Squamous Cell Carcinoma
Also called SCC, Squamous Cell Carcinomas are a form of skin cancer that can potentially spread
What is squamous cell carcinoma?
Squamous cell carcinoma (SCC) is a malignant skin cancer and affects approximately 200,000 people per year. It tends to affect people of older ages but can also affect younger people, and occurs most commonly on sun-exposed areas of the body
What do squamous cell carcinomas look like?
SCCs can vary from small, scaly growths, to larger ‘scabbed’ areas, to dome-shaped red growths a few centimetres in size. As they grow, they can ulcerate and bleed or even become infected.
They do not always show these features though, and can sometimes look and act very much like innocent growths. For this reason, if you have any concerns about a skin growth, seek medical advice immediately
Are squamous cell carcinomas dangerous?
Yes they can be – as well as growing wider and deeper, squamous cell carcinomas have the ability to spread to nearby lymph glands. This risk is approximately 2-5%, although some SCCs, such as those that arise from longstanding inflamed areas, have a 50% risk of spreading.
SCCs can then potentially spread elsewhere, to areas such as the lung or bone
What causes squamous cell carcinoma?
There are a number of risk factors for squamous cell carcinoma, the main ones being:
Sun exposure – this seems to be the most important risk factor, and protecting your skin with suncream through life will help reduce risks of skin cancer
Skin type – skin that burns easily and tans poorly is more at risk of SCC
Immunosuppression – people that have certain cancers such as lymphoma or those that are taking immunosuppression drugs (eg transplant patients) have a higher risk of SCC
Actinic keratosis – a small percentage of patients with actinic keratosis can develop squamous cell carcinoma
How is squamous cell carcinoma treated?
Often, a specialist can diagnose an SCC with relative confidence and proceed with treatment. Occasionally, the diagnosis is not obvious and a biopsy is needed – a small sample is taken and sent to a lab, and treatment decided according to the results.
Once a squamous cell carcinoma has been diagnosed, there are a number of treatment options, including:
Surgery – this is probably one of the most common treatment methods. The tumour is removed, often under local anaesthetic, and sent to the lab for confirmation of diagnosis. An extra margin of normal-looking skin is also taken at the same time to try and ensure that all the tumour is removed. If the area is relatively small, the defect can usually be closed with stitches. Larger areas may need a skin graft or other procedure to provide skin cover
Radiotherapy – some SCCs may be treated with radiotherapy, which is generally painless. Radiation treatment can affect the skin though, with ulceration and scarring occurring over the following years – for this reason, younger people are usually not suitable for radiotherapy. Older people that are unfit for surgery, or those with very large SCCs tend to benefit the most.
Mohs surgery – this is a form of surgery whereby small samples of the tumour are removed and examined in a lab on the same day. The process is continued until all the tumour has been removed. This can sometimes result in less normal tissue being removed than in standard surgery, with a slightly higher cure rate, but does often need multiple visits to the operating theatre. For this reason, Mohs surgery for squamous cell carcinoma is often reserved for areas such as the nose, where spare skin is in short supply, or for SCC that has recurred or been incompletely removed by standard surgery
Chemotherapy & immunotherapy – chemotherapy may occasionally be used for squamous cell carcinoma that cannot be removed or treated by the above options. Newer drugs will usually be used first though, such as immunotherapy drugs. These drugs may help slow the growth of SCC, or even shrink it enough to be treated with surgery or radiotherapy
The final treatment option will often depend on the body area, tumour size & progress, and of course patient preference. Your specialist will be able to discuss treatment options with you
What tests are needed for SCC?
Blood tests and scans are usually not required unless if a general anaesthetic is needed for surgery, or if the specialist suspects the SCC may have spread elsewhere or invaded into deeper areas such as bones
What happens after SCC treatment?
As squamous cell carcinomas have the potential to recur or spread to nearby glands and organs, follow-up in clinic is recommended after treatment, often for up to 5 years depending on the type of SCC. The specialist will be looking for any firm lumps or changes in the scar area, marble-sized lumps in the nearby glands or any SCCs starting elsewhere.
Having had one SCC, there are increased risks of getting another. A medical opinion should therefore be sought for any future suspicious growths
What are the overall risks to life from SCC?
The chances of an SCC spreading elsewhere are usually quite low, but if the SCC has spread to nearby glands or elsewhere, then this can pose a serious risk to life. For this reason, it is very important to seek medical advice as soon as any suspicious growths are found, to hopefully remove them before they get a chance to spread
How can squamous cell carcinomas be avoided?
Whilst the risks can never be zero, you can reduce your risks greatly with some simple steps:
Stay out of the sun, especially between 11am and 3pm, when it is most strong
Wear high factor sun cream if you need to go out in the sun (eg sports)
Reapply sun cream regularly and especially after swimming
Wear sun-protective clothing such as long-sleeved shirts and hats
Never get sunburnt, and keep children out of the sun
This information is for general information only. If you have any concerns about your health, have found any suspicious skin growths, or are considering any treatments, you should seek advice from a healthcare specialist