Squamous Cell Carcinoma

Simply put, skin cancer is an uncontrollable, abnormal growth of cells in the outer layer of skin, and it usually develops on areas that are frequently exposed to the sun. Unrepaired DNA damage caused by ultraviolet radiation triggers mutations, typically in the epidermis or top layer of skin—though it can affect the middle layer as well. There are three types of cells in this layer: squamous cells, basal cells, and melanocytes. Squamous cells are thin, flat cells, while basal cells are deeper round cells, and melanocytes are melanin-producing cells found in the lower area of the epidermis.

Squamous cell carcinoma develops in the flat cells that are close to the surface of the skin.

Along with basal cell carcinoma and melanoma, squamous cell carcinoma is one of the three major types of skin cancer. Squamous cell carcinoma is a non-melanoma type of skin cancer that occurs from an aberrant growth of keratinocytes, a type of skin cell that originates squamous cells. It is the second most common type of skin cancer, and it usually develops in sun-exposed skin, resulting in part from intense ultraviolet radiation and an accumulation of exposure to the sun over months to years.

Who is most likely to get squamous cell carcinoma? What is the primary risk factor for squamous cell carcinoma? There are certain variables that can make you more likely to develop this cancer. Although squamous cell carcinoma can affect anyone, some of the biggest risk factors are having long term sun exposure; sun damage to your skin at a young age; a pale or fair complexion; blue, green, or grey eyes; red or blond hair; being age 65 or older; having a weak immune system, a history of sunburns, pre-cancerous spots on the skin, or skin cancer; exposure to radiation; having Bowen’s disease, HIV, or AIDS; and exposure to chemicals such as arsenic. Men are about twice as likely to get squamous cell carcinoma.

What are the first signs of squamous cell carcinoma? What does squamous cell carcinoma start off looking like? What color is squamous cell carcinoma? If you have been noticing changes to the appearance of your skin, these are some of the things you might be wondering about. Squamous cell carcinoma of the skin is typically either a pinkish, reddish, or brown patch with overlying scaling. This skin cancer can manifest as a bump or larger plaque. Sometimes these abnormal cells may bleed and have a resulting crusted appearance. These lesions can grow very slowly, but there are some variants of squamous cell carcinoma that can grow quite rapidly. These are termed keratoacanthoma, and they typically appear more crateriform (meaning crater-like) in appearance on the edges with a thick, heaped up, central crust. Most commonly, squamous cell carcinoma, or SCC, prefers to stay on the surface of the skin, but lesions can run down hair follicles and spread more deeply into nerves in the surrounding area.

The next question patients will usually have is “How serious is squamous cell carcinoma?” or “Can you live with squamous cell carcinoma?” Squamous cell carcinoma typically grows slowly over time, but as with the more aggressive types of SCC that spread into the follicle areas or the nerves, these can potentially become dangerous—especially if left untreated. If a patient has a new lesion, growing lesion, or changes in the appearance of a lesion, they should seek out the evaluation and advice of a dermatologist such as Dr. Ellen Turner right away. Squamous cell carcinoma, when caught early, can be easily treated. When treated early, the best outcomes can occur, and can allow for a normal life span and good quality of life.

Dr. Turner will start by asking you about your medical history, including your history of severe sunburns or indoor tanning, discuss any discomfort or other symptoms of your condition, talk to you about when you first started to see the skin lesion, give you a physical exam to check the size, color, and other characteristics of the spot, and check for other spots on your body. Dr. Turner will remove a sample of the lesion to test it if it looks questionable.

To diagnose squamous cell carcinoma, Dr. Turner will work with members of her trained staff to perform a biopsy, which involves anesthetizing the area to be sampled and surgically removing some of the skin cells in question. A certified dermatopathologist, who is specially trained to identify skin conditions, will examine the sample in a pathology lab, seeking to identify malignant cells and, if present, determine how far they extend into the skin. Superficial squamous cell carcinoma is limited to the uppermost layers, while the nodular form affects all of the skin’s layers in the sample. Equipped with this knowledge, Dr. Ellen Turner will recommend the best treatment possible.

Patients dealing with squamous cell carcinoma/cancer should know that there are several potential treatment options, including surgical excision, which involves either the dermatologist who handled the biopsy or a surgeon specially trained in the Mohs technique cutting out the malignant cells and a small amount of the surrounding healthy tissue. As a dermatologist, Dr. Ellen Turner guides her patients toward the squamous cell carcinoma treatment best suited for that particular cancer and its location.

No matter which type of excision a patient chooses, the procedure will generally require several hours spent with a dermatologist or surgeon, who will use local anesthetization. Typically, this can be done in the doctor’s office—no need for a hospital or outpatient facility.

A specialist trained in Mohs surgery will surgically remove the malignancy, as well as a thin layer of tissue surrounding the area where the tumor had been. This tissue will be scrutinized under a microscope, which will allow the surgeon to determine whether any cancer cells are present. These steps will continue until no cancer cells are visualized in the layers taken. This method is very accurate and has a high cure rate.

The American Academy of Dermatology recommends that surgeons performing standard surgical excision take a 5-mm margin of tissue from around the tumor, with the idea that cancer cells that cannot be seen will also be removed.

Both surgical excisions leave a scar, though the visible mark will become less noticeable over about four to six months after a procedure.

If a biopsy reveals that squamous cell carcinoma is superficial, topical therapy may be a viable treatment option. One chemotherapy topical cream is 5-fluorouracil, which works on the skin’s surface—causing redness, some swelling, and crusting—over the course of several weeks of application.

As medical advances have continued to expand treatment possibilities, superficial radiation has become an increasingly useful option for non-melanoma skin cancer, including squamous cell carcinoma. Like Mohs, this treatment has a very high cure rate; unlike the surgical option, there is no resulting scar. The therapy is especially suited for highly visible and sensitive areas, including the nose, ear, and eyelids. Dr. Ellen Turner has found that many of her patients choose this options in the Dallas/Fort Worth area.

Squamous cell carcinoma patients who have a successful treatment with Dr. Ellen Turner should keep up with regular skin checks, performed twice a year. This focused attention on the skin gives the dermatologist a better chance of spotting new suspicious lesions and other potential problems, which, in turn, allows for better outcomes.

Aside from squamous cell carcinoma, the Dermatology Office of Dr. Ellen Turner offers treatments for many other types of conditions or disorders that affect the skin, including other forms of skin cancer such as basal cell carcinoma (BCC), melanoma, and pre-cancerous lesions like actinic keratosis. Dr. Turner treats patients with common conditions such as acne, eczema or atopic dermatitis, psoriasis, and rosacea.