Squamous Cell Carcinoma
Squamous cell carcinoma is a primary skin cancer often beginning as a red, scaling papule or patch. These cancers usually appear on skin that has had a history of extensive sun-exposure such as the face, neck, arms, chest, or back. Several of the most common areas are the face, scalp, and back of the hands. A common history is one of slowly or rapidly growing scaling or rough bump that occasionally ulcerates or bleeds, and does not heal. It is widely believed that actinic keratoses serve as precursors for squamous cell carcinomas either within the actinic keratosis itself, or as a marker for de nova squamous cell carcinoma development.
Squamous cell carcinomas can grow superficially in the top layer of the skin (superficial squamous cell carcinoma) or be more aggressive by growing downward from where they arise (invasive squamous cell carcinoma). While basal cell carcinomas have a rare incidence of metastasis, squamous cell carcinomas are full able to move to the lymph nodes and spread throughout the body. The risk of these cancers growing downward to the point where spread throughout the body is possible makes these tumors a high priority for treatment.
Treatment of sqamous cell carcinoma is primarily surgical. Routine surgical excision with some normal surrounding skin is undertaken and the wound repaired. In areas where the squamous cell carcinoma may be invading sensitive surroundings such as the eye, nose, lip, or ears, specialized Mohs micrographic surgery may be performed both to make sure that the tumor is completely removed, and to save as much normal skin as possible for repairing the resulting wound. Additional treatment options include liquid nitrogen cryotherapy or topical imiquimod (Aldara®) treatment.
As these cancers are caused by chronic sun exposure, risk of future cancer development can be prevented somewhat through diligent sun avoidance and sunscreen use. Monthly self-exams and periodic thorough skin exams by your dermatologist are strongly recommended. In addition, routine identification and treatment of actinic keratoses should be undertaken.
Don Mehrabi MD, FAAD
Dermatologist, Certified by the American Board of Dermatology
Los Angeles, California
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