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What Is Cutaneous Squamous Cell Carcinoma

What Are The Stages Of Squamous Cell Carcinoma

Overview of Cutaneous Squamous Cell Carcinoma

Squamous cell carcinoma is classified into the following stages, which are partly based on how far the cancer has spread throughout the body:

  • Stage 0 Squamous cell carcinoma develops in the squamous cells, which are located in the epidermis . During Stage 0, the cancer hasnt spread beyond the epidermis.
  • Stage 1 When squamous cell carcinoma progresses to Stage 1, it means that the cancer has spread deeper into the skin, but not into any lymph nodes or healthy tissues.
  • Stage 2 A Stage 2 classification means that, in addition to progressing deeper into the skin, the cancer also displays at least one high-risk feature. This might include metastasizing to the lower skin layers or the nerves. However, at this stage, the cancer still hasnt spread to lymph nodes or healthy tissues.
  • Stage 3 Once squamous cell carcinoma reaches Stage 3, the cancer has spread into lymph nodes but not any other tissues or organs.
  • Stage 4 This is the final stage of squamous cell carcinoma, where the cancer has spread to at least one distant organ, whether that be the brain, the lungs or a separate area of skin.

If you think you might have squamous cell carcinoma, its important to seek prompt medical attention to minimize the risk of cancer spread. The specialists in Moffitt Cancer Centers Cutaneous Oncology Program can provide you with the comprehensive diagnostic and treatment services you need. Call or complete our new patient registration form online to request an appointment.

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Squamous Cell Carcinoma Risk Factors

Certain things make you more likely to develop SCC:

  • Older age
  • Bowens disease, HPV, HIV, or AIDS

Your doctor may refer you to a dermatologist who specializes in skin conditions. They will:

  • Ask about your medical history
  • Ask about your history of severe sunburns or indoor tanning
  • Ask if you have any pain or other symptoms
  • Ask when the spot first appeared
  • Give you a physical exam to check the size, shape, color, and texture of the spot
  • Look for other spots on your body
  • Feel your lymph nodes to make sure they arent bigger or harder than normal

If your doctor thinks a bump looks questionable, theyll remove a sample of the spot to send to a lab for testing.

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Effective Options For Early Stage Scc

Most squamous cell carcinomas of the skin can be cured when found and treated early. Treatment should happen as soon as possible after diagnosis, since more advanced SCCs of the skin are more difficult to treat and can become dangerous, spreading to local lymph nodes, distant tissues and organs. Find out more about treatment options for advanced or recurring SCCs here.

If youve been diagnosed with an SCC that has not spread, there are several effective treatments that can usually be performed on an outpatient basis. The choices available to you depend on the tumor type, size, location and depth, as well as your age and overall health.

Options include:

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What Are The Clinical Features Of Intraepidermal Scc

Intraepidermal SCC presents as one or more irregular scalyplaques of up to several centimetres in diameter. They are often an orange-red colour but may also be brown.

Although intraepidermal SCC may arise on any area of skin, it is most often diagnosed on sun-exposed sites of the ears, face, hands and lower legs. When there are many plaques, distribution is not symmetrical .

Intraepidermal squamous cell carcinoma

Intraepidermal SCC may start to grow under a nail when it results in a red streak that later may destroy the nail plate.

Intraepidermal squamous cell carcinoma of the nail

What Does Invasive Squamous Cell Carcinoma Mean

Squamous Cell Carcinoma Risks and Diagnosis

Squamous cell carcinoma is the second most common type of skin cancer, with an estimated 1.8 million cases diagnosed each year. What makes this non-melanoma skin cancer unique is that in addition to appearing on the skins surface, it can also develop internally as well, in places like the mouth, throat, and lungs. What does invasive squamous cell carcinoma mean? Squamous cell carcinoma can become invasive by growing deeper than its originating area, penetrating additional layers of the skin and potentially spreading to other parts of the body.

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How To Spot An Scc

SCC of the skin can develop anywhere on the body but is most often found on exposed areas exposed to ultraviolet radiation like the face, lips, ears, scalp, shoulders, neck, back of the hands and forearms. SCCs can develop in scars, skin sores and other areas of skin injury. The skin around them typically shows signs of sun damage such as wrinkling, pigment changes and loss of elasticity.

SCCs can appear as thick, rough, scaly patches that may crust or bleed. They can also resemble warts, or open sores that dont completely heal. Sometimes SCCs show up as growths that are raised at the edges with a lower area in the center that may bleed or itch.

Removal Of 17 Samples

We assessed the quality of sequencing data and removed 17 tumors from all analyses. Thirteen of these tumors had few, if any, discernible point mutations, and among the point mutations detected, their mutant allele frequencies were close to our detection limit. These patterns suggest poor sampling of the neoplastic cells. Two cases had less than fivefold coverage in the reference tissues, making it difficult to confidently distinguish somatic mutations from germline single nucleotide polymorphisms . One tumor and reference pair were not properly matched, which was evident from their patterns of germline SNPs. Finally, one reference tissue had high levels of tumor contamination, prohibiting us from sensitively detecting somatic mutations.

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What You Can Do

Examine yourself head to toe once a month: Keep an eye out for new or changing lesions that grow, bleed, or do not heal. Learn how to check your skin here.

When in doubt, check it out. Follow your instincts and visit your doctor if you see a spot that just doesnt seem right.

See your dermatologist for a professional skin exam every year even if you dont see anything suspicious. These specialists are skilled at identifying and treating abnormal skin growths that may be undetectable to the untrained eye and can check areas of your body that are difficult for you to see yourself.

Follow up regularly: Especially if youve already had either SCC or basal cell carcinoma , melanoma or precancers like actinic keratosis, be sure to see your dermatologist for a skin exam at recommended intervals.

Practice sun safety: Making daily sun protection a part of your lifestyle is the single most effective way to reduce your risk of developing skin cancer.

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How Widespread Is Scc

Overview of Cutaneous Squamous Cell Carcinoma

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.

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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.

Molecular Basis Of Cscc

Cutaneous squamous cell cancer is one of the most highly mutated human cancers . A deeper knowledge of the molecular basis of CSCC would be useful for developing better ways of treating this disease.

The mutation of the tumor suppressor gene TP53 has an important role early in the pathogenesis of CSCC and occurs in 54%95% of cases . Mutations of TP53 are induced by ultraviolet radiation , the most important environmental risk factor for CSCC, and are reported in pre-malignant AK lesions and CSCC . UVR-induced mutagenesis results in characteristic C-T and CC-TT dipyrimidine transitions, which enable tumor cells to prevent apoptosis and to promote clonal expansion of p53 mutant keratinocytes . The role of p53 in ultraviolet B-induced carcinogenesis has been confirmed in p53/ mice, which have an increased propensity for developing AK lesions and CSCCs secondary to ultraviolet B exposure . Furthermore, several groups have confirmed the presence of p53 mutations in CSCC cell lines . P53 mutations are an early event in CSCC development and are ultimately responsible for great genomic instability.

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What Is The Prognosis Of Squamous Cell Carcinoma Of Tongue

  • In general, Squamous Cell Carcinoma of Tongue is an aggressive form of cancer. If metastasis is observed, then the prognosis is guarded or unpredictable
  • Tumors in their early stage with complete excisional treatment typically have good prognosis
  • In cases of metastasis, its prognosis depends upon a set of several factors that include:
  • Stage of tumor: With lower-stage tumors, when the tumor is confined to site of origin, the prognosis is usually excellent with appropriate therapy. In higher-stage tumors, such as tumors with metastasis, the prognosis is poor
  • The surgical respectability of the tumor
  • Overall health of the individual: Individuals with overall excellent health have better prognosis compared to those with poor health
  • Age of the individual: Older individuals generally have poorer prognosis than younger individuals
  • Whether the tumor is occurring for the first time, or is a recurrent tumor. Recurring tumors have a poorer prognosis compared to tumors that do not recur
  • Response to treatment: Tumors that respond to treatment have better prognosis compared to tumors that do not respond so well to treatment

Exposure To Uv Radiation

Squamous Cell Carcinoma of the Skin

The most common reason for the development of squamous cell carcinoma is ultraviolet radiation. Both types of UV radiation promote SCC. The sun, tanning beds, and sun lamps emit UVA, which is responsible for the tanning the color of the skin. UVB causes sunburns and is mostly responsible for SCC and melanoma. Fair-skinned individuals with a history of severe sunburns, sun poisoning, and blisters are at a high risk for SCC.

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What Are The Symptoms Of Squamous Cell Cancer

SCC often occurs in areas exposed to UV radiation, such as the face, ears, and hands. However, it can also appear in the mouth, in the anal area, and on the genitals.

In its early stages, SCC often presents itself as a scaly, reddish patch of skin. As it progresses, it can turn into a raised bump that continues to grow. The growth may also crust or bleed. In the mouth, this cancer will take on the appearance of a mouth ulcer or a white patch.

In some cases, youll notice a new growth on a preexisting scar, mole, or birthmark. Any existing lesions or sores that arent healing can also indicate SCC.

Make an appointment with your doctor or dermatologist right away if you notice any of these symptoms. Early diagnosis and treatment are critical for preventing complications.

How Is Squamous Cell Cancer Diagnosed

Your doctor will first perform a physical exam and inspect any abnormal areas for signs of SCC. Theyll also ask you about your medical history. If SCC is suspected, your doctor may decide to take a biopsy to confirm the diagnosis.

A biopsy usually involves removing a very small portion of the affected skin. The skin sample is then sent to a laboratory for testing.

In some cases, your doctor may need to remove a larger part or all of the abnormal growth for testing. Talk to your doctor about any potential scarring or biopsy concerns.

Treatment for SCC varies. Treatment is based on:

  • the extent and severity of your cancer
  • your age
  • your overall health
  • the location of the cancer

If SCC is caught early, the condition can usually be successfully treated. It becomes harder to cure once it has spread. Many treatments can be performed as in-office procedures.

Some doctors may also use photodynamic therapy, laser surgery, and topical medications to treat SCC. However, the Food and Drug Administration hasnt approved these methods for treating SCC:

Once SCC has been treated, its critical to attend all follow-up visits with your doctor. SCC can return, and its important to monitor your skin for any precancerous or cancerous areas at least once per month.

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Squamous Cell Carcinoma Treatment

Squamous cell carcinomas detected at an early stage and removed promptly are almost always curable and cause minimal damage. However, left untreated, they may grow to the point of being very difficult to treat.

A small percentage may even metastasize to distant tissues and organs. Your doctor can help you determine if a particular SCC is at increased risk for metastasis and may need treatment beyond simple excision.

Fortunately, there are several effective ways to treat squamous cell carcinoma. The choice of treatment is based on the type, size, location, and depth of penetration of the tumor, as well as the patients age and general health. Squamous cell carcinoma treatment can almost always be performed on an outpatient basis.

What Is Intraepidermalsquamous Cell Carcinoma

Cutaneous Squamous Cell Carcinoma

Intraepidermal squamous cell carcinoma is a common superficial form of keratinocytecancer. It is also known as Bowen disease, intraepidermal carcinoma and carcinoma in situ .

Intraepidermal SCC is derived from squamous cells, the flat epidermal cells that make keratin, the horny protein that makes up skin, hair and nails. Intraepidermal and in situ mean the malignant cells are confined to the tissue of origin, in this case, the epidermis.

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Squamous Cell Carcinoma In Situ

Early forms of squamous cell carcinoma, also known as Bowen disease, are classified as in situ, which means in place in Latin. This simply means that the cancer cells havent yet spread beyond the epidermis. When the carcinoma spreads deeper into the skin, into the lymph nodes or organs, it is considered to be metastasized.

Typically, Bowen disease will first appear as a red, scaly plaque of skin, often larger than 1/2 inch across. It can also sometimes appear as a hard domed bump. Both varieties typically feel rough and crusty and can bleed when scraped. Cancer usually shows up on areas of the skin that are exposed to the sun, such as the face, ears, lips, arms, legs, and tops of hands, but it can also more rarely appear on areas not exposed to the sun including the lower lip and genitals. This cancer usually develops slowly but can spread to the lymph nodes and other organs if left untreated. If caught early though, it is highly treatable.

A doctor will diagnose squamous cell carcinoma with a biopsy. Treatment of the cancer will then vary depending on location, size, severity, how far it has spread and the health of the patient.

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?

  • If it is located on your face, neck, scalp, hands, feet, or shins
  • If it is an aggressive subtype of squamous cell carcinoma
  • If it is greater than 2 cm located anywhere on your body
  • 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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    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.

    Complications Of Untreated Squamous Cell Carcinoma

    Squamous Cell Carcinoma of the Skin

    Left untreated, SCC may spread and infiltrate nearby skin tissues. Invasive SCC means cancer has spread to lymph nodes or internal organs. Although rarely fatal, the cancer can cause serious health problems and disfigurement. Aggressive SCC is associated with how deep or large the lesion is, whether lesions form on mucous membranes , and the overall health of the person at the time of diagnosis.

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