How Fast Does Squamous Cell Carcinoma Spread
Squamous cell carcinoma rarely metastasizes , and when spreading does occur, it typically happens slowly. Indeed, most squamous cell carcinoma cases are diagnosed before the cancer has progressed beyond the upper layer of skin. There are various types of squamous cell carcinoma and some tend to spread more quickly than others.
When Skin Cancer Spreads
If squamous cell carcinoma spreads it first moves to nearby lymph nodes. From the lymph nodes it can metastasize to other organs. In most cases the cancer spreads to the lungs, although it can travel elsewhere.
The risk of metastasis is low. It is estimated that from two to six percent of cases metastasize. Generally, it is the high-risk cases of the disease that have this problem, when they are left untreated. Factors such as age, sun exposure, and fair skin increase risk. Once the cancer has reached the lymph nodes the morbidity rate is significant. If squamous cell carcinoma reaches the lungs it cannot be cured.
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.
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Untreated Squamous Cell Carcinomas
The incidence of Squamous Cell Carcinoma is rising and can be life-threatening.
While Squamous Cell Carcinomas seldom spread to vital organs, Squamous Cell Carcinomas respond well to early treatment. If untreated the consequences could include:
- Disfigurement
- Nerve, or muscle injury, or other injury to nearby structures like eyelids or nostrils
- Certain rare, aggressive forms can be lethal if not treated promptly.
The larger the tumour has grown, the more extensive any surgical treatment would be. This could result in scarring.
In 2016 it is estimated that there were 560 deaths in Australia from non-melanoma skin cancers. It is not possible to identify how many of these are Squamous Cell Carcinomas as this data is not separately recorded.
Stage Ii Squamous Cell Carcinoma
Once the tumor grows bigger than 2 cm, it moves into the zone of stage II SCC. It has at this stage, spread into the dermis or lower, deeper layers of the skin from the epidermis. However, it is still contained within the skin and does not affect the bone, cartilage or muscle. It may, however, have two or more high-risk features.8
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Predictions Based On Doubling Times
Looking at doubling times of tumors is helpful only if the estimated doubling times can be used to predict the growth of a person’s tumor. One study looked at predicted survival times of people who had inoperable lung cancers and found that there was a close correlation between survival predicted from doubling time and actual survival.
How Do People Find Bcc On Their Skin
Many people find it when they notice a spot, lump, or scaly patch on their skin that is growing or feels different from the rest of their skin. If you notice any spot on your skin that is growing, bleeding, or changing in any way, see a board-certified dermatologist. These doctors have the most training and experience in diagnosing skin cancer.
To find skin cancer early, dermatologists recommend that everyone check their own skin with a skin self-exam. This is especially important for people who have a higher risk of developing BCC. Youll find out what can increase your risk of getting this skin cancer at, Basal cell carcinoma: Who gets and causes.
Images used with permission of:
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The American Academy of Dermatology National Library of Dermatologic Teaching Slides.
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J Am Acad Dermatol. 2019 80:303-17.
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What Is Squamous Cell Cancer
Squamous cell carcinoma of the skin is a common skin cancer that typically develops in chronic sun-exposed areas of your body. This type of skin cancer is usually not nearly as aggressive as melanoma and is uncontrolled growth of cells in the epidermis of your skin.
It can become disfiguring and sometimes deadly if allowed to grow. Squamous cell carcinomas are at least twice as frequent in men as in women. They rarely appear before age 50 and are most often seen in individuals in their 70s.
An estimated 700,000 cases of SCC are diagnosed each year in the United States, resulting in approximately 2,500 deaths.
Treatments For Skin Cancer That Spreads Beyond The Skin
When squamous cell carcinoma spreads to other parts of the body, drug treatments might be recommended, including:
- Chemotherapy. Chemotherapy uses powerful drugs to kill cancer cells. If squamous cell carcinoma spreads to the lymph nodes or other parts of the body, chemotherapy can be used alone or in combination with other treatments, such as targeted drug therapy and radiation therapy.
- Targeted drug therapy. Targeted drug treatments focus on specific weaknesses present within cancer cells. By blocking these weaknesses, targeted drug treatments can cause cancer cells to die. Targeted drug therapy is usually combined with chemotherapy.
- Immunotherapy. Immunotherapy is a drug treatment that helps your immune system to fight cancer. Your body’s disease-fighting immune system might not attack cancer because the cancer cells produce proteins that blind the immune system cells. Immunotherapy works by interfering with that process. For squamous cell carcinoma of the skin, immunotherapy might be considered when the cancer is advanced and other treatments aren’t an option.
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What Is The Best Treatment For Squamous Cell Carcinoma
Squamous Cell Skin Cancer Treatment Mohs Surgery. Mohs surgery has the highest cure rate of all therapies for squamous cell carcinomas. Curettage and Electrodessication. This very common treatment for squamous cell carcinoma is most effective for low-risk tumors. Cryosurgery. Laser Surgery.
The Clinical Course Of Squamous Cell Carcinoma
Although most patients who develop SCCs have localized disease that can be cured, tumor recurrence, tumor spread to other parts of the body, and death occasionally occurs.
Larger tumors may cause disfigurement as they may penetrate into the underlying tissues causing nerve or muscle damage. SCCs that have spread into the underlying tissue have been resistant to previous therapy or have reoccurred are considered advanced SCCs.
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Metastatic Squamous Cell Carcinoma
In addition to a 65-fold higher risk of developing squamous cell carcinoma , SCC that develop in adult transplant recipients are at higher risk for metastasis, 5-7%, compared to the general population, ~2% . ~13% of SCC that occur in pediatric patients metastasize. SCC that occur on the lip of pediatric patients are at particularly high risk .
SCC metastasis is generally associated with a poor prognosis with a 3-year disease-free survival rate in adult patients of 56% . Relapse of SCC is common, with the cumulative relapse rate ~29% within 1-year of treatment.
Clinical Characteristics of Metastatic Squamous Cell Carcinoma
Onset:Few large studies of metastatic cutaneous squamous cell carcinoma are available. One of the largest was performed by Martinez et al 2003 who followed 68 pts with 73 distinct metastatic skin cancers . In this study, the mean onset of metastatic SCC occurred 10.7-years following transplantation. The mean time with which metastatic SCC was detected after diagnosis of the primary SCC lesion was 1.4-years.
Location:The location where metastatic SCC was detected varied. 36% of patients had in-transit metastasis, metastasic foci located between the primary tumor and the closest lymph node region. These usually represent SCC spread along lymphatic vessels and/or nerves. 78% had lymph node metastasis occurring in draining nodal basins, and 35% had distant systemic/visceral metastasis. The most common sites for distant disease were lung and bone.
What Are The Symptoms Of Squamous Cell Skin Cancer
Squamous cell cancers 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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When Does Lung Cancer Begin
A different question looks at when the lung cancer first began. People may think of a stressful time in their life, or a specific chemical exposure, and wonder if it could have been the “cause” of their cancer. There isn’t a precise answer, but there are some theories.
One idea is to look at the patterns of mutation. A 2017 study published in the New England Journal of Medicine suggested that it takes along time for a lung cancer to develop, perhaps decades, especially for lung adenocarcinomas.
Data From The Largest 5
New findings from the largest-to-date 5-year follow-up of cutaneous squamous cell carcinoma patients suggest that nearly all recurrences happen within 2 years of primary tumor excision, with perineural invasion standing out as the strongest prognostic indicator of local recurrence and nodal metastasis.1
Take Note
- 96% of squamous cell carcinoma recurrences occurred within 2 years after cutaneous tumor excision.
- Size of primary tumor, anatomical location of primary tumor, and depth of margin from clearance were not significantly associated with recurrence.
- Perineural invasion emerged as a strong predictor of both local recurrence and lymph node metastasis.
The 2018 study, published in the Journal of Plastic, Reconstructive & Aesthetic Surgery, retrospectively analyzed 5-year outcomes from 598 cutaneous SCC excision patients from 4 centers across the United Kingdom. Total recurrence rate, including local recurrence and nodal metastasis, time to recurrence, and risk factors associated with recurrence were investigated.
New findings and their implications
While a higher proportion of recurrence did occur in patients with the narrowest deep margin from clearance , this did not reach statistical significance. 1
Take-home messages
References
- 4. NCCN Clinical Practice Guidelines in Oncology for Squamous Cell Skin Cancer V.2.2018. National Comprehensive Cancer Network, Inc. 2018. Accessed June 20, 2018.
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Treatments For Larger Skin Cancers
More invasive treatments might be recommended for larger squamous cell carcinomas and those that extend deeper into the skin. Options might include:
- Simple excision. In this procedure, your doctor cuts out the cancerous tissue and a surrounding margin of healthy skin. Your doctor may recommend removing additional normal skin around the tumor in some cases . To minimize scarring, especially on your face, consult a doctor skilled in skin reconstruction.
- Mohs surgery. During Mohs surgery, your doctor removes the cancer layer by layer, examining each layer under the microscope until no abnormal cells remain. This allows the surgeon to be certain the entire growth is removed and avoid taking an excessive amount of surrounding healthy skin.
- Radiation therapy. Radiation therapy uses high-energy beams, such as X-rays and protons, to kill cancer cells. Radiation therapy is sometimes used after surgery when there is an increased risk that the cancer will return. It might also be an option for people who can’t undergo surgery.
What Is Skin Cancer
Cancer can start any place in the body. Skin cancer starts when cells in the skin grow out of control.
Skin cancer cells can sometimes spread to other parts of the body, but this is not common. When cancer cells do this, its called metastasis. To doctors, the cancer cells in the new place look just like the ones from the skin.
Cancer is always named based on the place where it starts. So if skin cancer spreads to another part of the body, its still called skin cancer.
The skin
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How Is Metastatic Squamous Cell Carcinoma Treated
Each patients ideal course of metastatic squamous cell carcinoma treatment will vary according to the location of the primary cancer, how far it has spread, the overall health of the patient and several other factors. Many treatment plans include a combination of surgery to remove skin lesions and affected lymph nodes, as well as chemotherapy and radiation therapy to help shrink or destroy cancer cells that have traveled to other parts of the body.
Moffitt Cancer Centers Cutaneous Oncology Program offers a full spectrum of diagnostics and leading-edge treatment options to patients with squamous cell carcinoma of any stage. To speak with a Moffitt oncologist specializing in skin cancer, submit a new patient registration form online or call .
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Squamous Cell Carcinoma Is The Second Most Common Skin Cancer
Squamous cell carcinoma is the second most common type of skin cancer. Only basal cell carcinoma is more common. It accounts for about 20% of all skin cancers.
In the United States, it is estimated that over 700,000 new cases of cutaneous squamous cell carcinomas are diagnosed. Because CSSCs are excluded from national registries, the exact incidence, along with the exact number of deaths from this skin cancer is unknown.
Like basal cell carcinoma, SCCs are caused by long term exposure to ultraviolet radiation from sun exposure and indoor tanning devices.
Although SCCs may occur anywhere on the body, they most frequently develop in areas that have been exposed to the sun. These include:
- face
- legs
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What Causes Squamous Cell Carcinomas
Squamous cell carcinomas of the skin develop when the flat, thin squamous cells in the outer layer of the skin develop errors in their DNA. In ordinary, healthy skin, new cells push older cells toward the skin surface, where they die and are shed. When the DNA is damaged, the squamous cells instead grow out of control, forming a squamous cell carcinoma.
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:
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Superficial radiation therapy: Beams of radiation are directed just beneath the skin, which treats only the tumor.
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External beam radiation therapy: High-energy beams of radiation are sent into the tumor in order to kill cancer cells.
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Brachytherapy : Radioactive implants are placed inside the cancer. Also called internal radiation, this therapy is often used to treat prostate cancer.
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Tests That May Be Done
The doctor will ask you questions about when the spot on your skin first showed up and if it has changed in size or the way it looks or feels. The rest of your skin will be checked. During the exam your doctor will check the size, shape, color and texture of any skin changes. If signs are pointing to skin cancer, more tests will be done.
Skin biopsy
In a biopsy, the doctor takes out a small piece of tissue to check it for cancer cells. A biopsy is the only way to tell for sure if you have skin cancer and what kind it is.
There are many types of skin biopsies. Ask your doctor what kind you will need. Each type has pros and cons. The choice of which type to use depends on your own case.
In rare cases basal and squamous cell skin cancer can spread to the nearby lymph nodes Ask your doctor if your lymph nodes will be tested.
Basal and squamous cell cancers don’t often spread to other parts of the body. But if your doctor thinks your skin cancer might spread, you might need imaging tests, such as MRI or CT scans.