How Can You Tell If Squamous Cell Carcinoma Has Spread

December 1, 2021

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How To Tell If Squamous Cell Carcinoma Has Spread

Squamous Cell Carcinoma – Mayo Clinic

While its not common for squamous cell carcinoma to spread, it is helpful to be mindful of the signs. First, there are certain known risk factors to be aware of, as these characteristics have been associated with a higher stage of squamous cell carcinoma. Risk factors for squamous cell spreading include:

The tumor is thicker than 2 millimeters.
The tumor has grown into the lower dermis or subcutis layers of the skin.
The tumor has grown into the nerves in the skin.
The tumor is present on the ear or on a hair-bearing lip.

Knowing the stage of your cancer will help your medical team understand how serious it is and how best to treat it. Staging squamous cell carcinoma is based on a physical exam, detailed history, skin biopsy, lymph node biopsy, and imaging studies.

To determine if your cancer has spread, your physician may recommend several diagnostic tests. A skin or lymph node biopsy can show how far cancer cells have spread in the region of the primary tumor. Your medical team may also recommend a computed tomography scan to determine the spread.

You may also be able to recognize squamous cell carcinoma spreading by its appearance. Possible symptoms of squamous cell carcinoma include:

A thick, red, scaly patch of skin
An open sore or scar
An elevated growth that is usually pink, red, or the color of your flesh.
A wartlike nodule with raised edges

While most squamous cell carcinoma lesions are painless, it is possible to experience pain or numbness at the site.

What Are Basal And Squamous Cell Skin Cancers

Basal and squamous cell skin cancers are the most common types of skin cancer. They start in the top layer of skin , and are often related to sun exposure.

Cancer starts when cells in the body begin to grow out of control. Cells in nearly any part of the body can become cancer cells. To learn more about cancer and how it starts and spreads, see What Is Cancer?

How Skin Cancer Progresses

All cancer starts in one part of your body. With SCC, it starts in your skin. From there, cancer cells can spread.

How far your cancer has spread is known as its stage. Doctors assign skin cancers a stage number between 0 and 4.

Stage 4 means your cancer has spread beyond your skin. Your doctor might call the cancer advanced or metastatic at this stage. It means your cancer has traveled to one or more of your lymph nodes, and it may have reached your bones or other organs.

The stage of your cancer and where it is located will help your doctor find the right treatment for you. At stage 4 your cancer may not be curable, but it is still treatable.

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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.

Having an organ transplant: People who have received organ transplants are about 100 times more likely to get an SCC than the general population.

Having skin injuries such as burns, scars, ulcers, and skin areas that were previously exposed to chemicals or X-rays.

Having the genetic disease called xeroderma pigmentosum which means that you need to avoid the sun because your skin cannot repair itself.

Having long-lasting and repeated infections and inflammations of the skin.

Having a job or hobby that means that you are outside for long periods of time.

Other Factors That Can Affect Outlook And Treatment Options

The stage of a skin cancer can help give an idea of how serious the cancer is likely to be, including how likely it might be to return after treatment. But other factors are also important to consider. Some of these include:

The location of the tumor
How fast the tumor has been growing
How well-defined the borders of the tumor are
If the tumor has been causing symptoms, such as pain or itchiness
How the cancer cells look under a microscope
If the cancer cells have invaded small nerves or blood vessels in and around the tumor
If the cancer is in a place that was previously treated with radiation
If the person has a weakened immune system

Your doctor can explain if any of these factors might affect your treatment or outlook.

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Basal Cell Carcinoma Stages

There are certain features that are considered to make the cancer at higher risk for spreading or recurrence, and these may also be used to stage basal cell carcinomas. These include:

Greater than 2 mm in thickness
Invasion into the lower dermis or subcutis layers of the skin
Invasion into the tiny nerves in the skin
Location on the ear or on a hair-bearing lip

After the TNM components and risk factors have been established, the cancer is given a stage. For basal cell carcinoma staging, the factors are grouped and labeled 0 to 4. The characteristics and stages of basal cell carcinoma are:

Stage 0: Also called carcinoma in situ, cancer discovered in this stage is only present in the epidermis and has not spread deeper to the dermis.

Stage 1 basal cell carcinoma: The cancer is less than 2 centimeters, about 4/5 of an inch across, has not spread to nearby lymph nodes or organs, and has one or fewer high-risk features.

Stage 2 basal cell carcinoma: The cancer is larger than 2 centimeters across, and has not spread to nearby organs or lymph nodes, or a tumor of any size with 2 or more high-risk features.

Stage 3 basal cell carcinoma: The cancer has spread into facial bones or 1 nearby lymph node, but not to other organs.

Stage 4 basal cell carcinoma: The cancer can be any size and has spread to 1 or more lymph nodes which are larger than 3 cm and may have spread to bones or other organs in the body.

How Is The Stage Determined

The system most often used to stage basal and squamous cell skin cancers is the American Joint Commission on Cancer TNM system. The most recent version, effective as of 2018, applies only to squamous and basal cell skin cancers of the head and neck area . The stage is based on 3 key pieces of information:

The size of the tumor and if it has grown deeper into nearby structures or tissues, such as a bone
If the cancer has spread to nearby lymph nodes
If the cancer has spread to distant parts of the body

Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced.

Once a persons T, N, and M categories have been determined, this information is combined in a process called stage grouping to assign an overall stage. The earliest stage of skin cancer is stage 0 . The other stages range from I through IV . As a rule, the lower the number, the less the cancer has spread. A higher number, such as stage IV, means cancer has spread more.

If your skin cancer is in the head and neck area, talk to your doctor about your specific stage. Cancer staging can be complex, so ask your doctor to explain it to you in a way you understand. For more information, seeCancer Staging.

Survival Rates By Tnm Stage

The first approach is based on the TNM stage statistical survival times are matched to the stage of the disease.

TNM Lung Cancer Stage
M1c	6.3 months

By contrast, the one-year survival rate for stage 4 lung cancer was reported in one study to be between 15% and 19%, meaning this portion of patients with metastatic disease lived for at least a year.

What Are The 5 Stages Of Skin Cancer

Understanding Squamous Cell Carcinoma

Staging is an important tool used to treat skin cancer. Your stage helps the medical team determine where the tumor is, how large it is, where it has spread, your prognosis, and the most effective treatment plan.

The five stages of squamous cell carcinoma include:

Stage 0: Also known as carcinoma in situ, in this stage cancer is present in the epidermis. It has not spread to deeper layers.
Stage 1: The tumor is smaller than 2 centimeters and has not spread to nearby lymph nodes or other organs. The individual has one or fewer risk factors for spread.
Stage 2: The tumor is wider than 2 centimeters and has not spread to nearby lymph nodes or other organs. This stage also applies to any sized tumor when the individual has two or more risk factors.
Stage 3: The tumor has spread into nearby facial bones or one lymph node. It has not spread to other organs.
Stage 4: The tumor is of any size and has metastasized to one or more of the lymph nodes. It may have spread to the bones and other distant organs.

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How To Spot A Bcc: Five Warning Signs

Check for BCCs where your skin is most exposed to the sun, especially the face, ears, neck, scalp, chest, shoulders and back, but remember that they can occur anywhere on the body. Frequently, two or more of these warning signs are visible in a BCC tumor.

An open sore that does not heal, and may bleed, ooze or crust. The sore might persist for weeks, or appear to heal and then come back.

A reddish patch or irritated area, on the face, chest, shoulder, arm or leg that may crust, itch, hurt or cause no discomfort.

A shiny bump or nodule that is pearly or clear, pink, red or white. The bump can also be tan, black or brown, especially in dark-skinned people, and can be mistaken for a normal mole.

A small pink growth with a slightly raised, rolled edge and a crusted indentation in the center that may develop tiny surface blood vessels over time.

A scar-like area that is flat white, yellow or waxy in color. The skin appears shiny and taut, often with poorly defined borders. This warning sign may indicate an invasive BCC.

Please note: Since not all BCCs have the same appearance, these images serve as a general reference to what basal cell carcinoma looks like.

An open sore that does not heal

A reddish patch or irritated area

A small pink growth with a slightly raised, rolled edge and a crusted indentation in the center

A shiny bump or nodule

A scar-like area that is flat white, yellow or waxy in color

Treating Squamous Cell Carcinoma

Most of squamous cell carcinomas can be cured if they are treated early. Once squamous cell carcinoma has spread beyond the skin, though, less than half of people live five years, even with aggressive treatment.

There are many ways to treat squamous cell carcinoma that has not spread. These include:

cutting away the cancer and a small amount of healthy tissue around it. If a large area of skin is removed, a skin graft may be necessary.
scraping away the cancer with a surgical tool. An electric probe is used to kill any cancerous cells left behind.
freezing cancer cells with liquid nitrogen. This treatment is usually used only for very small tumors or for a patch of skin that looks abnormal but isn’t yet cancerous.
destroying the tumor with radiation.
shaving away the cancer, one thin layer at a time. Each layer is examined under the microscope as it is removed. This technique helps the doctor preserve as much healthy skin as possible.
applying drugs directly to the skin or injecting them into the tumor
using a narrow laser beam to destroy the cancer.

The treatment that is best for you depends on the size and location of the cancer, whether it has returned after previous treatment, your age, and your general health.

Once your treatment is finished, it’s important to have regular follow-up skin exams. Your doctor may want to see you every three months for the first year, for example, and then less often after that.

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Can Squamous Cell Carcinoma Be Prevented

The best way to prevent SCC is to avoid sunburn. Avoid going outin the sun when the UV Index is higher than 3, such as in the middle of theday. Seek shade, wear a hat, sunglasses and clothing that protects you from thesun, and always use an SPF30+ sunscreen. Do not go to tanningsalons.

If you are at very high risk of developing another skin cancer, yourdoctor may prescribe you specific vitamins.

How The Stage Is Determined

Once you have been diagnosed with squamous cell carcinoma, your doctor will want to determine its stage. While the risk of this type of cancer spreading is low, determining the stage will help your doctor develop the best treatment plan.

The TNM system is a uniform system for staging many types of cancer. TNM stands for:

T is for tumor: How far has the primary tumor grown through the layers of skin or to nearby tissues?
N is for nodes: Have cancer cells spread to the lymph nodes near the tumor?
M is for metastasis: Has the cancer metastasized to distant sites in the body such as the lungs or liver?

Skin Cancer Doctor Discussion Guide

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How Do Dermatologists Treat Squamous Cell Carcinoma Of The Skin

Most patients are treated with a type of surgery called surgical removal. Your dermatologist or Mohs surgeon can often perform this type of treatment during an office visit.

The following describes what to expect from surgical removal and other treatments for this skin cancer:

Surgical removal: Three types of surgical removal are used to treat this type of skin cancer. All can be performed during an office visit while you remain awake.

Your dermatologist will choose the type of surgical removal you receive, based on where the skin cancer appears on your body, how deeply the cancer has grown, and other considerations.

During surgical removal, your dermatologist cuts out the tumor. When the cancer is caught early, this may be the only treatment you need.

Here’s what happens during each type of surgical removal used to treat this skin cancer:

Radiation therapy: If surgical removal alone cannot treat the cancer or you cannot have surgical removal, your treatment plan may include radiation treatments.

The different types of radiation therapy used to treat SCC are:

Superficial radiation therapy: Beams of radiation are directed just beneath the skin, which treats only the tumor.
External beam radiation therapy: High-energy beams of radiation are sent into the tumor in order to kill cancer cells.
Brachytherapy : Radioactive implants are placed inside the cancer. Also called internal radiation, this therapy is often used to treat prostate cancer.

Is It Possible To Get Squamous Cell Skin Cancer

Skin cancers that are found early are typically much easier to treat than those found at a later stage. Smoking has been linked to an increased risk of squamous cell skin cancer, as well as to many other types of cancer. If you smoke and are thinking about quitting, call the American Cancer Society for information and support at 1-800-227-2345.

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Questions To Ask The Doctor

Do you know the stage of the cancer?
If not, how and when will you find out the stage of the cancer?
Would you explain to me what the stage means in my case?
What will happen next?

There are many ways to treat skin cancer. The main types of treatment are:

Surgery
Immunotherapy
Chemotherapy

Most basal cell and squamous cell cancers can be cured with surgery or other types of treatments that affect only the spot on the skin.

The treatment plan thats best for you will depend on:

The stage and grade of the cancer
The chance that a type of treatment will cure the cancer or help in some way
Your age and overall health
Your feelings about the treatment and the side effects that come with it

How Is Squamous Cell Carcinoma Of The Skin Treated When It Spreads

Overview of Cutaneous Squamous Cell Carcinoma

When this cancer spreads beyond the skin, it travels to the lymph nodes or other organs. Once it spreads, a patient has advanced cancer.

If you’ve been diagnosed with advanced SCC, you will be cared for by a team of medical professionals. This team will include oncologists . Your treatment plan may include one or more of the following:

Surgery: When surgery can remove the cancer and youre healthy enough to have surgery, this is often the preferred treatment. After surgery, another treatment, such as radiation therapy or chemotherapy, is often given. Adding another treatment helps to kill cancer cells.

Radiation therapy: Radiation can target cancer cells in the skin, lymph nodes, or other areas of the body. When a patient has advanced SCC, radiation therapy is often used along with another treatment.

Immunotherapy: This type of treatment helps strengthen your immune system so that it can fight the cancer. Drugs called immunotherapy medications are given for this purpose.

The U.S. Food and Drug Administration has approved one immunotherapy medication for the treatment of advanced SCC of the skin. Its called cemiplimab-rwlc.

In the clinical trials that led the FDA to approve cemiplimab-rwlc, about half the patients who had advanced SCC of the skin had their tumors shrink. In many patients who had tumor shrinkage, the shrinking lasted 6 months or longer. A few patients had their tumors disappear completely.

Immunotherapy

Pembrolizumab is also given by IV infusion.

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