keratoses commonly look like pink or red patches with overlying scale or hard crust.

If you discover any worrisome findings, consider getting a professional full skin examination.

Diagnosis

Diagnosis begins with a skin examination. A specialized lighted device, called a dermatoscope, is sometimes used to examine certain lesions carefully. If there are any suspicious lesions noted on examination, your doctor may ask if you would agree to a skin biopsy. This procedure involves removing the lesion or a sample of the lesion of concern so that it may be sent for pathologic evaluation. Pathologic evaluation can determine if the lesion is a skin cancer and if so, what type of skin cancer it is. Biopsies can usually be performed as an outpatient office procedure under local anesthesia. When the pathology is reviewed, you are then notified of the results and if any further testing or treatment is recommended.

Treatment

Treatment for skin cancer will depend on the type, size and extent of the skin cancer.  Smaller skin cancers may be treated by your Dermatologist, while certain cancers on the face or larger or more extensive skin cancers may require Mohs surgery and/or multidisciplinary care.  Our Mohs surgeon has specialty training in this technique and is located with our CTRC clinic.  If multidisciplinary care is required, we will often coordinate efforts among our many available subspecialties.  Specialties that we often coordinate with include our colleagues in Medical and Surgical Oncology, ENT, Ophthalmology, Plastic Surgery, Nuclear medicine and Radiation therapy.

Treatment options will be discussed with you.  Treatment options may include:

Cryotherapy or freezing lesions with liquid nitrogen.  This is treatment often used to destroy small precancerous lesions, such as actinic keratoses.

Electrodesiccation and curettage.  This treatment may be used for superficial skin cancers.  The doctor will scrape away cancer cells using a curette and use an electric needle to destroy cancer cells.

Excisional surgery.  The doctor will cut out or excise the tumor with a margin of healthy tissue.  The margin of tissue will depend on the type and extent of the skin cancer.  Usually, this tissue is sent for pathologic evaluation.

Mohs surgery.  This procedure is used for skin cancers that need to be removed from areas such as the face or digits, where there is not a lot of normal tissue to spare.  This procedure allows skin cancer to be removed without taking an excessive amount of surrounding normal tissue.  Mohs surgery gives excellent curative rates as 100% of the margin is evaluated for tumor.  This technique is also best for larger, recurrent or more aggressive tumors where looking at the entire margin is critical.

Blu-U photodynamic therapy.  This procedure involves using a topical medicine that makes cancer cells sensitive to light and then applying light therapy to destroy cancer cells.

Chemotherapy, topical and systemic, and biologic therapies.  There are a variety of topical medications, such as 5 fluorouracil (Efudex, Carac), and systemic medications that can be used to destroy cancerous cells, as well as immunomodulators that can alter your immune system.

Radiation therapy.  Radiation therapy can be used particularly for patients in whom surgery is not the best option as well as for adjunctive treatment.

Prevention

There are many ways you can help prevent skin cancer.

Seek the shade, especially between 10am and 4pm

Cover up your skin with dark, tight woven clothing over your arms and legs; wear large brimmed hats and sunglasses

Wear sunscreen everyday that provides broad spectrum coverage, both UVA and UVB, and is at least SPF 30

Don't use tanning beds and don't burn

Examine your skin from head to toe every month and see your doctor every year for a professional skin examination

Dermatology

If you would like to request an appointment with a physician, or if there is a direct referral from a physician, please call:

Appointments: (210) 450-9840

Fax: (210) 450-6092