Squamous Cell Carcinoma (SCC) is the second most common form of skin cancer, after basal cell carcinoma. SCC usually occurs in areas that are easily exposed to the sun, such as the head, upper back, neck, hands, legs, and even the ears and lips. Although it is a fairly slow growing cancer, it is important to catch it early before it becomes dangerous and difficult to treat. Once the cancer has spread to areas of local lymph nodes or distinct tissues and organs, it becomes a very serious issue. Superficial SCCs only affect the upper-most layer of the skin, the epidermis. Minimally invasive SCCs have penetrated down to the second layer of skin, the dermis, but have no high risk characteristics.
If SCC is found and diagnosed early, it can be treated through the following options…
How it works- During this process, the surgeon removes the entire tumor by cutting it out along with some of the healthy tissue around it, called a “safety margin”. This is to ensure that any surrounding tissue that cancer cells may have invaded is removed as well. The amount of healthy tissue removed depends on the size and location of the tumor. Following the extraction, the tumor is then sent to a lab to be tested. The patient may need additional surgery if cancer cells have grown beyond these “margins.”
When it is used- Excisional surgery is typically the only treatment necessary if the squamous cell carcinoma has not spread.
How it works- During this process, skin is removed in very thin layers. As each layer is removed, the surgeon examines each one under a microscope to determine if cancer cells still remain. The layers are progressively removed, and this process is repeated until only cancer-free tissue remains. Mohs Surgery is typically performed in just one visit.
When it is used- Mohs Surgery is considered the most effective treatment to remove squamous cell carcinoma with a 97 percent average cure rate the first time around. It also has the leverage of sparing the maximum amount of healthy tissue as opposed to other techniques.
Mohs surgery can be used for reoccurring tumors, SCCs with indistinct edges, and those located in cosmetically or functionally important areas like the eyes, nose, scalp, fingers, ears, toes and genitals. This process is also commonly used on SCCs that are growing rapidly or are already enlarged.
Curettage and electrodesiccation (electrosurgery):
How it works- During this process, a spoon-shaped instrument known as a curette is used to scrape the skin affected with cancer. After removal, the surgeon will cauterize the area with heat or a chemical agent to destroy any additional cancer cells and minimize bleeding. The process is repeated until no cancer cells remain.
When it’s used- Electrosurgery can be used in cases with small, superficial or minimally invasive squamous cell carcinoma.
How it works- During this process, liquid nitrogen is used to destroy the tumor by freezing the abnormal tissue. The frozen tissue will eventually fall off and allow new healthy skin to form in its place.
When it’s used- Cryosurgery is generally less invasive than other surgeries so they can be beneficial for those with bleeding disorders. It is also used for those with implantable cardiac devices or those who have issues going under anesthesia.
How it works- During this process, the doctor uses an intense beam of light, a laser, to destroy the cancer cells. There are different types of lasers used during this procedure. While some vaporize the skin cancer, other lasers convert the beam of light to heat to destroy the tumor, as a non-ablative alternative.
When it’s used- Laser surgery is sometimes it is used for superficial SCCs or when other types of surgeries have been unsuccessful. This process is not FDA-approved for treatment of SCCs.
How it works- During the process, the doctor uses radiation, a low energy x-ray beam, to destroy the cancerous cells, ultimately creating an environment where the cells can’t divide or grow. Although radiation sometimes makes it possible to avoid surgery and anesthesia, multiple treatments are typically required.
When it’s used- Radiation is used in a variety of cases. It is most used for SCCs that are difficult to treat surgically. Sometimes, surgery is not advised for the elderly or those in poor health, making radiation a more acceptable alternative. In some cases, radiation is used in addition to surgery, or in combination with other forms of treatment, when the SCC is advanced.
Photodynamic therapy (PDT):
How it works- During this process, a light-sensitizing agent is applied. After allowing a period of time for absorption, a laser is used to activate the topical agent and kill the cancerous cells. This procedure kills cancer cells, while sparing healthy tissue nearby. Patients are advised to avoid sunlight for a minimum of 48 hours, as exposure to sunlight could continue to activate the agent causing severe sunburn.
When it’s used- Photodynamic therapy is used for superficial SCC on the face or the scalp. It best used when treating potential precursors to cancer, such as actinic keratoses. It is not recommended for invasive SCCs.
How it works- Creams and gels, such as 5-FU (5-flourouracil), imiquimod, ingenol mebutate, are used as topical medications to treat superficial SCCs. There is small risk for scarring. Some of these medications directly target the cancerous tissue, while others activate the immune system.
When it’s used- Topical medications are only used for superficial tumors as they are not FDA approved for treating SCCs. Also, these medications are used as a preventative, to treat actinic keratoses.
Additional Information About Treatments for SCCs
In cases where SCC has spread, invaded the deep layers of the skin, caused severe local damage, are large in size, or has resisted a variety of treatments, more extensive treatment is likely to be necessary.
If you have been treated for, diagnosed with, or suspect that you have a Squamous Cell Carcinoma, the best first step toward effective treatment is to schedule a consultation at one of our dermatology clinics in The Villages or Leesburg. As one of the top Mohs Surgeons in the country, Dr. Gurgen has effectively treated hundreds of SCC patients. Contact us for a consult today.