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.
Types Of Cutaneous Squamous Cell Carcinoma
Distinct clinical types of invasive cutaneous SCC include:
- Cutaneous horn the horn is due to excessive production of keratin
- Keratoacanthoma a rapidly growing keratinising nodule that may resolve without treatment
- Carcinoma cuniculatum , a slow-growing, warty tumour on the sole of the foot
- – a cutaneous SCC that has developed in a scar or chronic ulcer
- Multiple eruptive SCC/KA-like lesions arising in syndromes, such as multiple self-healing squamous epitheliomas of Ferguson-Smith and Grzybowski syndrome
The pathologist may classify a tumour as well differentiated, moderately well differentiated, poorly differentiated or anaplastic cutaneous SCC. There are other variants.
Subtypes of cutaneous squamous cell carcinoma
Treatment Of Squamous Cell Carcinoma
Usually locally destructive techniques
Treatment of squamous cell carcinoma is similar to that for basal cell carcinoma Treatment Basal cell carcinoma is a superficial, slowly growing papule or nodule that derives from certain epidermal cells. Basal cell carcinomas arise from keratinocytes near the basal layer, which are read more and includes curettage and electrodesiccation, surgical excision, cryosurgery, topical chemotherapy and photodynamic therapy, or, occasionally, radiation therapy. Treatment and follow-up must be monitored closely because of the greater risk of metastasis compared with a basal cell carcinoma.
Squamous cell carcinoma on the lip or other mucocutaneous junction should be excised at times, cure is difficult.
Recurrences and large tumors should be treated aggressively with Mohs microscopically controlled surgery, in which tissue borders are progressively excised until specimens are tumor-free , or by a team approach with surgery and radiation therapy. Because tumors with perineural invasion are aggressive, radiation therapy should be considered after surgery.
Metastatic disease is responsive to radiation therapy if metastases can be identified and are isolated. Widespread metastases do not respond well to chemotherapeutic regimens. For inoperable advanced disease or metastatic disease, programmed death receptor 1 inhibitors are now an option.
Prevention Of Squamous Cell Carcinoma
Because squamous cell carcinoma seems to be related to ultraviolet exposure, a number of measures are recommended to limit exposure.
Sun avoidance: Seeking shade, minimizing outdoor activities between 10 AM and 4 PM , and avoiding sunbathing and the use of tanning beds
Use of protective clothing: Long-sleeved shirts, pants, and broad-brimmed hats
Use of sunscreen: At least sun protection factor 30 with broad-spectrum UVA/UVB protection, used as directed should not be used to prolong sun exposure
Squamous Cell Carcinoma Risk Factors
Certain things make you more likely to develop SCC:
- Older age
- Blue, green, or gray eyes
- Blonde or red hair
- Spend time outside, exposed to the sun’s UV Rays
- History of sunburns, precancerous spots on your skin, or skin cancer
- Tanning beds and bulbs
- Long-term exposure to chemicals such as arsenic in the water
- 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.
Read Also: Merkel Cell Carcinoma Immunotherapy
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 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.
You May Like: How Long Until Melanoma Spreads
How Can Cutaneous Squamous Cell Carcinoma Be Prevented
There is a great deal of evidence to show that very careful sun protection at any time of life reduces the number of SCCs. This is particularly important in ageing, sun-damaged, fair skin in patients that are immune suppressed and in those who already have actinic keratoses or previous SCC.
- Stay indoors or under the shade in the middle of the day
- Wear covering clothing
- Avoid indoor tanning
Oral nicotinamide in a dose of 500 mg twice daily may reduce the number and severity of SCCs in people at high risk.
Patients with multiple squamous cell carcinomas may be prescribed an oral retinoid . These reduce the number of tumours but have some nuisance side effects.
How Is Invasive Squamous Cell Carcinoma Treated
An exact diagnosis will dictate what method of invasive squamous cell carcinoma treatment will be most effective. Options include:
- Mohs surgery: using a scalpel, this procedure surgically removes cancerous cells while leaving behind unaffected areas.
- Chemotherapy: using intravenous drugs, this treatment floods the body with medicine designed to break down and destroy infected cells.
- IG-SRT: using radiotherapy technology, this method uses low-level doses of radiation to target cancer from the surface down, achieving results without cutting or drugs.
Talk with your dermatologist to determine whats best for you.
What Are The Risk Factors Associated With The Squamous Cell Carcinoma Of The Skin
Squamous cell carcinoma of the skin can occur to anyone at any age. But, there are a few factors that can make you more vulnerable to this condition. The most common risk factors include:
Fair skin is usually a risk factor for several skin cancers because it has less pigment . Pigment offers protection against UV radiation. Hence, if you are fair and have blonde hair with light-colored eyes, you are at risk of developing this cancer.
Excessive Sun Exposure
Sun emits UV rays, and prolonged exposure to the sun can increase your chances of developing squamous cell carcinoma of the skin. What makes you more vulnerable to the condition is if you do not use clothing or any other cover to protect your skin.
Frequent Use of Tanning Beds
Tanning beds might be making you look great, but they are harmful to your skin as they emit UV light to tan your skin. If you have the habit of using tanning beds, start avoiding them.
History of Sunburns
If you have had one, or more blistering sunburns during childhood or teenage, your risk for squamous cell carcinoma of the skin as an adult. Sunburns during adulthood are also a risk factor.
A personal history of precancerous skin lesions
Having a precancerous skin lesion like Bowens disease or actinic keratosis, raises your risk of squamous cell carcinoma of the skin.
Weakened immune system
A Rare Form of Genetic Disorder
What Treatment Options are Available for The Squamous Cell Carcinoma of The Skin?
Treatment for Small sized Cancers
What Are The Signs And Symptoms Of Squamous Cell Carcinoma
SCC signs and symptoms include skin changes like:
- A rough-feeling bump or growth which might then crust over and bleed.
- A growth that is higher than the skin but has a depression in the middle.
- A sore that will not heal, or a sore that heals and then comes back.
- A piece of skin that is flat, is scaly and red.
- A precancerous growth called actinic keratosis, which is a bump or lump that can feel dry, itchy, scaly, or be discolored.
- A precancerous skin lesion called actinic cheilitis, which happens mainly on the lower lip. The tissue becomes pale, dry, and cracked.
- A precancerous condition called leukoplakia, in which white spots develop in the mouth, on the tongue, gums, or cheeks
Also Check: Basal Cell Melanoma Prognosis
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.
What Causes The Squamous Cell Carcinoma Of The Skin
The squamous cells usually die and fall off on their own giving way for the new cells. All the information about when to grow and when to die is stored in the DNA. When the DNA of the squamous cells develop mutations, their growth becomes abnormal. These mutations are what cause the squamous cell carcinoma of the skin.
The abnormal DNA of the squamous cells leads to uncontrolled growth. This lets the damaged cells to continue living, instead of dying and falling off.
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.
What Is The Treatment For Cutaneous Squamous Cell Carcinoma
Other methods of removal include:
- Shave, curettage, and electrocautery for low-risk tumours on trunk and limbs
- Aggressive cryotherapy for very small, thin, low-risk tumours
- Mohs micrographic surgery for large facial lesions with indistinct margins or recurrent tumours
- Radiotherapy for an inoperable tumour, patients unsuitable for surgery, or as adjuvant
Also Check: Large Cell Cancers
What Causes This Cancer
The reason why a particular cat may develop this, or any cancer, is not straightforward. Very few cancers have a single known cause. Most seem to be caused by a complex mix of risk factors, some environmental and some genetic or hereditary. Exposure to ultraviolet rays/sunlight has been attributed to the development of SCC in cats. Exposure to papilloma-like viruses also appears to contribute to multicentric SCC in the mouth and other areas of the skin where squamous cells are present.
White and light-colored cats are more likely to get these tumors. A risk has been reported in Siamese, Himalayan, and Persian breeds, likely related to their protective pigment.
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.
Don’t Miss: Survival Rates For Invasive Ductal Carcinoma
Questions To Ask Your Doctor
- I spent a lot of time in the sun as a child. Am I at higher risk of developing skin cancer?
- One of my parents had skin cancer. Am I more likely to get it?
- What should I look for when I do a self-examination of my skin?
- I have darker skin. Can I still get skin cancer?
- What can I do to protect my child from the sun?
- Is there anything I can do to keep the cancer from coming back after treatment?
When Should I Call The Doctor About Squamous Cell Carcinoma
If you have never had skin cancer or if you have had SCC, contact your doctor if:
- You have any skin changes that cause you worry, including a new lump, mole, or sore that does not heal, or changes in a mole or spot you have had for some time.
- You need to schedule your yearly skin check appointment.
- You have any issues related to your treatment for SCC that worry you, such as excessive pain, bleeding or itching.
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
Living With Squamous Cell Carcinoma
Most cases of squamous cell carcinoma can be cured with treatment. How well you do after treatment depends on many things, including how early the cancer was diagnosed. Left untreated, this skin cancer can spread to other parts of the body, including internal organs. This could cause serious health problems. The earlier this skin cancer is found and treated, the better.
Some cancers like this can return. If youve had skin cancer before, you are at higher risk of getting it again.
Don’t Miss: Merkel Cancer Prognosis
Can Better Detection Mean A Cure
With better screening, some people want to know if theres a certain tumor size that suggests the lung cancer can be cured. In 2017, researchers created a simulation model. They found that the most aggressive NSCLCs would need to be diagnosed at only 10 mm in size in males and 15 mm in females. The average size of a lung tumor at diagnosis without screening is 33 mm.
Diagnosis Of Cutaneous Squamous Cell Carcinoma
Diagnostic workup of suspected cSCC will include computed tomography scanning to evaluate for soft tissue or bony invasion and lymph node metastasis. Magnetic resonance imaging may be used to rule out invasion of neural or vital structures. Incisional or excisional biopsy are essential for definitive diagnosis. The choice of biopsy will depend on the size and location of the lesion.
Recommended Reading: Stage 3b Melanoma Survival Rate