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.
Can It Be Treated
Oral SCC is a very aggressive cancer in the cat. Severe and extensive bone involvement is common. Most cats present with advanced disease, making surgical removal impossible.
Radiation and chemotherapy have been used to treat oral SCC in the cat with little success. Although these tumors may shrink initially with treatment, the tumors often regrow rapidly after treatment is completed. Most cats have enough difficulty eating at the time of diagnosis that feeding tubes may be necessary if radiation therapy is to be pursued.
Preparing For An Appointment
If you have a skin wound or lesion that concerns you, make an appointment with your doctor. You may be referred to a doctor who specializes in the diagnosis and treatment of skin conditions .
If you’ve already had skin cancer, you have an increased risk of a second cancer. Talk with your dermatologist about how often you should have a skin examination to look for signs of another skin cancer.
Here’s some information to help you get ready for your appointment, and what to expect from your doctor.
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How Is It Diagnosed
A tissue biopsy is necessary to definitively diagnosis SCC. X-rays of the jaw are helpful in determining the presence of bone destruction, but often underestimate the extent of involvement. Routine bloodwork and chest X-rays are recommended to assess your cats overall health prior to anesthesia and biopsy.
How Is Squamous Cell Carcinoma Of Oral Cavity Treated
Early diagnosis and treatment of Squamous Cell Carcinoma of Oral Cavity is important to avoid complications such as metastasis to other regions. The treatment measures may include:
- In most cases, a wide surgical excision and removal of the entire tumor is the preferred treatment option. This may be followed by radiation therapy and/or chemotherapy
- If the tumor has metastasized , then a combination of chemotherapy, radiation therapy, and invasive procedures may be used to treat the tumor
- Targeted therapy medications are generally used for locally infiltrated or metastatic SCCs. This therapy destroys the tumor cells by acting against the proteins that are responsible for tumor growth
- Reconstructive surgery may be necessary after cancer therapy
- Post-operative care is important: One must maintain minimum activity levels, until the surgical wound heals
- Follow-up care with regular screening and check-ups are important and encouraged
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What Are The Risk Factors For Squamous Cell Carcinoma Of Oral Cavity
The risk factors for Squamous Cell Carcinoma of Oral Cavity include:
- Smoking and chewing of tobacco are strong risk factors for this type of Oral Cavity Cancer
- Radiation therapy in the face or mouth region
- Arsenic exposure
- Coal tar exposure
- Individuals with weak immune system, which could be due to cancer treatment, AIDS, or those on immunosuppressant drugs after receiving an organ transplant
- Caucasians are more vulnerable compared to other dark-skinned individuals
It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.
Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.
Systemic Therapy Options For Scc In Dogs
Chemotherapy, COX-2 inhibitors, and other systemic therapy options may be recommended for canine squamous cell carcinoma in the following cases:
- Growth is inoperable
- The tumor is poorly differentiated
- Metastasis is already present at the time of diagnosis
- Mass is in a location known for aggressive biologic behavior.
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Scc Is Mainly Caused By Cumulative Uv Exposure Over The Course Of A Lifetime
If youve had a basal cell carcinoma you may be more likely to develop a squamous cell skin carcinoma, as is anyone with an inherited, highly UV-sensitive condition such as xeroderma pigmentosum.
Chronic infections, skin inflammation, HIV and other immune deficiency diseases, chemotherapy, anti-rejection drugs used in organ transplantation, and excessive sun exposure can all lead to a risk of squamous cell carcinoma.
Occasionally, squamous cell carcinomas arise spontaneously on what appears to be normal, healthy skin. Some researchers believe the tendency to develop these cancers can be inherited.
SCCs may occur on all areas of the body including the mucous membranes and genitals, but are most common in areas frequently exposed to the sun:
- Previous BCC or SCC
- Chronic inflammatory skin conditions or chronic infections
But anyone with a history of substantial sun exposure is at increased risk. Those whose occupations require long hours outside or who spend their leisure time in the sun are also at risk.
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.
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.
What Are The Signs And Symptoms Of Squamous Cell Carcinoma Of Oral Cavity
The signs and symptoms of Squamous Cell Carcinoma of Oral Cavity include:
- In majority of the cases, the condition is asymptomatic and does not present any signs or symptoms
- Generally, squamous cell carcinomas are slow-growing tumors though SCC of Oral Cavity is an aggressive form of cancer
- The mouth parts affected may include the cheek, hard and soft palate, gums, etc.
- The skin lesions may appear as crusted ulcer, plaques, and nodules
- It may ulcerate and bleed. Occasionally, after the ulcer heals, it may become ulcerated again
- The size of the lesions range from 1-10 cm average size is usually less than 3 cm
- Individuals with immunocompromised states have more aggressive tumors
- Due to the presence of the lesion on the oral mucosa, it may be difficult for the individual to consume food and drink. Also, speaking may be difficult and painful
How Is Squamous Cell Carcinomas Diagnosed
Depending on where the tumor develops , a diagnosis may be achieved with a fine needle aspiration or a biopsy. FNA involves taking a small needle with a syringe and suctioning a sample of cells directly from the tumor and placing them on a microscope slide. A veterinary pathologist then examines the slide under a microscope.
In some cases, results from FNA may not be entirely clear and biopsy may be necessary. A biopsy is a surgical excision of a piece of the tumor. Pieces of the tumor are then examined by a veterinary pathologist under the microscope. This is called histopathology. Histopathology is not only helpful to make a diagnosis but can indicate how the tumor is likely to behave.
What Are The Signs Of Scc
Typically, these lesions are found in light-skinned areas and can be highly variable in their appearance. It may look like a small area of irritated, red, or ulcerated skin. Alternatively, there could be plaques or crusts that develop over the region. SCC lesions of the toe or nail bed tend to be red, irritated, bothersome, and ulcerated. Dogs may even lose nails on the affected toes.
Lesions of the skin or nose may become dry, irritated, and bothersome for your pet. The lesion may get larger, spread, and ulcerate which can be very painful as well. Your pet should not be allowed to scratch, lick, or bite the area.
SCC of the toe can be very painful. Your pet may be reluctant to go for walks, and you may notice blood on the floor or on your dogs toes. Your dog may attempt to lick or chew the affected toe aggressively and you may notice missing toe nails. These lesions are typically painful, and your veterinarian may prescribe pain medications. Secondary infection is also possible for which antibiotics may be required.
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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. The removed lymph nodes are looked at under a microscope to see if they contain cancer cells. Sometimes, radiation therapy might be recommended after surgery.
Immunotherapy: For advanced squamous cell cancers that cant be cured with surgery or radiation therapy, one option might be using an immunotherapy drug such as cemiplimab or pembrolizumab . However, these drugs havent been studied in people with weakened immune systems, such as people who take medicines for autoimmune diseases or who have had an organ transplant, so the balance between benefits and risks for these people isnt clear.
Systemic chemotherapy and/or targeted therapy:Chemotherapy and targeted therapy drugs might be other options for patients with squamous cell cancer that has spread to lymph nodes or distant organs. These types of treatment might be combined or used separately.
Staging Squamous Cell Skin Cancer: High
Certain high-risk features are markers of an aggressive squamous cell skin cancer. These features are related to the location, size, and pathologic features of the tumor as well as certain characteristics of the patient.
When the specialist examines your pathology specimen from the biopsy, s/he will evaluate if your cancer is advanced or not. If the tumor is not advanced and is still localized, a critical step is determining if the tumor has high-risk features suggesting it is aggressive. Whats aggressive behavior for a squamous cell skin cancer? We can think of an aggressive skin cancer as one that spreads to distant body sites. But squamous cell skin cancers can also act aggressively when they spread locally and invade other tissues such as your nerves, bone, and other structures. An estimated five percent of squamous cell skin cancers are aggressive, meaning they are at increased risk for causing a lot of damage when they grow deep below your skin, coming back to the same location, or spreading to other parts of your body.
Below are the features that make squamous cell skin cancer high risk. These can be related to the primary tumor or the characteristics of the person who has the tumor.
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What Are The Symptoms
Owners may notice a mass in the cats mouth. Tumors that occur in the back of the mouth or under/on the tongue are rarely seen until signs of drooling, weight loss, halitosis , difficulty eating, and bloody discharge from the mouth are noted. Loose teeth can also be a symptom of oral cancer in the cat.
What Are The Symptoms Of Squamous Cell Carcinoma
The first sign of an SCC is usually a thickened, red, scaly spot thatdoesnt heal. You are most likely to find an SCC on the back of your hands,forearms, legs, scalp, ears or lips. If its on your lips, it can look like asmall ulcer or patch of scaly skin that doesnt go away.
An SCC may also look like:
- a crusted sore
- a sore or rough patch inside your mouth
- a red, raised sore around your anus or genitals
An SCC will probably grow quickly over several weeks or months.
When Your Cancer Comes Back
Finishing your treatment can come as a huge relief, especially if your doctor tells you youre in remission. Yet your cancer can come back. This is called a recurrence.
See your doctor for regular follow-up visits to catch any recurrence early, when its most treatable. The doctor who treated your cancer will let you know how often to get check-ups. You may see your doctor every 3 months for the first year, and then less often.
How Can Squamous Cell Carcinoma Of Oral Cavity Be Prevented
A few methods to prevent Squamous Cell Carcinoma of Oral Cavity include:
- Maintain proper oral hygiene
- Avoid chewing tobacco and smoking
- Avoid prolonged and chronic exposure to the sun
Regular medical screening at periodic intervals with blood tests, scans, and physical examinations, are mandatory, due to its high metastasizing potential and possibility of recurrence. Often several years of active vigilance is necessary.
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What Is The Prognosis
The prognosis of oral SCC in the cat is extremely poor. The 1 year survival rate is less than 10%, even with combinations of radiation therapy and chemotherapy. Pain medications, such as piroxicam and buprenorphine, may be helpful in reducing discomfort associated with the tumor. However, most cats are euthanatized due to their inability to eat and drink and poor quality of life within 1-3 months of diagnosis.
University of Florida
What Is Squamous Cell Carcinoma
Squamous cell carcinoma is one of the most common forms of skin cancer. It can develop on parts of the body that get a lot of sun, such as the head, neck, face, hands and arms. Squamous cell carcinoma is not as dangerous as melanoma, but it can spread to other parts of the body if not treated. Every year, some people in Australia die from aggressive SCCs.
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Factors Affecting Squamous Cell Carcinoma Prognosis
There are a handful of factors that can affect a patients prognosis, including:
- Having a weakened immune system
- The location of the tumortumors found on the face, scalp, fingers and toes spread more easily, as do tumors that arise in an open wound
- If the cancer has recurred
- Larger tumors and those that are growing deep in the skin
Squamous Cell Carcinoma Stages
Squamous cell carcinoma stages represent the size of a tumor and how far it has spread. However, squamous cell carcinoma is usually very slow to metastasize most cases are diagnosed while the cancer is still confined to the upper layer of the skin. As a result, these tumors may not be staged if it is clear that the cancer has not invaded nearby tissues at the time of diagnosis.
If a squamous cell carcinoma does require staging, oncologists will evaluate a number of factors, including:
- The size of the tumor
- Whether the tumor has grown into the dermis or subcutis levels of the skin
- Whether the cancer has invaded the bones
- Where on the body the tumor developed
- How the cells appear when viewed under a microscope
- Whether the cancer has spread to lymph nodes or distant organs
After evaluating these factors, the oncologist will assign one of the following squamous cell carcinoma stages to the tumor:
- Stage 0 Cancer is only present on the epidermis .
- Stage 1 Cancer has grown deep into the skin, but has not spread to nearby lymph nodes or healthy tissues.
- Stage 2 Cancer has grown deep into the skin and displays one or more high-risk features , but has not spread to nearby lymph nodes or healthy tissues.
- Stage 3 Cancer has grown into lymph nodes, but has not spread to any organs other than the skin.
- Stage 4 Cancer has spread to one or more distant organs, such as the lungs, liver, brain or distant parts of the skin.
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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.