What Is Squamous Cell Cancer
Squamous cell cancer , also known as squamous cell carcinoma, is a type of skin cancer that typically begins in the squamous cells.
Squamous cells are the thin, flat cells that make up the epidermis, or the outermost layer of the skin.
SCC is caused by changes in the DNA of these cells, which cause them to multiply uncontrollably.
According to the Skin Cancer Foundation , cutaneous SCC is the second most common form of skin cancer. Approximately 700,000 people in the United States are diagnosed with this type of skin cancer each year.
People with SCC often develop scaly, red patches, open sores, or warts on their skin. These abnormal growths can develop anywhere, but theyre most often found in areas that receive the most exposure to ultraviolet radiation, either from sunlight or from tanning beds or lamps.
The condition usually isnt life threatening, but it can become dangerous if it goes untreated. When treatment isnt received promptly, the growths can increase in size and spread to other parts of your body, causing serious complications.
Treating Squamous Cell Cancer In The Neck
Its important for oncologists to identify the primary cancer because this information can influence treatment. For instance, squamous cell cancers that start in the skin and spread to the neck are still treated as a form of skin cancer. Similarly, squamous cell cancers that originate in the esophagus and spread to the neck are still treated as esophageal cancer. When the primary cancer is unknown, however, oncologists may take a different approach to treatment based on what they know about a patients diagnosis, such as the number, size and location of the lymph nodes that contain cancerous cells.
At Moffitt Cancer Center, we offer a comprehensive range of treatments for metastatic squamous cell cancer in the neck, including:
- Surgery to remove lymph nodes, the jugular vein and muscles or nerves that show signs of cancer
- Radiation therapy to the head and neck
- Chemotherapy medications
Sometimes, a combination of treatments is best. For instance, one common approach to treating metastatic squamous cell cancer is to administer chemotherapy and hyperfractionated radiation therapy at the same time. Some patients also choose to enroll in clinical trials to access the latest therapies before those options are widely available in other settings. At the same time, they can take pride in knowing that they are helping our oncologists gain valuable knowledge about the most effective ways to treat these complex tumors.
Growth Rate Varies At Different Stages
Tumor growth also may change during different stages in the life of the developing cancer cells. Tumors are not just copies of the exact same abnormal cells involved in out-of-control growth. The cells experience new mutations that change the tumor. Many people see this when new mutations make their cancers resist treatment that worked in the past. Some of the new mutations in a tumor may cause cancer cells to grow and divide more rapidly than when it first began.
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What Are The Signs And Symptoms Of Squamous Cell Carcinoma
SCC signs and symptoms include skin changes like:
- A rough-feeling bump or growth which might then crust over and bleed.
- A growth that is higher than the skin but has a depression in the middle.
- A sore that will not heal, or a sore that heals and then comes back.
- A piece of skin that is flat, is scaly and red.
- A precancerous growth called actinic keratosis, which is a bump or lump that can feel dry, itchy, scaly, or be discolored.
- A precancerous skin lesion called actinic cheilitis, which happens mainly on the lower lip. The tissue becomes pale, dry, and cracked.
- A precancerous condition called leukoplakia, in which white spots develop in the mouth, on the tongue, gums, or cheeks
What Are The Symptoms Of Squamous Cell Carcinoma
Squamous cell carcinomas are usually raised growths, ranging from the size of a pea to the size of a chestnut. They may appear as scaly red patches, open sores or protruding growths with a dented center, or they may look like a wart. Most are found in areas of the body that are frequently exposed to the sun, such as the ears, lips, face, balding scalp, neck, hands, arms, and legs. Less commonly, they may appear on mucous membranes and genitals. Regardless of what form the bumps take, they do not heal or go away on their own.
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What Is Squamous Cell Carcinoma Of Oral Cavity
- Squamous Cell Carcinoma of Oral Cavity is a common malignant tumor of the mouth that typically affects elderly men and women. It is more aggressive than conventional squamous cell carcinoma affecting other body regions
- The cause of the condition is unknown, but genetic mutations may be involved. Factors that may influence its development include smoking and chewing of tobacco, radiation treatment for other reasons, and exposure to coal tar and arsenic
- The squamous cell carcinoma may appear as slow-growing skin lesions. The lesions may ulcerate and cause scarring of the oral cavity. It may be difficult to eat, swallow food, or even to speak
- The treatment of choice is a surgical excision with clear margins followed by radiation therapy or chemotherapy, as decided by the healthcare provider. In majority of the cases, the prognosis is good with appropriate treatment
- Nevertheless, the prognosis of Squamous Cell Carcinoma of Oral Cavity depends upon many factors including the stage of the tumor and health status of the affected individual. There is a possibility of local or regional metastasis, which can involve the lymph nodes. This may dictate the course of the condition
Diagnosing Squamous Cell Carcinoma
The main way to diagnose squamous cell carcinoma is with a biopsy. This involves having a small piece of tissue removed from the suspicious area and examined in a laboratory.
In the laboratory, a pathologist will examine the tissue under a microscope to determine if it is a skin cancer. He or she will also stage the cancer by the number of abnormal cells, their thickness, and the depth of penetration into the skin. The higher the stage of the tumor, the greater the chance it could spread to other parts of the body.
Squamous cell carcinoma on sun-exposed areas of skin usually does not spread. However, squamous cell carcinoma of the lip, vulva, and penis are more likely to spread. Contact your doctor about any sore in these areas that does not go away after several weeks.
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What About Other Treatments That I Hear About
When you have cancer you might hear about other ways to treat the cancer or treat your symptoms. These may not always be standard medical treatments. These treatments may be vitamins, herbs, special diets, and other things. You may wonder about these treatments.
Some of these are known to help, but many have not been tested. Some have been shown not to help. A few have even been found to be harmful. Talk to your doctor about anything youre thinking about using, whether its a vitamin, a diet, or anything else.
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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Treatment With A Curative Intent
For people with an isolated adrenal metastasis, treatment may potentially result in long-term survival. Options include:
- Surgery: Both open and laparoscopic adrenalectomy may be done with a curative intent for some people.
- Stereotactic body radiotherapy : If surgery isnât possible, studies suggest that SBRT may be effective and well tolerated. SBRT involves using a high dose of radiation to a small area, and sometimes has results similar to surgery. In a 2018 study, local treatment of lung cancer adrenal metastases with SBRT resulted in overall survival rates at 6 months, 1 year, and 2 years of 85.8%, 58.1%, and 54%.
- Ablation: Image-guided percutaneous ablation is yet another option. A 2018 study found that, although survival was poorer for those with non-small cell lung cancer who underwent the procedure than with some other cancers, image-guided percutaneous ablation of adrenal metastases may extend local progression-free survival as well as overall survival. In the study, the average overall survival at 1, 3, and 5 years was 82%, 44%, and 34% following the procedure.
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Symptoms Of Squamous Cell Carcinoma
Squamous cell carcinoma is characterized by its thick, scaly, irregular appearance, but it can have various appearances, and a doctor may be suspicious of any sores on sun-exposed surfaces that do not heal.
Squamous cell carcinoma begins as a red area with a scaly, crusted surface. As it grows, the tumor may become somewhat raised and firm, sometimes with a wartlike surface. Eventually, the cancer becomes an open sore and grows into the underlying tissue.
Squamous cell carcinomas can have various appearances. This photo shows one that is raised, scaly, and crusted.
Image provided by Thomas Habif, MD.
This red, irregular area on the arm was diagnosed as squamous cell carcinoma after a biopsy.
Squamous cell carcinomas can have various appearances. This photo shows an area that is scaly, crusted, and darker than the surrounding skin. It was diagnosed as squamous cell carcinoma after a biopsy.
DR P. MARAZZI/SCIENCE PHOTO LIBRARY
This squamous cell carcinoma on the lip shows excess build up of keratin that has broken down to form an open sore.
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How To Treat Advanced Squamous Cell Carcinoma
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.
To confirm squamous cell skin cancer, we need to take a biopsy. This procedure involves numbing the area affected with a local anesthetic and taking off a very small skin sample of the affected tissue.
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What Causes Skin Cancer
Ultraviolet light exposure, most commonly from sunlight, is overwhelmingly the most frequent cause of skin cancer.
Other important causes of skin cancer include the following:
- Use of tanning booths
- Immunosuppression – This means impairment of the immune system. The immune system protects the body from foreign entities, such as germs or substances that cause an allergic reaction. This suppression may occur as a consequence of some diseases or can be due to medications prescribed to combat conditions such as autoimmune diseases or prevent organ transplant rejection.
- Exposure to unusually high levels of X-rays
- Contact with certain chemicals-arsenic , hydrocarbons in tar, oils, and soot
The following people are at the greatest risk:
- People with fair skin, especially types that freckle, sunburn easily, or become painful in the sun
- People with light hair and blue or green eyes
- Those with certain genetic disorders that deplete skin pigment such as albinism, xeroderma pigmentosum
- People who have already been treated for skin cancer
- People with numerous moles, unusual moles, or large moles that were present at birth
- People with close family members who have developed skin cancer
- People who had at least one severe sunburn early in life
A basal cell carcinoma usually looks like a raised, smooth, pearly bump on the sun-exposed skin of the head, neck, or shoulders.
A squamous cell carcinoma is commonly a well-defined, red, scaling, thickened patch on sun-exposed skin.
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What Survival Rates Mean
The survival rate is the percentage of people who live for a certain period of time with this cancer. The number is based on research done on large groups of people with the same stage of cancer.
Experts dont know the exact survival numbers for late-stage SCC, because cancer registries dont track statistics for this cancer. However, your doctor may be able to give you an estimate of your prognosis.
When it comes to surviving cancer, everyone is different. Your outcome will depend on the specific treatments you have and how well you respond to them. Talk to your doctor about your outlook and what it means.
Squamous Cell Carcinoma Causes
Exposure to ultraviolet rays, like the ones from the sun or a tanning bed, affects the cells in the middle and outer layers of your skin and can cause them to make too many cells and not die off as they should. This can lead to out-of-control growth of these cells, which can lead to squamous cell carcinoma.
Other things can contribute to this kind of overgrowth, too, like conditions that affect your immune system.
Skin Grafting And Reconstructive Surgery
After surgery to remove a large basal or squamous cell skin cancer, it may not be possible to stretch the nearby skin enough to stitch the edges of the wound together. In these cases, healthy skin can be taken from another part of the body and grafted over the wound to help it heal and to restore the appearance of the affected area. Other reconstructive surgical procedures, such as moving ‘flaps’ of nearby skin over the wound, can also be helpful in some cases.
When To See A Doctor About Skin Cancer
Many people, especially those who have fair coloring or have had extensive sun exposure, should periodically check their entire body for suggestive moles and lesions.
Have your primary healthcare professional or a skin specialist check any moles or spots that concern you.
See your healthcare professional to check your skin if you notice any changes in the size, shape, color, or texture of pigmented areas .
If you have skin cancer, your skin specialist or cancer specialist will talk to you about symptoms of metastatic disease that might require care in a hospital.
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Is A Sore That Doesnt Heal Always Cancer
This nonmelanoma skin cancer may appear as a firm red nodule, a scaly growth that bleeds or develops a crust, or a sore that doesnât heal. It most often occurs on the nose, forehead, ears, lower lip, hands, and other sun-exposed areas of the body. Squamous cell carcinoma is curable if caught and treated early.
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Surgical Procedures For Basal & Squamous Cell Skin Cancers
Basal or squamous cell skin cancers may need to be removed with procedures such as electrodessication and curettage, surgical excision, or Mohs surgery, with possible reconstruction of the skin and surrounding tissue.
Squamous cell cancer can be aggressive, and our surgeons may need to remove more tissue. They may also recommend additional treatments for advanced squamous cell cancer, such as medications or radiation therapyenergy beams that penetrate the skin, killing cancer cells in the body.
Basal cell cancer is less likely to become aggressive, but if it does, our doctors may use surgery and other therapies to treat it.
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Squamous 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 squamous 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 assigned to one of the five squamous cell carcinoma stages, which are labeled 0 to 4. The characteristics and stages of squamous cell cancer 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 squamous 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 squamous 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 squamous cell carcinoma: The cancer has spread into facial bones or 1 nearby lymph node, but not to other organs.
Stage 4 squamous 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.
What Are The Types Of Squamous Cell Carcinoma
Squamous cell carcinoma develops when the flat cells in the toplayer of skin grow and divide in an uncontrolled way.
You can get an SCC wherever there are squamous cells which is in manydifferent parts of the body. However, typically they appear on parts of theskin that have been exposed to a lot of ultraviolet radiation from the sunor from tanning beds.
An SCC can be quite an aggressive cancer if left untreated. If you evernotice a sore, scab or scaly patch of skin that doesnt heal within 2 months,see a doctor.
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