Your doctor will take a thorough history from you about the area of concern, about you risk factors for developing skin cancer and your health in general. The doctor will then proceed to check your skin and look at the size, shape, color, and texture of any suspicious areas.

If a squamousl cell carcinoma (SCC) is suspected , a skin biopsy will be peformed to remove a piece of skin from the area in order to examine it under a microscope. This must be done to confirm the diagnosis of basal cell carcinoma or other skin cancers. There are many types of skin biopsies and the exact procedure depends on the location of the suspected skin cancer.

"Staging" is the process used to determine the size of a squamous cell carcinoma and where and how far it has spread. Staging helps your healthcare team plan:
  • The kind of treatment you need
  • The likely risk of the SCC coming back after treatment
  • Whether you need tests to see if the SCC has spread into lymph nodes close to the original lesion.
  • For most patients with SCC no formal staging beyond clinical examination for lymphadenopathy is required.
Pasted Graphic

Treatment varies depending on the size, depth, and location of the SCC. It also depends on the stage of the SCC. It can be removed using one of the following procedures:

Surgical excision cuts the tumor out and uses stitches to place the skin back together. This procedure involves excision of the lesion including a margin of normal skin. This form of skin tumour tends to be larger than BCC and has a very much higher risk of spread, therefore the margin of normal tissue taken around the lesion tends to larger than that for a BCC. Furthermore, SCCs tend to burrow deeper below the skin and start to destroy the underlying tissues. As a result of this, a skin graft or other form of reconstruction are often required and a plastic surgeon usually needs to be involved to perform this. Stage III (T4) lesions may need major reconstruction in order to reconstruct or replace the structures that have been damaged by the tumour. In this case, radiotherapy is usually given after the surgery to prevent the tumour coming back.

Surgery to Lymph Nodes is sometimes required for SCC patients. This is most common in the head and neck region, where a neck dissection may need to be performed. When spread to the lymph nodes is confirmed, radiotherapy is usually offered a few weeks after the surgery has been performed.

Mohs surgery: Mohs' micrographic surgery is a special type skin surgery that must be performed by an experienced Mohs' surgeon. It involves excision of the tumour and immediate examination of the tissue under the microscope to determine margins. If any residual tumour is left, it can be mapped out and excised immediately. The process of excision and examination of margins may have to be repeated several times. The advantage of this technique is that it is usually definitive and has been reported to have a lower recurrence rate than other treatment options. The disadvantage is the time and expense involved. This technique is used in areas where the margin of the tumour is indistinct or the location is cosmetically sensitive, such as the nose or eyelid. After the Mohs’ surgery, a complication reconstruction might be needed to repair the defect and a plastic surgeon may need to be involved to perform this.

Radiotherapy is often used in the treatment of primary tumors in patients who are not fit for surgery or have inoperable tumors. It may also be used where tumors are difficult to excise. It may also be used after the SCC has been excised to prevent it coming back again. The pathologist may see worrying fetaures of the lesion under the microscope, such as spread down a nerve or into a blood vessel that might make it necessary to offer radiotherapy. Radiotherapy uses high-energy rays or particles to kill cancer cells. External beam radiation therapy focuses radiation from outside the body on the skin tumor. This type of radiation therapy is used for treating some patients with SCC. The treatment is much like getting an x-ray, but the radiation is more intense. The procedure itself is painless. Each treatment lasts only a few minutes, although the setup time -- getting you into place for treatment -- usually takes longer. In some cases, it may be given as an adjuvant to surgery in the area where lymph nodes were removed, especially if many of the nodes contained cancer cells. This is to try to reduce the chance that the cancer will come back. Radiotherapy may also be used to treat SCC that has come back (recurred), either in the skin or lymph nodes, after surgery, or to treat distant spread of the disease. Radiotherapy is often used to relieve symptoms caused by metastases to the brain or bone (palliative therapy). Palliative radiation therapy is not expected to cure the cancer, but it may help shrink it for a time to control some of the symptoms.

Cryotherapy freezes and kills the cancer cells. It is used for early, stage 0 SCCs or actinic/solar keratoses.

Skin creams containing imiquimod or 5-fluorouracil may be used to treat early, stage 0 SCCs or actinic/solar keratoses.

Photodynamic therapy (PDT) is used in limited circumstances, such as when the SCC is stage 0 and arises in thin skin on the front of the leg.

In individual cases, even with similar tumour characteristics, the prognosis can vary with a range of other factors, e.g. age, degree of sun exposure, other diseases coexisting with the SCC. Early stage tumours will have a very high cure rate (>90%). Unfortunately, once patients have had one SCC another one is likely to develop over the following ten years. Patients are encouraged follow-up with their doctor as recommended and regularly examine their skin and lymph nodes once a month, using a mirror to check hard-to-see places.

Book an appointment with your GP if you notice any suspicious skin changes.

Patients with metastatic lymph node disease are more worrying and will need to be kept under close follow-up to look out for signs of recurrence. Often these patients are called back to clinic monthly for the first year. Immunosuppressed patients may need to be followed up in clinic for life or for as long as they are immunosuppressed.
UA-20538698-1 GSN-264747-I