How Serious Is Squamous Cell Carcinoma
Dear Cecil:
I’m 48 years old. A few months ago, a small growth appeared on the upper side of my left forearm. It looked like a wart, but I went to a doctor recently and had it excised and biopsied. It was a squamous cell carcinoma. The doctor told me there was almost nothing to worry about since squamous cell is one of the least dangerous forms of cancer. Still, it’s hard not to stress about this. I trust your always excellent feedback. What is a squamous cell carcinoma? Do they metastasize at predictable rates? How much do I really have to worry about? If it makes any difference, I smoked cigarettes off and on for 30 years, but quit for good 14 months ago
Neil Flowers, Santa Cruz
Cecil replies:
Nothing like cancer to make an aging baby boomer realize hes not a kid anymore. Not to argue with your doctor, but least dangerous is not a term I would apply to squamous cell carcinoma. It is much less dangerous than some cancers, but it can spread and it can kill you. Whats more, if youve had it once, there is significantly increased risk that you will get it again. See a doctor immediately about any new growths. Also, while the damage has probably already been done, Id skip any future sunbathing squamous cell carcinoma appears to be directly related to solar exposure.
Cecil Adams
When To Seek Medical Care For Skin Cancer
Many people, especially those who have fair coloring or have had extensive sun exposure, periodically check their entire body for suspicious moles and lesions.
Have your primary health care provider or a dermatologist check any moles or spots that concern you.
See your health care provider to check your skin if you notice any changes in the size, shape, color, or texture of pigmented areas .
If you have skin cancer, your skin specialist or cancer specialist will talk to you about symptoms of metastatic disease that might require care in a hospital.
Squamous Cell Carcinoma Stages
There are certain features that are considered to make the cancer at higher risk for spreading or recurrence, and these may also be used to stage squamous cell carcinomas. These include:
- Greater than 2 mm in thickness
- Invasion into the lower dermis or subcutis layers of the skin
- Invasion into the tiny nerves in the skin
- Location on the ear or on a hair-bearing lip
After the TNM components and risk factors have been established, the cancer is assigned to one of the five squamous cell carcinoma stages, which are labeled 0 to 4. The characteristics and stages of squamous cell cancer are:
Stage 0: Also called carcinoma in situ, cancer discovered in this stage is only present in the epidermis and has not spread deeper to the dermis.
Stage 1 squamous cell carcinoma: The cancer is less than 2 centimeters, about 4/5 of an inch across, has not spread to nearby lymph nodes or organs, and has one or fewer high-risk features.
Stage 2 squamous cell carcinoma: The cancer is larger than 2 centimeters across, and has not spread to nearby organs or lymph nodes, or a tumor of any size with 2 or more high risk features.
Stage 3 squamous cell carcinoma: The cancer has spread into facial bones or 1 nearby lymph node, but not to other organs.
Stage 4 squamous cell carcinoma: The cancer can be any size and has spread to 1 or more lymph nodes which are larger than 3 cm and may have spread to bones or other organs in the body.
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Prognosis For Oral Squamous Cell Carcinoma
If carcinoma of the tongue is localized , 5-year survival is > 75%. For localized carcinoma of the floor of the mouth, 5-year survival is 75%. Lymph node metastasis decreases survival rate by about half. Metastases reach the regional lymph nodes first and later the lungs.
For lower lip lesions, 5-year survival is 90%, and metastases are rare. Carcinoma of the upper lip tends to be more aggressive and metastatic.
Factors That Could Affect Your Prognosis
Certain aspects of your health or cancer could affect your outlook. For example, people who have a weakened immune system from a disease like HIV or a medication they take tend to have a less positive outlook.
The location of the tumor also matters. Cancers on the face, scalp, fingers, and toes are more likely to spread and return than those on other parts of the body. SCC that starts in an open wound is also more likely to spread.
Larger tumors or ones that have grown deep in the skin have a higher risk of growing or returning. If a cancer does recur after treatment, the prognosis is less positive than it was the first time around.
Ask your doctor if you have any risk factors that can be managed or controlled. You may need more aggressive treatment, or to be monitored more closely for recurrence.
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How Can I Prevent Squamous Cell Carcinoma From Coming Back
Most squamous cell carcinomas can be treated and cured. However, it is possible for these types of cancers to recur or for new skin cancers to appear.
Do the following to reduce the risk of new cancers occurring:
- Keep all follow-up appointments with your GP or skin specialist.
- Regularly check all your skin . If you see anything that is growing, bleeding or in any way changing, go and see your doctor straight away. See skin checks.
- Protect your skin from the sun and avoid indoor tanning. This is essential to prevent further damage, which will increase your risk of getting another skin cancer.
Risks Associated With Untreated Squamous Cell Carcinoma
Squamous cell carcinoma is the second most common type of skin cancer. This type of cancer has a variable growth rate. Some squamous cell carcinomas grow slowly, while others can grow rapidly. Smaller squamous cell carcinomas have a lower risk of metastasis, however, if they are large, they are at higher risk for spreading to other organs, including the lymph nodes. In certain locations, such as the ear, lip, and temple, there is a higher risk of spread as well. As with all skin cancers, treatment in earlier stages is always recommended to prevent cancer from spreading. Squamous cell carcinomas can be life-threatening if left untreated.
According to Dr. Truong, We recommend patients keep a close eye on any changes to their skin color, texture, or sensation by completing self-exams at home every month or every other month. With squamous cell carcinoma, the first thing patients notice is red, rough, and scaly patches of skin. This type of skin cancer can be asymptomatic, but can also be painful to the touch. Some patients experience abnormal sensations in the areas . The feelings of pain and numbness may be the first sign that squamous cell carcinoma is spreading and impacting surrounding nerves, therefore it is important to let your dermatologist know if you are experiencing these symptoms.
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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.
What Do Cancer Survival Rates Mean
When learning about cancer survival rates, its important to keep in mind that these statistics are based on a very large and diverse group of people. Because no two people with squamous cell carcinoma are alike, the general survival rate cannot be used to predict a specific patients outcome. Additionally, survival rates are broad benchmarks. While useful as a baseline point of reference for physicians, this information is not detailed enough to reflect the different treatments people have had, nor is it recent enough to include the results of the latest breakthrough treatments now available to patients through clinical trials .
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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
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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What Are The Risk Factors For Squamous Cell Carcinoma
Risk factors for squamous cell carcinoma include:
- Unprotected exposure to ultraviolet rays
- Light-colored hair, skin, or eyes
- History of skin cancer
- The pathologists report
- Recurrence after treatment
Treatment for squamous cell carcinoma usually involves surgery to remove the lesion. The surgical options include:
- Excision: The physician cuts out the tumor with a scalpel, along with a small margin of healthy skin around the tumor.
- Curettage and electrodesiccation: Used in small lesions, the physician scrapes away cancer cells, then cauterizes the skin to prevent bleeding.
- Mohs surgery: The surgeon removes layers of skin and examines them under a microscope to determine if cancer is present. This process continues until no cancer cells are visible.
Rarely, squamous cell carcinoma is treated with chemotherapy , radiation therapy , and immunotherapy when it has metastasized to other areas of the body.
Is A Squamous Cell Carcinoma Fatal
Most SCCs are not serious. When identified early, and treated promptly, they are easily treated. However, if overlooked, they are harder to treat and can cause disfigurement. While 95 percent of SCCs are localized, the small percentage of remaining cases can spread to distant organs and become life-threatening. This is especially true among immunocompromised and transplant patients.
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How Is Squamous Cell Carcinoma Different From Basal Cell Cancer
Squamous cell carcinoma that develops on the skin is usually caused by spending too much time in the sun over the course of your life. This type of skin cancer tends to grow and spread more than basal cell cancers. In rare cases, it may spread to the lymph nodes. Squamous cell carcinomas may crust or bleed and can include: Renal cell carcinoma.
Tumour Staging For Cutaneous Scc
TX: Th Primary tumour cannot be assessed
T0: No evidence of a primary tumour
Tis: Carcinoma in situ
T1: Tumour 2cm without high-risk features
T2: Tumour 2cm or Tumour 2 cm with high-risk features
T3: Tumour with the invasion of maxilla, mandible, orbit or temporal bone
T4: Tumour with the invasion of axial or appendicular skeleton or perineural invasion of skull base
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How Is Metastatic Squamous Cell Carcinoma Of Skin Diagnosed
A diagnosis of Squamous Cell Carcinoma of Skin is made by:
- Complete physical examination with detailed medical history evaluation
- Examination by a dermatologist using a dermoscopy, a special device to examine the skin
- Woods lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
- Radiological studies that may include:
- Plain x-ray of the affected region
- CT or CAT scan of the affected region with contrast usually shows a mass. This radiological procedure creates detailed 3-dimensional images of structures inside the body
- MRI scans of the affected region: Magnetic resonance imaging uses a magnetic field to create high-quality pictures of certain parts of the body, such as tissues, muscles, nerves, and bones. These high-quality pictures may reveal the presence of the tumor
- Ultrasound scan of the affected region
- MRI scans and PET scans may help detect areas of metastasis
Although the above modalities can be used to make an initial diagnosis, a tissue biopsy of the tumor is necessary to make a definitive diagnosis to begin treatment.
Tissue biopsy:
In case of Metastatic SCC, the following diagnostic procedures can be used to procure the tissue sample:
- Fine needle aspiration biopsy of the lymph node
- Core biopsy or open biopsy of the tumor
What Are The Risk Factors For Metastatic Squamous Cell Carcinoma Of Skin
Metastatic Squamous Cell Carcinoma of Skin is the advanced form of SCC of skin. The chief contributing factors for squamous cell carcinoma of skin include:
- Exposure to intense sun for long periods during the course of work or due to regular participation in outdoor sports activities
- Frequent use of tanning beds, tanning parlors
- People living in geographical regions where hot-dry, desert-like climatic conditions prevail
- Radiation therapy
- Coal tar exposure
- Smoking, tobacco chewing
- Individuals with weak immune system, which could be due to cancer treatment, AIDS, or those on immunosuppressant drugs after receiving an organ transplant
- Those with sensitive skin, who get easily sunburned
- Caucasians are more vulnerable compared to other darker-toned individuals
SCC of skin in certain locations has higher chances of metastasis and they include:
- On the lips
- In the region of radiation scar
- In the region of scar due to burns
- Vulvar skin
- Perianal skin
The following subtypes are the more aggressive forms of SCC of skin, and hence, there is a greater possibility of metastasis:
- Acantholytic squamous cell carcinoma of skin
- Spindle cell squamous cell carcinoma of skin
- Pseudovascular squamous cell carcinoma of skin
- Adenosquamous carcinoma of skin
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.
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How Do You Treat Melanoma
The first step in treatment is the removal of the melanoma, usually by surgical excision done in the office as an outpatient procedure with local anesthesia. Scars are usually small and improve over time. Surgery is less extensive than in the past, so scars are smaller. If the melanoma is large and requires more extensive surgery, the repair can involve a flap or graft of normal skin. For deeper melanomas , there is a trend toward performing a sentinel lymph node biopsy at the same time. In this instance, the entire procedure will be done in the hospital by a surgical oncologist.
Which Grows Faster Basal Cell Or Squamous Cell Carcinoma
Squamous Cell Carcinoma Growth Rate: Squamous cell cancers, while still slow-growing, are known to grow more rapidly than Basal cell cancers. And, unlike Basal cell cancers, there is an increased risk of Squamous cell cancers spreading to other areas of the body like the local lymph system if left untreated.
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Exams And Tests For Skin Cancer
If you think a mole or other skin lesion has turned into skin cancer, your primary care provider will probably refer you to a dermatologist. The dermatologist will examine any moles in question and, in many cases, the entire skin surface. Any lesions that are difficult to identify, or are thought to be skin cancer, may then be checked. Tests for skin cancer may include:
- The doctor may use a handheld device called a dermatoscope to scan the lesion. Another handheld device, MelaFind, scans the lesion then a computer program evaluates images of the lesion to indicate if it’s cancerous.
- A sample of skin will be taken so that the suspicious area of skin can be examined under a microscope.
- A biopsy is done in the dermatologist’s office.
If a biopsy shows that you have malignant melanoma, you may undergo further testing to determine the extent of spread of the disease, if any. This may involve blood tests, a chest X-ray, and other tests as needed. This is only needed if the melanoma is of a certain size.
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What Is The Prognosis Of Metastatic Squamous Cell Carcinoma Of Skin
- The prognosis of Metastatic Squamous Cell Carcinoma of Skin is generally guarded or unpredictable
- The prognosis may further depends upon the following set of factors:
- Stage of tumor: In higher-stage tumors, such as tumors with metastasis, the prognosis is typically poor
- The subtype of squamous cell carcinoma of skin
- The site of metastasis: Metastasis to the local lymph nodes do better than the spread of cancer to distant sites
- The surgical resectability 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
If Metastatic SCC of Skin occurs in the following group of individuals, the prognosis is worse to poor:
- Individuals who have undergone an organ transplant
- Individuals who are chronically alcoholic
- Those with genetic disorders such as xeroderma pigmentosa
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