Squamous Cell Carcinoma

What is squamous cell carcinoma?

Squamous cell carcinoma is a more aggressive type of non-melanoma skin cancer. It is the second most common type of skin cancer in the U.S. If left untreated, it may spread, and sometimes cause death. It grows much faster compared to basal cell carcinoma.

What are the possible causes and risk factors for squamous cell carcinoma?

Long-term exposure to ultraviolet radiation from sun or tanning devices, a fair skin,  X-ray treatments, long-lasting non-healing sores or scarring conditions, poor immune system, or use of  immunosuppressing medicines as in organ-transplant patients, and infection with certain types of human papilloma viruses are risk factors and possible causes of squamous cell carcinoma.

How does squamous cell carcinoma look and feel like?

Squamous cell carcinoma may look like a rough, scaly and red area or bump anywhere on the skin, but mostly on the face, ears and backs of the hands. It can be painful when touched, but it does not have to have any abnormal feeling. It sometimes may bleed, and cause an open sore (ulcer) and crust on the skin.

OK, I think I have a squamous cell carcinoma, what should I do?

You should see your health care provider who will hear your story and examine the spot. Usually a good physical exam with touching the spot, and looking at it with special instrument called a dermatoscope (a handheld instrument that looks similar to battery lamp, but with special system of polarized lenses and LED light that enables your health care provider to take deeper look into the skin. It is usually used by dermatologists) will be enough to decide if a biopsy is needed.

A man is examining the arm of another person.
Dermatoscopic examination of the skin

A skin biopsy is a cutting a small sample of the changing skin off to be looked under microscope. There are two types of biopsies, both performed under the local anesthesia and both taking about 5 -10 minutes to perform – a shave biopsy and a punch biopsy.

Shave biopsy is the most common type since it is usually preferred both by patients and by their health care providers, since it does not require placement of stitches and is faster. Your health care provider will numb the skin with small amount of fast acting local anesthetic and then use a razor blade or a more sophisticated instrument called a Dermablade (our favorite), which is actually a razor blade with handles that enable your healthcare provider to have a better control over the depth of the biopsy. Afterwards, the bleeding is stopped by using special liquid called aluminum chloride (which is, by the way, the active ingredient in many anti-sweating deodorants). Then plain Vaseline or a double antibiotic ointment and bandage are placed on the biopsy wound.

Punch biopsy is also a very fast procedure, where your health care provider will numb the skin with small amount of fast acting local anesthetic and then sterilize the skin using special cleansing swabs soaked with povidone-iodine, or chlorhexidine gluconate, put sterile drape over the area, and then use a pen-like cylindrical instrument called a punch, which looks like a very small cookie-cutter that would produce small cylindrical specimen with diameter of about 4 mm and depth of about 5-8 mm. We usually close the wound and stop the bleeding by placing a nylon stitch that should be removed in 1-2 weeks. Then plain Vaseline or a double antibiotic ointment and bandage are placed on the biopsy wound.

The results of the skin biopsy are usually available within 1-2 weeks. We always call our patients with all the results. Please, never agree to a policy of “no news is good newsâ€, since results may be misplaced with possible bad outcome to your health.

A person is getting their arm shaved by another person.
Shave biopsy

I have just been diagnosed with squamous cell carcinoma, what now?

Your health care provider should make a treatment plan depending on biopsy results, the size of the cancer and its location on your skin. There are several treatment options depending on the microscopic type of squamous cell carcinoma, its overall size and its location on your skin:

  • 5% fluorouracil cream (brand name Efudex) for the squamous cell carcinoma-in-situ (i.e. the cancer that did not get deep into the skin) – this is off-label use (i.e. it is not FDA approved indication).
  • 5% imiquimod cream (brand name Aldara), also for the squamous cell carcinoma-in-situ – this is off-label use (i.e. it is not FDA approved indication).
  • Freezing the cancer off using liquid nitrogen (medical name is cryotherapy). It is used for the squamous cell carcinoma-in-situ.
  • Curettage (i.e. scraping the cancer off with a sharp instrument called curette) followed by electrodesiccation or aluminum chloride soaks. It is usually used for the squamous cell carcinoma-in-situ .
  • Excision, which is cutting the cancerous skin off with a scalpel together with the rim of a normal looking skin around the cancer to ensure its complete removal.
  • Mohs surgery (named after its inventor Dr. Frederic E. Mohs) is a microscopically controlled excision of the cancer in order to achieve the complete removal of the cancer, but with the smallest possible wound and scar. It is used for cancers on cosmetically sensitive areas (nose, ears, eyelids etc.), for  more aggressive squamous cell carcinomas and for those that have come back after the previous treatment.
  • X-ray therapy. It is used for selected squamous cell carcinomas when patients are not good candidates for the options mentioned above, or when the patient declines the other options.

I had my treatments, but what now?

 You should have regular skin exams by your board certified dermatologist, or your health care provider (e.g. in 3 months after the treatment then every 6 months for 2 years, then a little bit less often depending on the findings).

How can I prevent squamous cell carcinoma?

The best would be to stay away from sun, or at least seek shade between 10 a.m. and 2 p.m., wear lightweight, loose-fitting long-sleeved shirts, pants, a  wide-brimmed hat and sunglasses. In good old times ladies wore gloves and carried parasols as well.  Also avoid use of any indoor tanning devices. Second step would be to generously apply a broad-spectrum sunscreen with a SPF (Sun Protection Factor) of at least 30. Our family favorite is Banana Boat Kids SPF 50  (with titanium dioxide and zinc oxide), which is, by the way, one of the cheapest sunscreens.

Also, avoid any tanning, since tan is a sign of skin’s struggle with a genetic damage caused by the ultraviolet radiation. Not everyone who tans will get skin cancer, but everyone will age much faster. Therefore, if you want to preserve your youthful look, please consider the information above.  We also like to point one fact to our patients – The Sun is a humongous nuclear reactor in the sky, and there is only an empty space between you and that nuclear reactor. When you think like that, it is a bit easier to follow the above recommendations. Worth of mentioning is an iconic Slip-Slop-Slap sun protection campaign in Australia during the 1980s.

It stands for:

Slip on a shirt,

Slop on the 30+ sunscreen,

Slap on a hat

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