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Telephone: 404-851-1766 Toll Free: 866-851-5030

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Patient Education

Squamous Cell Carcinoma

Squamous cell carcinoma is the second most common type of skin cancer, after basal cell carcinoma. More than 700,000 new cases of squamous cell carcinoma are diagnosed every year. It is a slow growing type of cancer arising from keratinocytes. These are the cells that make up the surface layer of the skin (epidermis). Squamous cell carcinomas can occur anywhere on the body but are most common in chronically sun-exposed areas such as the ears, lower lip, face, hairless scalp, neck, hands, forearms, and lower legs. Occasionally, the carcinoma may arise at the site of chronic inflammatory conditions, scars, ulcer wounds, and burns. 


Squamous cell carcinoma develops predominantly in persons with a long history of sun-exposure, especially those with fair skin and light hair.  Other risk factors include smoking, tobacco use, radiation, and exposure to certain chemicals such as arsenic.  It is also seen frequently in those who have a very depressed immune system such as organ transplant recipients. Men are about twice as likely as women to develop a squamous cell carcinoma. Most squamous cell carcinomas develop after the age of fifty and are seen with increased frequency in older age.


Many squamous cell carcinomas arise from untreated precancerous lesions known as actinic (solar) keratoses.  These precancerous lesions represent areas of atypical keratinocytes that only partially involve portions of the epidermis.  When this type of cancer involves the entire thickness of epidermis, it is referred to as in-situ squamous cell carcinoma or Bowen’s disease.  In situ squamous cell carcinoma usually presents as a red, scaly or crusty patch that may resemble an area of eczema or psoriasis.  Some forms of in situ carcinoma can also affect the genital areas and mucous membranes and are related to infection by human papillomavirus (HPV). When atypical keratinocytes involve the deeper layer of the skin (dermis), they are then referred to as invasive squamous cell carcinoma.  Invasive squamous cell carcinomas tend to appear as thickened rough and scaly areas of skin that may bleed or crust.  Some may also present as persistent sores or ulcers that do no heal. Keratoacanthoma and verrucous carcinoma are two special variants of squamous cell carcinoma which usually tend to have less aggressive behavior. Keratoacanthomas appear as rapidly growing dome shaped nodules with a central crater filled with skin debris (keratin) resembling a volcano. Verrucous carcinomas are slow growing lesions with an irregular warty surface seen on the sole of the foot, the mouth, and the genital area.


The majority of squamous cell carcinomas can be cured when diagnosed and treated early. If they are left to grow, they can cause further tissue destruction and disfigurement, needing more extensive treatment. In addition, squamous cell carcinomas can also have a 5% risk of spreading to other organs of the body (metastasis).  Metastatic cancer is more difficult to treat and may result in death. The choice of treatment depends on several factors including the tumor’s size, location, and level of invasion into the skin. The treatments options for squamous cell carcinoma are similar to those used for basal cell carcinoma.  The most common treatment is standard surgical excision (cutting a margin of skin around the tumor). Electrodessication and curettage (scraping and burning the tumor with electric current) can be used for superficial cancers. Mohs micrographic surgery is a specialized surgical technique that may be used in certain situations including treating tumors that are poorly demarcated, recurrent, or in cosmetically important areas such as the eyes, nose, lips, and ears.  This technique usually saves the greatest amount of healthy tissue and has the highest cure rate.  Other treatment options include localized forms of radiation, photodynamic therapy (a special type of light treatment), and laser. Most of these treatments can be done in an outpatient setting. 


Any person who has developed a squamous cell carcinoma is at higher risk for developing additional squamous cell carcinomas as well as other types of skin cancers.  For this reason, regular skin examinations by medical professionals after treatment are essential. Continued sun protective measures are also crucial in preventing further tumors. These measures include sun avoidance during the middle of the day, wearing broad-spectrum sunscreens or sun-protective clothing, and avoiding tans. 


Additional Clinical Images:

In situ Squamous Cell Carcinoma













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