Squamous Cell Carcinoma

Definition

Definition of Squamous Cell Carcinoma
Squamous cell carcinoma (SCC or SqCC) is a cancer of a kind of epithelial cell, the squamous cell. These cells are the main part of the epidermis of the skin, and this cancer is one of the major forms of skin cancer. However, squamous cells also occur in the lining of the digestive tract, lungs, and other areas of the body, and SCC occurs as a form of cancer in diverse tissues, including the lips, mouth, esophagus, urinary bladder, prostate, lung, vagina, and cervix, among others. Despite sharing the name squamous cell carcinoma, the SCCs of different body sites can show tremendous differences in their presenting symptoms, natural history, prognosis, and response to treatment.

Symptoms

Symptoms of Squamous Cell Carcinoma
Symptoms are highly variable depending on the involved organs. SCC of the skin begins as a small nodule and as it enlarges the center becomes necrotic and sloughs and the nodule turns into an ulcer.

1. The lesion caused by SCC is often asymptomatic
2. Ulcer or reddish skin plaque that is slow growing
3. Intermittent bleeding from the tumor, especially on the lip
4. The clinical appearance is highly variable
5. Usually the tumor presents as an ulcerated lesion with hard, raised edges
6. The tumor may be in the form of a hard plaque or a papule, often with an opalescent quality, with tiny blood vessels
7. The tumor can lie below the level of the surrounding skin, and eventually ulcerates and invades the underlying tissue
8. The tumor commonly presents on sun-exposed areas (e.g. back of the hand, scalp, lip, and superior surface of pinna)
9. On the lip, the tumor forms a small ulcer, which fails to heal and bleeds intermittently
10. Evidence of chronic skin photodamage, such as multiple actinic keratoses (solar keratoses)
11. The tumor grows relatively slowly
12. Unlike basal cell carcinoma (BCC), squamous cell carcinoma (SCC) has a substantial risk of metastasis
13. Risk of metastasis is higher in SCC arising in scars, on the lower lips or mucosa, and occurring in immunosuppressed patients.

Causes

Causes of Squamous Cell Carcinoma
Squamous cell cancer may occur in normal skin or in skin that has been injured or inflamed. Most skin cancers occur on skin that is regularly exposed to sunlight or other ultraviolet radiation.

The earliest form of squamous cell skin cancer is called Bowen's disease (or squamous cell in situ). This type has not spread to nearby tissues.

Actinic keratosis is a precancerous skin lesion that rarely may become a squamous cell cancer.

Diagnosis

Diagnosis of Squamous Cell Carcinoma
Your doctor will check your skin and look at the size, shape, color, and texture of any suspicious areas.

If your doctor thinks you might have skin cancer, a piece of skin will be removed and sent to a lab for examination under a microscope. This is called a skin biopsy. There are different types of skin biopsies.

A skin biopsy must be done to confirm squamous cell skin cancer or other skin cancers.

Treatment

Treatment of Squamous Cell Carcinoma
Treatment depends on the size and location of the skin cancer, how far it has spread, and your overall health. Some squamous cell skin cancers may be more difficult to treat.

Treatment may involve:

1. Excision: Cutting out the skin cancer and stitching the skin together
2. Curettage and Electrodesiccation: Scraping away cancer cells and using electricity to kill any that remain; It is used to treat cancers that are not very large or deep
3. Cryosurgery: Freezing the cancer cells, which kills them
4. Medication: Skin creams containing imiquimod or 5-fluorouracil for superficial (not very deep) basal cell cancer
5. Johns Surgery: Removing a layer of skin and looking at it immediately under a microscope, then removing many layers of skin until there are no signs of the cancer; Usually used for skin cancers on the nose, ears, and other areas of the face.
6. Photodynamic Therapy: Treatment using light, may be used to treat Bowen's disease (BD).

Prognosis

Prognosis of Squamous Cell Carcinoma
How well a patient does depends on many things, including how quickly the cancer was diagnosed. Most of these cancers are cured when treated early.

Prevention

Prevention of Squamous Cell Carcinoma
Appropriate clothing, sunscreen with at least SPF 30, and avoidance of intense sun exposure may prevent skin cancer.