Squamous Cell Carcinoma

Squamous Cell Carcinoma (SCC) is the second most common cancer of the skin. Squamous cell carcinoma is a tumor that arises in the outer layer of the skin (the epithelium). Squamous cell carcinoma is also associated with exposure to the sun’s harmful ultra violet rays. More than 250,000 new SCC’s are diagnosed every year in the U.S. Middle aged and elderly persons, especially those with fair complexions and frequent sun exposure are most likely to be affected. Squamous cell carcinomas begin in the outer layer of the skin and can arise from actinic or solar keratoses (small precancerous scaley growths). If treated in a timely manner, it is uncommon for skin squamous cell carcinoma to spread to lymph nodes or distant organs. There is an increased risk for metastasis when the tumor is large, recurrent, located on the scalp ears, lips, or has aggressive growth characteristics.

How do you get squamous cell carcinoma?

Ultraviolet light exposure (through the sun or tanning parlors) greatly increases the chance of developing skin cancer. Persons with light skin who sunburn easily are at highest risk, although anyone can get squamous cell carcinoma. With increasing age, the risk of developing skin cancer grows. Heavy sun exposure and severe sunburns as a child may especially increase the likelihood of skin cancer.

What does squamous cell carcinoma look like?

A squamous cell carcinoma appears as a crusted or scaly area of the skin, with a red, inflamed base. Squamous cell carcinoma can present as a growing tumor, a non-healing ulcer, ore just as a crust. Any worrisome skin lesions, especially those that are not healing, are growing, bleeding, or changing in appearance, should be evaluated by a dermatologist. A skin biopsy for microscopic examination is usually necessary to confirm the diagnosis.

Where does squamous cell carcinoma appear?

Squamous cell carcinomas are common in sun-exposed areas like the face, neck, and arms. The scalp, back of hands, and ears are especially common. However, SCC can occur anywhere on the body, even on the lips, inside the mouth, and on the genitalia.

How serious is squamous cell carcinoma?

Usually these skin cancers are locally destructive. If left untreated, squamous cell carcinoma can destroy the skin and may result in the loss of a nose or ear. In certain aggressive types of squamous cell carcinoma, especially those on the lips, ears, and scalp, or those that are left untreated, the tumor can spread to the lymph nodes and other organs, resulting in approximately 2,500 deaths each year in the United States.

How do dermatologists treat squamous cell carcinoma?

Dermatologist use a variety of different surgical treatment options depending on location of the tumor, size of the tumor, microscopic characteristics of the tumor, health of the patient, and other factors. Most treatment options are relatively minor office-based procedures that require only local anesthesia. Surgical excision to remove the entire cancer is the most commonly used treatment option. In many instances, Mohs Micrographic Surgery will be recommended.

I have been referred for Mohs Micrographic surgery. What does this mean?

Mohs Microhraphic surgery was named after Dr.Frederick Mohs, a surgeon who invented the technique of examining the removed tissue in a very precise way prior to suturing the wound closed. It is recommended when it is imperitive to attain the highest cure rate, and/or to spare as much normal skin as possible. With Mohs surgery, the entire perimeter and undersurface of the removed tissue are examined while the patient waits, in order to ensure removal prior to reconstruction. Because 100% of the margin gets examined, the Mohs surgeon can minimize the amount of tissue removed, and maximize conservation of healthy/normal tissue.

Mohs micrographic surgery is performed by specially trained dermatologic surgeons who specialize in the removal of skin cancer, and in post operative reconstruction. The skin cancer is removed under local anesthesia in an office setting and microscopic sections are prepared on slides while you wait. Your Mohs surgeon examines the slides to determine if the cancer cells have been removed. If not, additional layers are taken until the cancer is completely excised. The advantage of this technique is that a minimum amount of tissue is removed and all the edges of the specimen are carefully studied. Mohs surgery results in the highest cure rate and in maximal tissue conservation, thus optimizing the cosmetic outcome.

Mohs micrographic surgery is indicated for tumors that are:
      • Located on cosmetically sensitive areas (face)
      • Located on structures where tissue conservation is imperative (eyes, ears, nose, lips)
      • Aggressive in their growth characteristics
      • Persistent or recurrent despite previous treatment
      • Large in size

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