Cancer Stage Determines Risk Of Spreading And Line Of Treatment
A cancer of the upper layers of the skin in the epidermis, SCC is the second most common form of skin cancer after basal cell carcinoma and affects an estimated 1 million new people every year in the United States alone. Cancer staging is done for SCC with the intention of categorizing the size of cancer and to judge how much it has grown. And theres a clear line of treatment and way forward for each stage.1
With skin cancers like basal cell carcinoma, the likelihood of cancer spreading to other parts of the body is very low and early diagnosis and treatment usually tackles the problem before it spreads. SCC, however, is a little trickier. While the risk of spreading is still quite small, there is a relatively higher chance of it progressing depending on what stage the cancer is at. For those with weakened immune systems, say, people whove had organ transplants or anyone infected with HIV, the risk is a little higher. Also, when the cancer is in the head and neck region, it may have a slightly higher risk of recurring or spreading.2
The actual stage of this form of cancer is determined based on the TNM protocol devised by the American Joint Commission on Cancer.3
- T : The size/extent of the tumor
- N : Whether it has spread to lymph nodes
- M : Whether it has spread to other parts of the body
Signs And Symptoms Of Cutaneous Squamous Cell Carcinoma
Clinically, cSCC presents as a shallow ulcer with elevated margins, often covered by a plaque and usually located in a sun-exposed area. Typical surface changes may include scaling, deep ulceration, crusting, and cutaneous horn.
A less common presentation of cSCC includes a pink cutaneous nodule without overlying surface changes. Regional metastasis of head and neck cSCC may result in enlarged and palpable submandibular or cervical lymph nodes.
If cSCC invades the adjacent peripheral nerve, it causes numbness, pain, and muscle weakness. These may be some of the clinical signs of invasion other than palpable lymph nodes.
What Does Squamous Cell Carcinoma Look Like
Squamous cell carcinomas most often affect areas with lot of sun exposure such as the face, scalp, neck, ears, backs of hands, forearms, and shins. Squamous cell carcinomas can occur in many other areas of the skin. Squamous cell carcinoma often looks like a rough scaly spot, scab or sore that just will not heal. They tend to bleed easier than normal skin.
Scabs and scratches typically heal within 4 weeks. Skin cancer does not heal because the cells are abnormal. If you have a non-healing scab or sore, and it has been more than 4 weeks you should call your dermatologist to have this spot examined.
It is very important to note that while these characteristics are some of the most common signs of squamous cell carcinoma, there is no substitute for your skin concern being examined in person by a Board-Certified Dermatologist. This is the gold standard for having any of your skin concerns addressed. Your Board-Certified Dermatologist will perform a comprehensive examination and is the expert when it comes to diagnosis and treating skin cancers.
What causes squamous cell carcinoma?
How is squamous cell carcinoma diagnosed?
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Do Some People Have A Higher Risk Of Developing Squamous Cell Carcinoma Skin Cancer
Yes. The key risk factors for getting this skin cancer are listed below. A risk factor is anything that increases your risk of developing a disease.
While having one or more risk factors for SCC of the skin increases your risk of developing it, some people who get this skin cancer dont seem to have any risk factors. People of all colors get this skin cancer, including people of African, Asian, and Latin descent.
If you find a spot on the skin that is growing, bleeding, or changing in any way, see a board-certified dermatologist to find out what it is. Youll find out how this skin cancer is diagnosed and treated at, Squamous cell carcinoma of the skin: Diagnosis and treatment.
1 American Academy of Dermatology. Indoor tanning fact sheet. Last accessed January 31, 2019.
2 Omland SH, Ahlstrom MG, et al. Risk of skin cancer in patients with HIV: A Danish nationwide cohort study. J Am Acad Dermatol 2018 79:689-95.
ReferencesAnadolu-Brasie R, Patel AR, et al., Squamous cell carcinoma of the skin. In: Nouri K, et al. Skin Cancer. McGraw Hill Medical, China, 2008: 86-114.
Nadhan KS, Chung CL, et al. Risk factors for keratinocyte carcinoma skin cancer in nonwhite individuals: A retrospectiveaAnalysis. J Am Acad Dermatol , doi: https://doi.org/10.1016/j.jaad.2019.01.038.
Omland SH, Ahlstrom MG, et al. Risk of skin cancer in patients with HIV: A Danish nationwide cohort study. J Am Acad Dermatol 2018 79:689-95.
How Does This Cancer Typically Progress
In the skin form of the disease, although spread to nearby lymph nodes or other organs is possible, it is very uncommon. With SCC of the nose, spread may occur to the lymph nodes under the chin .
Dogs with multicentric SCC often develop new lesions in other sites after surgical removal of lesions.
The digit form of SCC is far more aggressive. It can spread to the local lymph nodes and beyond. For this reason, your veterinarian may recommend staging . Staging may include bloodwork, urinalysis, X-rays of the lungs, and possibly an abdominal ultrasound. If any lymph nodes appear to be affected , samples may be taken via FNA to determine if the tumor has spread into them.
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Can Squamous Cell Carcinoma Be Prevented Or Avoided
Most cases of squamous cell carcinoma can be prevented by avoiding exposure to UV rays.
- Avoid the sun, especially during peak hours of 10 a.m. to 4 p.m.
- Use sunscreen, even on cloudy days.
- Wear a wide-brimmed hat, protective clothing, and sunglasses when you go outside.
- Avoid places that reflect light, such as water, sand, or concrete.
- Dont try to get a tan, including using tanning beds or sunlamps.
If squamous cell carcinoma is caught early, it is usually easy to treat. Examine your skin once a month. See your family doctor right away if you find anything that looks suspicious.
What To Look For
SCCs occur most frequently on areas of the body that have been exposed to the sun for prolonged periods. Usually, the skin in these areas reveals telltale signs of sun damage, such as wrinkling, changes in pigmentation and loss of elasticity. It is important to look for the ugly duckling among lesions on sun-damaged skin. Spots that do not resemble the rest and are irregularly shaped, large, appear in different shades of colour, and have evolved over time should warrant further investigation:
- A wart-like growth that crusts and occasionally bleeds
- A persistent, scaly red patch with irregular borders that sometimes crusts or bleeds.
- An open sore that bleeds and crusts and persists for weeks.
- An elevated growth with a central depression that occasionally bleeds. A growth of this type may rapidly increase in size.
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Prognosis Of Squamous Cell Carcinoma
Typically, the prognosis for small tumors that are removed early and adequately is excellent. Treatment is usually effective, and most people survive. Most squamous cell carcinomas affect only the area around them, penetrating into nearby tissues. However, some spread to distant parts of the body, nearby skin and lymph nodes, and eventually to nearby organs and can be fatal. Tumors that are more than 2 centimeters in diameter or grow more than 2 millimeters deep, or tumors that occur near the ears and lips, in scars, or around nerves are more likely to spread. About one third of cancers on the tongue or elsewhere in the mouth have metastasized before diagnosis .
If the cancer is treated before it metastasizes, the person is usually cured. However, if the cancer has metastasized, the chance of surviving the next 5 years, even with treatment, is only 34%.
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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History Of Indoor Tanning
Tanning beds emit UV radiation that is dangerous and raises your risk of developing SCC. People who have tanned indoors have a 67 percent increased risk of developing SCC compared with those who havent.
SCCs account for about 168,000 of the 419,000 cases of skin cancer diagnosed in the U.S. each year that are linked to indoor tanning.
In the last 30 years, the number of women under age 40 diagnosed with SCC has risen steadily a statistic that experts also believe is linked to indoor tanning.
References And Information Sources Used For The Article:
Wolff, K., & Johnson, R. A. . Fitzpatricks color atlas and synopsis of clinical dermatology. McGraw-Hill Medical.
Thiers, B. H. . Year Book of Dermatology 1988. Archives of Dermatology, 125, 1150.
Burns, T., & Breathnach, S. . Rooks Textbook of dermatology Vol 4. London: Blackwell Scientific Publications, 1992.
Bolognia, J. L., Schaffer, J. V., Duncan, K. O., & Ko, C. J. . Dermatology Essentials E-Book. Elsevier Health Sciences.
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What Are The Signs Of Scc
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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.
Prevention Of Squamous Cell Carcinoma
People whose squamous cell carcinomas have returned or are large should be treated with a technique called Mohs microscopically controlled surgery Mohs Microscopically Controlled Surgery Basal cell carcinoma, the most common skin cancer, originates in certain cells of the outer layer of the skin . Usually, a small, shiny bump appears on the skin and enlarges slowly… read more. Radiation therapy may be done after surgery.
Squamous cell carcinoma that has spread to only one or a few other parts of the body is treated with radiation therapy. If the cancer is widespread, radiation therapy may not be used, and chemotherapy is usually not effective.
People who cannot have surgery and who have large squamous cell carcinomas that have spread to underlying tissue or elsewhere in the body may be given PD-1 inhibitors . PD-1 inhibitors help the body’s immune system destroy the cancer. These drugs are called PD-1 inhibitors because they block the action of a protein on the surface of the cancer cell called programmed cell death protein 1. This protein protects the cancer cell from the effects of the immune system. When PD-1 inhibitors block the protein, the immune system is able to attack the cancer cell and kill it.
Because there is a greater risk of metastasis than with basal cell carcinoma, doctors closely monitor treatment and follow-up.
What Causes Basal And Squamous Cell Skin Cancers
While many risk factors for basal and squamous cell skin cancers have been found, its not always clear exactly how these factors might cause cancer.
Most basal cell and squamous cell skin cancers are caused by repeated and unprotected skin exposure to ultraviolet rays from sunlight, as well as from man-made sources such as tanning beds.
UV rays can damage the DNA inside skin cells. DNA is the chemical in each of our cells that makes up our genes, which control how our cells function. We usually look like our parents because they are the source of our DNA. But DNA affects more than just how we look.
Some genes help control when our cells grow, divide into new cells, and die:
- Genes that help cells grow, divide, and stay alive are called oncogenes.
- Genes that keep cell growth in check by slowing down cell division or causing cells to die at the right time are called tumor suppressor genes.
Cancers can be caused by DNA changes that keep oncogenes turned on, or that turn off tumor suppressor genes. These types of gene changes can lead to cells growing out of control.
Researchers dont yet know all of the DNA changes that result in basal or squamous cell skin cancer, but they have found that in many skin cancers the cells have changes in tumor suppressor genes.
These are not the only gene changes that play a role in the development of skin cancer. There are many others as well.
What Is A Squamous Cell Carcinoma Of The Skin
Squamous cell carcinoma is a tumor of skin cells. As shown in the illustration, the skin is made up of several layers of cells with the squamous layer at the top. Because this type of cancer arises from squamous cells, tumors can develop anywhere that these cells are present. This can include the nail bed, paw pads, abdomen, back, ears, or the nose, including the nasal planum .
Squamous cell carcinomas usually appear as a single, solitary lesion in one location, but there is a kind of SCC called multicentricsquamous cell carcinoma that presents as many lesions in multiple locations on the body. Multicentric SCC is very rare in dogs.
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Answer: Invasive Scc Diagnosis
First, I applaud you for noticing something that wasnt healing and going in to have it checked. Although invasive SCC sounds very scary, its usually quite treatable with a Mohs surgery in that location. You will be ok. Continue to check your skin often. Now that youve had one type of skin cancer, you are prone to more surfacing over time .This answer has been solicited without seeing this patient and cannot be held as true medical advice, but only opinion. Seek in-person treatment with a trained medical professional for appropriate care.
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What Is The Best Treatment For Squamous Cell Carcinoma
The best treatment for squamous cell carcinoma depends on several factors: the type of squamous cell carcinoma the location of the skin cancer your health and medical conditions. Your dermatologist can assess your skin cancer and come up with an individualized treatment to meet your goals and specific needs.
When appropriate, Mohs surgery is the treatment that offers the highest cure rate amongst all treatments. 99% of all squamous cell carcinomas can be cured with Mohs Surgery. Mohs surgery is a technique that preserves your normal skin, only removing the skin cancer, and thereby minimizing scaring and maximizing your cosmetic outcome. Mohs surgery is the most advanced treatment for squamous cell carcinoma.
When is it appropriate to treat a squamous cell carcinoma with Mohs Surgery?
Did you know:
- You can use your smartphone to take photos of your skin to document your moles, both how they look and their location. Then, if in the future you are concerned a spot changed, you can refer back to those high-quality photos.
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Is There Anything Else I Should Know
As UV rays/sunlight may play a role in the development of SCC, it is best to limit your dogs exposure to the sun, especially between the hours of 10am and 3pm, and especially in dogs with thin haircoats. Your dog should not be allowed to rub, scratch, lick, chew, or bite the affected area, as this may cause trauma and increase the risk of secondary infection. Secondary infections are common and treated with antibiotics as recommended by your veterinarian. Your veterinarian may also recommend medications for pain.
What Is The Outlook For Someone Who Has Squamous Cell Carcinoma Of The Skin
When found early, this cancer is highly treatable. Left untreated, however, SCC can spread deep into the skin and travel to other parts of the body, making treatment difficult.
While treatment can remove the cancer, its important to know that this cancer can return. You also have a greater risk of developing another skin cancer.
Thats why self-care becomes so important after treatment for SCC of the skin. Youll find the self-care that dermatologists recommend at, Squamous cell carcinoma of the skin: Self-care.
ReferencesAlam M, Armstrong A, et al. Guidelines of care for the management of cutaneous squamous cell carcinoma. J Am Acad Dermatol 2018 78:560-78.
Anadolu-Brasie R, Patel AR, et al., Squamous cell carcinoma of the skin. In: Nouri K, et al. Skin Cancer. McGraw Hill Medical, China, 2008: 86-114.
Marrazzo G, Zitelli JA, et al. Clinical outcomes in high-risk squamous cell carcinoma patients treated with Mohs micrographic surgery alone. J Am Acad Dermatol 2019 80:633-8.
Que SKT, Zwald FO, et al. Cutaneous squamous cell carcinoma: Management of advanced and high-stage tumors. J Am Acad Dermatol 2018 78:249-61.
Ribero S, Stucci LS, et al. Drug therapy of advanced cutaneous squamous cell carcinoma: Is there any evidence? Curr Opin Oncol. 2017 29:129-35.
U.S. Food and Drug Administration. FDA approves cemiplimab-rwlc for metastatic or locally advanced cutaneous squamous cell carcinoma. New release issued 9/28/2018. Last accessed 1/13/2020.
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