How Is Squamous Cell Skin Cancer Of The Head And Neck Diagnosed
Diagnosis is made by clinical exam and a biopsy. Squamous cell cancers are staged by size and extent of growth. Squamous cell cancers can metastasize to nearby lymph nodes or other organs, and can invade both small and large nerves and local structures.
Biopsy can help determine if the squamous cell cancer is a low-risk tumor or a high-risk tumor that requires more aggressive treatment. Low-risk tumors are less than 10 millimeters in size, less than or equal to 5 millimeters deep and do not involve structures beyond the surrounding fat. High-risk tumors in the head and neck are those that involve the central face, nose and eye area, as well as those tumors that are greater than or equal to 10 millimeters on the cheeks, scalp and neck, tumors that are more than 5 millimeters thick or involve adjacent structures, tumors that invade nerves, tumors that are recurrent or arising from previously radiated tissue, and tumors arising in patients who are immunosuppressed.
Treating Advanced Squamous Cell Cancers
Lymph node dissection:Removing regional lymph nodes might be recommended for some squamous cell cancers that are very large or have grown deeply into the skin, as well as if the lymph nodes feel enlarged and/or hard. The removed lymph nodes are looked at under a microscope to see if they contain cancer cells. Sometimes, radiation therapy might be recommended after surgery.
Immunotherapy: For advanced squamous cell cancers that cant be cured with surgery or radiation therapy, one option might be using an immunotherapy drug such as cemiplimab or pembrolizumab . However, these drugs havent been studied in people with weakened immune systems, such as people who take medicines for autoimmune diseases or who have had an organ transplant, so the balance between benefits and risks for these people isnt clear.
Systemic chemotherapy and/or targeted therapy:Chemotherapy and targeted therapy drugs might be other options for patients with squamous cell cancer that has spread to lymph nodes or distant organs. These types of treatment might be combined or used separately.
Treating Squamous Cell Skin Cancer: By Stage
When selecting a therapy for your squamous cell skin cancer, you and your doctor will discuss the stage of your disease, any other medical conditions you may have, and your personal preferences for different types of therapy. This section reviews recommendations for therapy by stage and provides some guidance on how to weigh the efficacy, safety, convenience, and other treatment factors that are important to you.
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Skin Cancer Types: Squamous Cell Carcinoma Overview
All content solely developed by the American Academy of Dermatology
The American Academy of Dermatology gratefully acknowledges the support from Sanofi Genzyme and Regeneron.
Squamous cell carcinoma of the skin
What is squamous cell carcinoma of the skin?A common type of skin cancer, squamous cell skin cancer can develop from a pre-cancerous skin growth called an actinic keratosis .
Is it contagious? No
Skin Color And Being Exposed To Sunlight Can Increase The Risk Of Basal Cell Carcinoma And Squamous Cell Carcinoma Of The Skin
Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesnt mean that you will not get cancer. Talk with your doctor if you think you may be at risk.
Risk factors for basal cell carcinoma and squamous cell carcinoma of the skin include the following:
- Being exposed to natural sunlight or artificial sunlight over long periods of time.
- Having a fair complexion, which includes the following:
- Fair skin that freckles and burns easily, does not tan, or tans poorly.
- Blue, green, or other light-colored eyes.
- Red or blond hair.
Although having a fair complexion is a risk factor for skin cancer, people of all skin colors can get skin cancer.
Older age is the main risk factor for most cancers. The chance of getting cancer increases as you get older.
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Basal Cell Carcinoma Squamous Cell Carcinoma Of The Skin And Actinic Keratosis Often Appear As A Change In The Skin
Not all changes in the skin are a sign of basal cell carcinoma, squamous cell carcinoma of the skin, or actinic keratosis. Check with your doctor if you notice any changes in your skin.
Signs of basal cell carcinoma and squamous cell carcinoma of the skin include the following:
- A sore that does not heal.
- Areas of the skin that are:
- Raised, smooth, shiny, and look pearly.
- Firm and look like a scar, and may be white, yellow, or waxy.
- Raised and red or reddish-brown.
- Scaly, bleeding, or crusty.
Basal cell carcinoma and squamous cell carcinoma of the skin occur most often in areas of the skin exposed to the sun, such as the nose, ears, lower lip, or top of the hands.
Signs of actinic keratosis include the following:
- A rough, red, pink, or brown, scaly patch on the skin that may be flat or raised.
- Cracking or peeling of the lower lip that is not helped by lip balm or petroleum jelly.
Actinic keratosis occurs most commonly on the face or the top of the hands.
Squamous Cell Carcinoma Risk Factors
Certain things make you more likely to develop SCC:
- Older age
- Blue, green, or gray eyes
- Blonde or red hair
- Spend time outside, exposed to the sun’s UV Rays
- History of sunburns, precancerous spots on your skin, or skin cancer
- Tanning beds and bulbs
- Long-term exposure to chemicals such as arsenic in the water
- Bowens disease, HPV, HIV, or AIDS
Your doctor may refer you to a dermatologist who specializes in skin conditions. They will:
- Ask about your medical history
- Ask about your history of severe sunburns or indoor tanning
- Ask if you have any pain or other symptoms
- Ask when the spot first appeared
- Give you a physical exam to check the size, shape, color, and texture of the spot
- Look for other spots on your body
- Feel your lymph nodes to make sure they arent bigger or harder than normal
If your doctor thinks a bump looks questionable, theyll remove a sample of the spot to send to a lab for testing.
Continued
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How Serious Is A Squamous Cell Carcinoma
Id had a few skin cancers removed before, all basal cell carcinomas , the most common type. But when I was diagnosed with a squamous cell carcinoma on my scalp, it seemed different, and a little more scary. I asked C. William Hanke, MD, a Mohs surgeon at the Laser and Skin Surgery Center of Indiana and a senior vice president of The Skin Cancer Foundation, what we need to know about this second most common form of skin cancer.
Q: When people talk about nonmelanoma skin cancers, they tend to lump basal cell and squamous cell carcinomas together as the ones that are far less dangerous than melanoma. Should we take SCCs more seriously?
Dr. Hanke: Yes and no. BCCs hardly ever metastasize. Ive seen two cases in my entire career. But when SCCs that havent been treated early get big, then the chance of metastasis becomes real. Its uncommon, but its much more common than in BCC. We see it in our practice. But we dont want to scare people into thinking that just because they have squamous cell, Oh wow, Ive got a chance of metastasis. Remember, the rate is very low. Its just those big ones.
Q: OK, so its rare. But what happens when an SCC does spread?
Q: Whats the usual treatment for SCCs?
Q: How can we detect SCCs as early as possible?
What Is Cutaneoussquamous Cell Carcinoma
Cutaneous squamous cell carcinoma is a common type of keratinocytecancer, or non-melanomaskin cancer. It is derived from cells within the epidermis that make keratin the horny protein that makes up skin, hair and nails.
Cutaneous SCC is an invasive disease, referring to cancer cells that have grown beyond the epidermis. SCC can sometimes metastasise;and may prove fatal.
Intraepidermal carcinoma and mucosal SCC are considered elsewhere.
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What Are The Clinical Features Of Cutaneous Squamous Cell Carcinoma
Cutaneous SCCs present as enlarging scaly or crusted lumps. They usually arise within pre-existing actinic keratosis or intraepidermal carcinoma.
- They grow over weeks to months
- They may ulcerate
- They are often tender or painful
- Located on sun-exposed sites, particularly the face, lips, ears, hands, forearms and lower legs
- Size varies from a few millimetres to several centimetres in diameter.
Cutaneous squamous cell carcinoma
Stages Of Metastatic Squamous Neck Cancer With Occult Primary
Once metastatic squamous neck cancer with occult primary is found, more tests will be done to find out how far the cancer cells have spread. This is called staging. A doctor needs to know the stage of the disease to plan treatment. The following stages are used for metastatic squamous neck cancer with occult primary:
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Certain Factors Affect Prognosis And Treatment Options
The prognosis for squamous cell carcinoma of the skin depends mostly on the following:
- Stage of the cancer.
- Whether the patient is immunosuppressed.
- Whether the patient uses tobacco.
- The patient’s general health.
Treatment options for basal cell carcinoma and squamous cell carcinoma of the skin depend on the following:
- The type of cancer.
- The stage of the cancer, for squamous cell carcinoma.
- The size of the tumor and what part of the body it affects.
- The patients general health.
Head And Neck Cancer Stages
While staging head and neck cancer, the pathologist determines where exactly the disease formed, how extensive it is and whether and how much it has spread. The stage of head and neck cancer is one of the most important factors in determining treatment options;that may be tailored to your needs.
Head and neck cancer stages are typically based on the results of physical exams, endoscopies, biopsies;and imaging tests, such as CT scans, MRIs, chest X-rays;and/or PET scans.
The American Joint Committee on Cancer developed the TNM cancer staging system to evaluate three primary factors when it comes to treating cancer:
T :;This refers to the size of the primary tumor and to which, if any, tissues in the oral cavity and oropharynx the cancer has spread.
N :;This;describes the involvement of lymph nodes near the primary tumor. Lymph nodes are small, bean-shaped clusters of immune system cells that are key to fighting infections and are usually one of the first sites in the body to which cancer spreads.
M :;This;indicates whether the cancer has spread to other areas of the body. With oral cancer, the most common site of metastases is the lungs, followed by the liver and bones.
Stage 0: The tumor is only growing in the part of the head and neck where it started. No cancer cells are present in deeper layers of tissue, nearby structures, lymph nodes or distant sites .
Stage 3 head and neck cancer: The tumor fits one of the following criteria:
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Stages Of Squamous Cell Carcinoma Of The Esophagus
Squamous cell carcinoma of the esophagus is staged differently than adenocarcinoma of the esophagus.
The most common staging system for SCC of the esophagus is the TNM system. For SCC of the esophagus there are 5 stages stage 0 followed by stages 1 to 4. Often the stages 1 to 4 are written as the Roman numerals I, II, III and IV. Generally, the higher the stage number, the more the cancer has spread. Talk to your doctor if you have questions about staging.
In some cases, the stage also depends on where the tumour is located along the esophagus the upper, middle or lower part.
The stages of SCC of the esophagus also depend on the grade.
Find out more about and .
The esophagus is made up of different layers of tissues. The stage often depends on which layer the tumour has grown into.
Classification Of Squamous Cell Carcinoma By Risk
Cutaneous SCC is classified as low-risk or high-risk, depending on the chance of tumour recurrence and metastasis. Characteristics of high-risk SCC include:
High-risk cutaneous squamous cell carcinoma has the following characteristics:
- Diameter greater than or equal to 2 cm
- Location on the ear, vermilion of the lip, central face, hands, feet, genitalia
- Arising in elderly or immune suppressed patient
- Histological thickness greater than 2 mm, poorly differentiated histology, or with the invasion of the subcutaneous tissue, nerves and blood vessels
Metastatic SCC is found in regional lymph nodes , lungs, liver, brain, bones and skin.
High-risk cutaneous squamous cell carcinoma
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Squamous Cell Carcinoma Treatment
Squamous cell carcinomas detected at an early stage and removed promptly are almost always curable and cause minimal damage. However, left untreated, they may grow to the point of being very difficult to treat.
A small percentage may even metastasize to distant tissues and organs. Your doctor can help you determine if a particular SCC is at increased risk for metastasis and may need treatment beyond simple excision.
Fortunately, there are several effective ways to treat squamous cell carcinoma. The choice of treatment is based on the type, size, location, and depth of penetration of the tumor, as well as the patients age and general health. Squamous cell carcinoma treatment can almost always be performed on an outpatient basis.
Squamous Cell Lung Carcinoma Outlook
The outlook for non-small cell lung cancers, such as squamous cell carcinoma, is better than for small cell lung carcinomas. Its also better when its caught and treated early. In fact, it can even be cured if caught early enough.
The outlook for people with cancer is measured by 5-year survival rates. This indicates the percentage of people who have a specific type of cancer who are alive 5 years or more after getting a diagnosis.
The American Cancer Society uses data from the National Cancer Institute to track the average 5-year survival rates for non-small cell lung cancers. It does this based on if and how cancer has spread:
- Localized: This is non-small cell lung cancer that hasnt spread outside of the lung. The 5-year survival rate is 63 percent.
- Regional: This is non-small cell lung cancer that has spread to the lymph nodes and other nearby organs in the chest. The 5-year survival rate is 35 percent.
- Distant: This is when non-small cell lung cancer has spread to more distant organs of the body, such as the liver, brain, or bones. The 5-year survival rate is 7 percent.
Its important to remember that these percentages are only a guide based on averages. Everyone is different. The percentages show that the key to having the best outlook is early detection and treatment before cancer spreads.
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What Causes Squamous Cell Carcinoma
Repeated exposure to ultraviolet light, either from the sun or from tanning beds, is the main cause of SCC. Indoor tanning is linked to about 168,000 cases of SCC in the US each year.
People with light skin, light hair , and light eyes have a higher risk of skin cancer in general, as well as SCCs. However, most of the skin cancers that develop in African Americans are SCCs.
Other risk factors include:
- Having an impaired immune system, including:
- Cancers of the blood or bone marrow.
- Chronic infections like HIV.
- Taking immunosuppressive medications, including chemotherapy or some biologic medications.
How Common Is Squamous Cell Carcinoma
Over 1 million people are diagnosed with SCC in the US each year. The incidence of SCC has risen about 200 percent over the past 30 years. There are more than 15,000 deaths each year in the US from SCC. Excluding head and neck SCC and CSCC in situ, about 200,000-400,000 new cases of SCC are diagnosed in the US every year, resulting in about 3,000 deaths.
Men are about two times more likely than women to develop SCCs. People over the age of 50 are most likely to get SCCs, but the incidence has been rising in younger people.
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Treating Squamous Cell Carcinoma Of The Skin
Treatment options for squamous cell skin cancer depend on the risk of the cancer coming back, which is based on factors like the size and location of the tumor and how the cancer cells look under a microscope, as well as if a person has a weakened immune system.
Most squamous cell skin cancers are found and treated at an early stage, when they can be removed or destroyed with local treatment methods. Small squamous cell cancers can usually be cured with these treatments. Larger squamous cell cancers are harder to treat, and fast-growing cancers have a higher risk of coming back.
In rare cases, squamous cell cancers can spread to lymph nodes or distant parts of the body. If this happens, treatments such as radiation therapy, immunotherapy, and/or chemotherapy may be needed.