What is Squamous Cell Carcinoma?

Squamous (rhymes with famous) cell carcinoma is the second most common type of skin cancer. There are about 700,000 cases of squamous cell carcinoma each year in the United States.   It comes from squamous cells which form the outer layer of the epidermis (the top layer of skin).  They can grow anywhere on the body, but are far more common in sun exposed areas like the rim of the ear, lower lip, the face, bald scalp, forearms and backs of the hands.  They often look like red or skin colored patches or bumps and are often scaly.  Many times, they look like warts or even just a patch of dry skin.

Unlike basal cell carcinomas which seldom spread, squamous cell carcinomas can get into the lymph nodes and blood and metastasize.  Early treatment almost always prevents this.  The tumors that more often spread are ones that are very large, located on the head, neck, or genitals, and have recurred after a previous treatment.  The overall rate of metastases is about 2%, but metastatic squamous cell carcinoma is difficult to treat and leads to about 2,500 deaths per year.

Who gets Squamous Cell Carcinoma?

There are several risk factors for squamous cell carcinoma:

  • People who have fair skin, light hair, and light colored eyes
  • Anyone with a history of lots of sun exposure, especially people who work outdoors like farmers, ranchers, or construction workers, as well as people who spend a lot of leisure time in the sun such as golfers, boaters, mountain climbers, and gardeners.
  • Anyone who has a different type of skin cancer
  • People who are on long-term immune suppression because of an organ transplant or other medical condition.  Organ transplant patients have a risk of squamous cell cancer that is 65x greater than normal and should be seen each year for surveillance.
  • People with a history of lymphoma or HIV.

Squamous cell carcinoma happens in men at least twice as much as in women.  Its unusual for them to occur before age 50.

People with dark colored skin get very few skin cancers in general, but the majority of skin cancers in African-Americans are squamous cell carcinomas.

What Causes Squamous Cell Carcinoma?

The sun.  Chronic sun exposure is the cause of most squamous cell cancers.

Tanning bed usage also increases the risk of skin cancer by about 2.5x.

Chronic inflammation of the skin also contributes to squamous cell carcinoma and tumors are sometimes seen in burns, scars, ulcers, long-standing sores and sites previously exposed to X-rays or certain chemicals (such as arsenic and petroleum by-products).

What does Squamous Cell Carcinoma Look like?

What are the stages of Squamous Cell Carcinoma

Actinic Keratoses

Actinic keratoses are precancerous lesions.  They show up as rough areas, sometimes pink, red, or brown in color on sun-exposed areas.  2-10% of them turn into squamous cell carcinomas, and most squamous cell carcinomas began as actinic keratoses.

Squamous Cell Carcinoma in Situ

This refers to the first truly cancerous stage of squamous cell carcinoma.  In these lesions, the cancerous cells remain entirely confined to the epidermis, or topmost layer of the skin.

Invasive Squamous Cell Carcinoma

At this stage, the squamous cell carcinoma has broken through the top layer of skin to penetrate more deeply.  At this point, treatment almost always requires surgery for the best outcome.

Treatment

The best treatment depends on the size of the tumor, the location of the tumor, whether the tumor has invaded into the skin, the health status of the patient, and the overall goals of objectives of the patient in their health care.  The various options include:

  1. Treatment with a topical cream called 5-Fluorouracil.  This treatment usually takes 3-6 weeks, has a high success rate, and usually leaves no scar, but is only suitable for actinic keratoses and certain superficial squamous cell carcinomas.
  2. Destruction with electrodessication and curettage or curettage and cryotherapy.  These are office-based treatments that take about 5 minutes.  It is highly effective for superficial squamous cell carcinomas in a low-risk setting.  It usually does leave a scar.
  3. Standard excisional surgery.  Here, the tumor and a safety margin are removed in a quick office surgery that will leave a scar.  This is utilized for larger tumors on the body and small lesions on the face.
  4. Mohs surgery.  This specialized type of surgery involves removing the tumor and a minimal amount of surrounding tissue. The tissue is checked while you wait to ensure that all the tumor has in fact been removed.  If it has not been removed completely, additional tissue is taken and rechecked.  The entire procedure usually takes a half to a full day, but is highly advantageous in areas of the body when there is little tissue to spare. It is also the treatment of choice for tumors that have recurred.
  5. Radiation treatment might be an option for some tumors and sometimes is recommended after removal of particularly high risk lesions.

What happens after treatment?

Treatment is usually curative.

Patients with squamous cell carcinoma are at increased risk of developing additional squamous cell carcinomas. They are also at increased risk of other skin cancers, especially basal cell carcinoma and melanoma.  Good sun protection helps to decrease these risks.