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Predicting Risk Of Advanced Disease Is Tough With Today’s Tools Though Recent Studies Suggest Steps Forward
Risk stratification is critical to the management of cutaneous squamous cell carcinoma because it helps identify patients at high risk of poor outcomes. Yet putting parameters around that risk remains one of the most vexing challenges in managing this disease, experts say — in part due to an evolution of different staging systems that, to varying degrees, help identify patients at risk of progression, metastasis, and death.
Poor outcomes aren’t a problem for most patients with CSCC, a very common neoplasm that accounts for about 20% of the 1.3 million non-melanoma skin cancers that arise each year in the U.S.
The great majority of cases are effectively managed with surgery and other local therapy. However, management of locally advanced or metastatic disease, collectively referred to as advanced CSCC, is an ongoing clinical challenge.
That’s because patients who develop advanced CSCC have outcomes that have historically been dismal, according to one retrospective report at the annual meeting of the American Society of Clinical Oncology .
Approximately 2-5% of cases will metastasize, statistics show. The death toll from CSCC is not insubstantial, reaching up to 15,000 per year in estimates from the Skin Cancer Foundation and others, with most of those deaths actually due to local or nodal disease that cannot be resected.
In Search of High-Risk CSCC
How the Staging Systems Compare
What’s Higher than High Risk?
What Is Squamous Cell Carcinoma Of The Skin
Squamous cells are found throughout the human body. These cells line organs, such as the lungs, throat, and thyroid. We also have squamous cells in our skin.
The job of squamous cells is to protect what lies beneath. In our skin, these cells sit near the surface, protecting the tissue beneath.
Anywhere we have squamous cells, we can develop a type of cancer called squamous cell carcinoma .
In the skin, this cancer is usually not life-threatening. It tends to grow slowly, but it can grow deep. When the cancer grows deep, it can injure nerves, blood vessels, and anything else in its path. As the cancer cells pile up, a large tumor can form.
Most people who develop this skin cancer have fair skin that they seldom protected with sunscreen or sun-protective clothing. Before developing this skin cancer, they tend to notice signs of sun damage on their skin, such as age spots, patches of discolored skin, and deep wrinkles.
Anyone can develop squamous cell carcinoma
While anyone can develop this skin cancer, you have a greater risk if you live with a transplanted organ, use tanning beds, or have fair skin that you seldom protected from the sun.
Another sign of sun-damaged skin is having one or more pre-cancerous growths on your skin called actinic keratoses . Some AKs progress, turning into squamous cell carcinoma of the skin.
To find out what this skin cancer can look like and see pictures of it, go to: Squamous cell carcinoma of the skin: Signs and symptoms.
Health Literacy To Empower Patients
With the right information, patients can make the best decisions about their care. By partnering with patients, healthcare providers, and hospitals, we hope to provide all patients with the tools and knowledge to understand their pathology report.
For more information about this site, contact us at .
Disclaimer: The articles on MyPathologyReport are intended for general informational purposes only and they do not address individual circumstances. The articles on this site are not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health. Never ignore professional medical advice in seeking treatment because of something you have read on the MyPathologyReport site. MyPathologyReport is independently owned and operated and is not affiliated with any hospital or patient portal. The articles on MyPathologyReport.ca are intended for use within Canada by residents of Canada only.
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What Are The Different Types Of Skin Cancer
Your skin has multiple layers. The outer, protective layer of the skin is known as the epidermis. The epidermis is made up of squamous cells, basal cells, and melanocytes. These cells are constantly shedding to make way for fresh, new skin cells.
However, when certain genetic changes occur in the DNA of any of these cells, skin cancer can occur. The main types of skin cancer are squamous cell carcinoma, basal cell carcinoma, and malignant melanoma.
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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.
What Does Scc Look Like
SCCs can appear as scaly red patches, open sores, rough, thickened or wart-like skin, or raised growths with a central depression. At times, SCCs may crust over, itch or bleed. The lesions most commonly arise in sun-exposed areas of the body.
SCCs can also occur in other areas of the body, including the genitals.
SCCs look different on everyone. You can find more images, as well as signs, symptoms and early detection strategies on our SCC Warning Signs page.
Please note: Since not all SCCs have the same appearance, these photos serve as general reference for what they can look like. If you see something new, changing or unusual on your skin, schedule an appointment with your dermatologist.
A persistent, scaly red patch with irregular borders that sometimes crusts or bleeds.
An open sore that bleeds or crusts and persists for weeks.
An elevated growth with a central depression that occasionally bleeds. It may rapidly increase in size.
A wart-like growth that crusts and occasionally bleeds.
Read Also: Can You See Skin Cancer
Skin Cancer Types: Squamous Cell Carcinoma Overview
All content solely developed by the American Academy of Dermatology
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
What Is The Outlook For People With Squamous Cell Cancer
Early detection of SCC is key to successful treatment. If SCC isnt treated in its early stages, the cancer may spread to other areas of the body, including the lymph nodes and organs. Once this occurs, the condition can be life threatening.
Those with weakened immune systems due to certain medical conditions, such as HIV, AIDS, or leukemia, have a greater risk of developing more serious forms of SCC.
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How Is Squamous Cell Skin Cancer Treated
Although squamous cell cancers usually grow slowly,;it is important to see a dermatologist quickly. “The sooner you see your doctor and the cancer is diagnosed and treated, the less complicated the surgery to remove it will be, and the faster you will make a complete recovery, Dr. Leffell explains. The treatment for squamous cell cancer varies according to the size and location of the lesion. The surgical options are the same as those for basal cell cancer:;
- Surgical excision: Removing a squamous cell lesion is a simple procedure that typically;takes place in the dermatologist’s office. After numbing the cancer and the area around it with a local anesthetic, the doctor uses a scalpel to remove the tumor and some of the surrounding skin to make sure all cancer is eliminated. Estimating how much to take requires skill and expertise, Dr. Leffell notes. The risk of taking too little tissue is that some cancer remains; taking too much leaves a larger scar than is necessary. Shaped like a football, the wound is stitched together, using plastic surgery techniques. If dissolvable stitches are used, they will disappear on their own as the area heals. Though the procedure leaves some redness and a small scar, it tends to become less noticeable over time. “The cure rate for this type of excision is typically about 90 to 93 percent,” says Dr. Leffell. But, of course, this is dependent on the skill and experience of the doctor.”
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.
Also Check: How Bad Is Basal Cell Skin Cancer
The Second Most Common Skin Cancer
Squamous cell carcinoma of the skin is the second most common form of skin cancer, characterized by abnormal, accelerated growth of squamous cells. When caught early, most SCCs are curable.
SCC of the skin is also known as cutaneous squamous cell carcinoma . Adding the word cutaneous identifies it as a skin cancer and differentiates it from squamous cell cancers that can arise inside the body, in places like the mouth, throat or lungs.
What Are The Risk Factors For Squamous Cell Skin Cancer
Squamous cell skin cancer is mainly caused by cumulative ultraviolet exposure from the sun, according to;Dr. Leffell.;
Daily year-round exposure to the suns UV light and intense exposure in;the;summer months add to the damage that causes this type of cancer, he says.;People at the highest risk for squamous cell skin cancer tend to have light or fair-colored skin; blue, green or gray eyes; a history of sun exposure; and a tendency to sunburn quickly. Squamous cell cancers occur four times more frequently in men than in women.
Although squamous cell cancer can be more aggressive than basal cell cancer, the risk of this type of cancer spreading;is lowas long as the cancer is treated early, Dr. Leffell says. He;notes;that the lesions must be treated with respect because they may grow rapidly and invade deeply.;While it is more difficult to treat squamous cell cancer;that has metastasized, up to half of cases can be cured.
In a small percentage of;cases, squamous;cell;skin;cancer;can grow along the tiny nerves in the skin. In this very serious condition, the squamous cell cancer of the face or scalp can travel along the nerves and spread to the brain.
What Makes Yale Medicines Approach To Squamous Cell Carcinoma Unique
Simple, small cancers can often be treated very well by a local dermatologist, according to Dr. Leffell.;We rarely see the small cancers. We get referred to the cases that need special attention. ;;
Dr. Leffell emphasizes that at Yale Medicine, the patient always comes first.;We like to have a discussion with the patient about what happens after the skin cancer is removed, he says. We talk about what’s;involved with plastic surgery and what’s involved with letting the area heal naturally. We prefer to take a minimalist approach and let the patient decide what they want us to do and how they want to let their skin heal.
If the decision is made to repair the wound using plastic surgery, we do that immediately in the office setting, Dr. Leffell says. Alternatively, allowing the wound to heal naturally is often a great option, and does not rule out doing plastic surgery down the road if needed, though that is very rarely the case.
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Seek Comprehensive Care If Your Skin Cancer Is Complicated To Treat
Complicated skin cancer may require the expertise of multiple specialists. Plastic surgeons may get involved when the cosmetic challenges are significant. An ocular surgeon or an oculoplastic specialist may be needed if you have an especially difficult-to-treat skin cancer close to the eye. A head and neck surgeon may join your care team if there is nerve involvement or if the cancer is too extensive for local anesthesia.;
The beauty of a comprehensive cancer center like MSK is that the expertise is all here, says Dr. Lee. We have a multidisciplinary program especially for people with complex skin cancer. You can usually see all of your doctors on the same day and in the same location. The dermatology team works with you to coordinate your appointments with your schedule.
How Widespread Is Scc
While SCC is less common than basal cell carcinoma , the number of reported SCC cases in the U.S. has steadily increased.
- An estimated;1.8 million cases of SCC are diagnosed each year, which translates to about 205 cases diagnosed every hour.
- SCC incidence has increased up to 200 percent in the past three decades.
Also Check: Where Does Skin Cancer Start
What Is Squamous Cell Carcinoma
Squamous cell carcinoma is the second most common form of skin cancer. Its usually found on areas of the body damaged by UV rays from the sun or tanning beds. Sun-exposed skin includes the head, neck, chest, upper back, ears, lips, arms, legs, and hands.
SCC is a fairly slow-growing skin cancer. Unlike other types of skin cancer, it can spread to the tissues, bones, and nearby lymph nodes, where it may become hard to treat. When caught early, its easy to treat.
SCC can show up as:
- A dome-shaped bump that looks like a wart
- A red, scaly patch of skin thats rough and crusty and bleeds easily
- An open sore that doesnt heal completely
- A growth with raised edges and a lower area in the middle that might bleed or itch
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Consider Getting A Second Opinion On Pathology
The first step in diagnosing skin cancer is a skin biopsy. The tissue sample taken during the biopsy is sent to a pathologist, who then examines the cells under a microscope. Pathologists are usually certain about their diagnoses. But there are instances when the cancer cells look unusual or the pathology is inconclusive for some other reason.
How do you know if you need a second opinion if no one has told you to get one? Start by asking your doctor, says Dr. Lee. One way you might phrase the question is, Was the pathology definitive? If the doctor says no, thats your cue to seek out a second opinion on your pathology.
You can also review the pathology report yourself. Sometimes the report will say the diagnosis is inconclusive. Also be on the lookout for phrases such as most in keeping with or features of, says Dr. Lee. This is terminology indicating that the pathologist formed a hypothesis but wasnt absolutely certain.
One of the benefits of coming to MSK for care is that we review the pathology, says Dr. Lee. Most of the time we confirm the original diagnosis, but occasionally we do see differences.
What Causes Squamous Cell Cancer
Skin cancer is caused by mutations that occur in skin cell DNA. These changes cause abnormal cells to multiply out of control. When this occurs in the squamous cells, the condition is known as SCC.
UV radiation is the most common cause of the DNA mutations that lead to skin cancer. UV radiation is found in sunlight as well as in tanning lamps and beds.
While frequent exposure to UV radiation greatly increases your risk of skin cancer, the condition can also develop in people who dont spend much time in the sun or in tanning beds.
These people may be genetically predisposed to skin cancer, or they may have weakened immune systems that increase their likelihood of getting skin cancer.
Those who have received radiation treatment may also be at greater risk of skin cancer.
Risk factors for SCC include:
- having fair skin
- having light-colored hair and blue, green, or gray eyes
- having long-term exposure to UV radiation
- living in sunny regions or at a high altitude
- having a history of multiple severe sunburns, especially if they occurred early in life
- having a history of being exposed to chemicals, such as arsenic
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