Squamous Cell Skin Cancer Of The Head And Neck Treatment
Surgery is the preferred management method for the majority of squamous cell skin cancers. Low-risk, early stage, small squamous cell cancers can be removed by Mohs surgery, which is a technique that spares normal tissue through repeated intraoperative margin testing, removing only the cancer and leaving adjacent normal tissue. Excision, curettage and desiccation, and cryosurgery can also be used to remove the cancer while sparing normal tissue. Radiation alone is an alternative for low-risk tumors when surgery is not desirable because of cosmetic concerns or medical reasons.
Large tumors and tumors with nerve or lymph node involvement are not suitable for Mohs surgery and require removal of at least 5-millimeter margins of normal tissue around the cancer and neck dissection for involved lymph nodes. Larger tumors require reconstruction, which can be done at the time of surgery if margin status is clear. Reconstruction should be staged when margins status is not clear.
Patients with high-risk tumors should meet with a radiation therapist to discuss postoperative radiation. Chemotherapy may be added to radiation for extensive lymph node involvement or positive margins that cannot be cleared with additional surgery. In patients with high-risk tumors who are not surgical candidates, systemic treatment with both radiation and chemotherapy is used. Such cases require multidisciplinary care by a team of surgeons, radiation oncologists and medical oncologists.
The Risks The Causes What You Can Do
Squamous cell carcinoma of the skin is caused by DNA damage that leads to abnormal changes in the squamous cells in the outermost layer of skin.
Understanding what causes this damage and the factors that increase your risk of developing SCC can help you detect the disease early or prevent it from happening in the first place.
These factors increase your SCC risk:
- Unprotected exposure to ultraviolet radiation from the sun or tanning beds.
- Weakened immune system due to illness or certain immunosuppressive medications.
- History of skin cancer including basal cell carcinoma .
- Age over 50: Most SCCs appear in people over age 50.
- Fair skin: People with fair skin are at an increased risk for SCC.
- Gender: Men are more likely to develop SCC.
- Sun-sensitive conditions including xeroderma pigmentosum.
- Chronic infections and skin inflammation from burns, scars and other conditions.
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.
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How Can A Squamous Cell Carcinoma Be Treated
Surgery is usually the recommended treatment. This involves removing the SCC with a margin of normal skin around it, using a local anaesthetic. The skin is then closed with stitches or sometimes a skin graft is needed. Sometimes other surgical methods are used such as curettage and cautery. This involves scraping the SCC away using local anaesthetic.
Radiotherapy can also be used to treat SCC. This involves shining a beam of X-rays onto the skin. Usually several sessions are required.
For advanced SCC, a combination of treatments may be used. For SCC that has spread to other parts of the body a combination of surgery, radiotherapy and/or chemotherapy may be used.
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.
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What Will Happen After Treatment
Youll be glad when treatment is over. Your doctor will want you to check your skin at least once a month. It will be very important to protect yourself from getting too much sun.
For years after treatment ends, you will see your skin cancer doctor. At first, your visits may be every few months. Then, the longer youre cancer-free, the less often the visits are needed. Be sure to go to all of these follow-up visits. Your doctor will ask about symptoms and check you for signs of the cancer coming back or a new skin cancer. Other exams and tests may also be done.
Having cancer and dealing with treatment can be hard, but it can also be a time to look at your life in new ways. You might be thinking about how to improve your health. Call us at 1-800-227-2345 or talk to your cancer care team to find out what you can do to feel better.
You cant change the fact that you have cancer. What you can change is how you live the rest of your life making healthy choices and feeling as good as you can.
Does The Rectum Have Squamous Cells
Squamous cell carcinoma of the rectum is a rare malignancy. It appears to be associated with chronic inflammatory conditions and infections. The clear association seen between Human Papilloma Virus and various squamous cancers has not been firmly established for the squamous cell cancer of the rectum.
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What Is Invasive Squamous Cell Carcinoma Of Anus
- Invasive Squamous Cell Carcinoma of Anus is a malignant condition affecting the skin or mucosal membranes of the anus, which developed from in situ squamous cell carcinoma
- This malignant carcinoma, which may be present as a lesion on the anus, has the potential to metastasize , usually to the inguinal lymph nodes
- The cause of Invasive Squamous Cell Carcinoma of Anus is unknown, but factors such as HPV infection, poor immunity, high-risk sexual practices, etc., are known to contribute towards its development. Middle-aged and elderly adults are at risk for the condition
- Any combination of chemotherapy, radiation therapy, and invasive procedures are used to treat Anal Invasive Squamous Cell Carcinoma. The outcome depends upon many factors including the stage of the tumor earlier the diagnosis and treatment, better is the prognosis
When To Seek Medical Care
If you have developed a new bump on sun-exposed skin, or if you have a spot that bleeds easily or does not seem to be healing, then you should make an appointment with your primary care physician or with a dermatologist. You should also make an appointment if an existing spot changes size, shape, color, or texture, or if it starts to itch, bleed, or become tender.Try to remember to tell your doctor when you first noticed the lesion and what symptoms, if any, it may have . Also be sure to ask your parents, siblings, and adult children whether or not they have ever been diagnosed with skin cancer, and relay this information to your physician.
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Contact The Skin Cancer Expert
Dr. Daniel C. Allison is a renowned orthopedic oncologist who has extensive expertise in diagnosing and treating various cancers including squamous cell and melanoma. He understands the complexities of cancer and is the ideal physician for providing you with a personalized treatment plan. Contact us today for a personal consultation at 310.683.4586 and learn how we can help you.
Squamous Cell Carcinoma: Prompt Treatment
The best treatment approach for squamous cell carcinoma first requires an evaluation of the location, size, and stage of the tumor. Orthopedic oncologists like Dr. Allison also consider a patients medical history, general health, and personal opinion when determining the most appropriate treatment.
Often treatment for skin cancers requires surgical removal of the carcinoma and surrounding area to make sure all diseased tissue is removed. Each case is unique and in circumstances where the cancer is aggressive, there might be a secondary treatment which could be topical chemotherapy or radiotherapy. Most SCC have a high cure rate with the most favorable cases being ones detected at an early stage.
For his skin cancer patients, Dr. Allison scheduled regular checkups so he can monitor them for signs of recurrence. There is a possibility of skin cancer reappearing for individuals who have been treated for it, but avoiding sun exposure can help towards minimizing the risk.
Learn more about SCC from medlineplus.gov.
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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.
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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 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 early form of skin cancer, called Bowen’s disease, which looks like a red, scaly patch, can also develop into an SCC if nottreated.
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.
Features Of T Categories
The T categories describe the main tumor based on its thickness, the presence of high-risk features, and invasion.2 Your doctor begins to gather this information by doing a skin biopsy. If the tumor is invasive, you will need imaging tests.
- Size. The longest dimension of the tumor is measured in centimeters.
- Invasion. The tumor is categorized by how far it has invaded the body. Invasion of the facial bones is categorized as T3. Invasion of bones in the rest of the body or the base of the skull is T4. Your doctor determines this using magnetic resonance imaging or computed tomography scan.
- High-risk features. High-risk features refer to the risk that the cancer returns or spreads . High-risk features of SCC are:2
- > 2 mm thick or Clark level IV
- Growing around a nerve
- Located on the ear or lip
- Poorly differentiated or undifferentiated cells. Differentiation means how much the cancer cells look like the normal tissue that it came from. Poorly differentiated cells grow and spread more quickly.
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What Are The Causes Of Invasive Squamous Cell Carcinoma Of Anus
Untreated squamous cell carcinoma in situ can result in invasive squamous cell carcinoma.
- The exact cause of development of squamous cell carcinoma in situ of anus is not completely known in a majority of cases
- In case HPV infection is associated with SCC in situ of anus, it is caused by alteration in the DNA by the human papilloma virus that results in uncontrolled cell proliferation
- Other factors that may contribute to the condition include compromised immune system, sexual promiscuity, smoking, and even poor hygiene
Ocular And Cutaneous Sccs: Clinical Features
Our final cohort included 106 samples from 87 distinct clinical lesions . Patients had a mean age at diagnosis of 72.4 years or 65.2 years , with no significant differences among subgroups. Cutaneous lesions in our cohort were relatively evenly divided between men and women, whereas ocular lesions were strongly skewed toward men. Altered immune status was present in 27% of patients with cutaneous lesions and 38% of patients with ocular lesions. Of patients with ocular lesions, four had a known history of human immunodeficiency virus .
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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.
What Does A Squamous Cell Carcinoma Look Like
SCC can vary in their appearance, but most usually appear as a scaly or crusty raised area of skin with a red, inflamed base. SCCs can be sore or tender and they can bleed but this is not always the case. They can appear as an ulcer.
SCC can occur on any part of the body, but they are more common on sun exposed sites such as the head, ears, neck and back of the hands.
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From The Harvard Health Letter May 2006
Summers the season for fun in the sunbut also for skin cancer. Of the three main types of skin cancer, melanoma is most deadly, and basal cell, most common. Squamous cell cancer falls in between. Its three times as common as melanoma . Though not as common as basal cell , squamous cell is more serious because it is likely to spread . Treated early, the cure rate is over 90%, but metastases occur in 1%5% of cases. After it has metastasized, its very difficult to treat.
What Causes A Squamous Cell Carcinoma
The most important cause is too much exposure to ultraviolet light from the sun or other sources. This can cause the DNA of skin cells in the outer layer of the skin to change. Sometimes this alteration in DNA allows the skin cells to grow out of control and develop into an SCC. Ultraviolet light damage can cause SCC directly, or sometimes it can induce a scaly area called an actinic keratosis or Bowens disease. These can change into SCC if they are not treated.
Squamous cell carcinomas can also develop in skin damaged by other forms of radiation, in burns and persistent chronic ulcers and wounds and in old scars. Certain human viral wart viruses can also be a factor. However, SCC itself is not contagious.
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What Are The Risk Factors For Squamous Cell Carcinoma
Risk factors for squamous cell carcinoma include:
- Unprotected exposure to ultraviolet rays
- Light-colored hair, skin, or eyes
- History of skin cancer
- The pathologists report
- Recurrence after treatment
Treatment for squamous cell carcinoma usually involves surgery to remove the lesion. The surgical options include:
- Excision: The physician cuts out the tumor with a scalpel, along with a small margin of healthy skin around the tumor.
- Curettage and electrodesiccation: Used in small lesions, the physician scrapes away cancer cells, then cauterizes the skin to prevent bleeding.
- Mohs surgery: The surgeon removes layers of skin and examines them under a microscope to determine if cancer is present. This process continues until no cancer cells are visible.
Rarely, squamous cell carcinoma is treated with chemotherapy , radiation therapy , and immunotherapy when it has metastasized to other areas of the body.