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Skin cancer: Squamous cell carcinoma treatment


Skin cancer: Squamous cell carcinoma treatment


How do dermatologists diagnose squamous cell carcinoma of the skin?

Because this cancer begins on the skin, it’s possible to find it early when it’s highly treatable.

Squamous cell carcinoma is highly treatable when found early

Found early, a dermatologist can often treat squamous cell carcinoma of the skin cancer in the office.

Female dermatologist examining male patient with dermascope, looking for signs of skin cancer.

When you see a board-certified dermatologist, your dermatologist will examine your skin carefully.

If your dermatologist finds a spot on your skin that could be any type of skin cancer, your dermatologist will first numb the area and then remove all (or part) of it. This can be done during an office visit and is called a skin biopsy. This is a simple procedure, which a dermatologist can quickly, safely, and easily perform.

Having a skin biopsy is the only way to know for sure whether you have skin cancer.

What your dermatologist removes will be examined under a high-powered microscope. Your dermatologist or a doctor who has in-depth experience diagnosing skin growths, such as a dermatopathologist, is best qualified to examine the removed tissue under a microscope.

After examining the removed tissue, the doctor writes a biopsy report. Also called a pathology report, this report explains what was seen under the microscope, including whether any skin cancer cells were seen.

If you have SCC of the skin, the report will contain the following information when possible:

  • Type of squamous cell skin cancer

  • Stage of the cancer

  • Whether the cancer has any features that make it aggressive

How do dermatologists treat squamous cell carcinoma of the skin?

When possible, SCC of the skin is treated with surgical removal. When the cancer is caught early, this can often be performed in your dermatologist’s office while you remain awake.

The following explains the types of surgical removal used to treat SCC of the skin, along with other treatment options.

Surgical removal: Three types of surgical removal are used to treat SCC of the skin. The type of surgical removal you receive depends largely on the type of SCC you have, where it’s located, and how deeply it goes.

Here’s what involved with each type of surgical removal:

  • Excision: Your dermatologist cuts out the cancer and an area of normal-looking skin around the tumor. Removing some normal-looking skin helps to remove stray cancer cells.

    What your dermatologist removes will be looked at under a high-powered microscope by a doctor, who is looking for cancer cells in the normal-looking skin. Your treatment is complete if the normal-looking skin contains no cancer cells.

    If cancer cells are found in the normal-looking skin, you will need more treatment.

  • Mohs (rhymes with nose) surgery: This is often used to treat SCC on the skin because many of these cancers develop on the face, neck, or hand where it can be difficult to remove an area of normal-looking skin. There just isn’t a lot of extra skin on these parts of the body.

    During Mohs surgery, you remain awake while the surgeon removes the least amount of tissue required to treat the cancer. This is possible because the surgeon can see where the cancer stops during the surgery.

    To learn more about what’s involved in having Mohs surgery and when it’s recommended, go to What is Mohs surgery?

  • Curettage and electrodessication: During this type of surgical removal, your dermatologist first scrapes the SCC from your skin, using a technique called curetting. Then, a procedure called electrodesiccation uses heat to destroy any remaining cancer cells.

    This surgery can be performed in a dermatology office while you remain awake. A dermatologist may use it to treat a small SCC that is classified as a low-risk tumor. Dermatologists do not use this surgery to treat SCC on areas of the body where hair grows heavily, such as on the scalp, a man’s beard area, or an armpit.

Radiation therapy: If surgery alone cannot treat the cancer or you cannot have surgery, your treatment plan may include radiation treatments.

The different types of radiation therapy used to treat SCC of the skin are:

  • Superficial radiation therapy: Sends beams of radiation just beneath the skin, treating only the tumor.

  • External beam radiation therapy: Directs high-energy beams of radiation into the tumor in order to kill cancer cells, but no radioactive sources are placed inside your body.

  • Brachytherapy (bray-key-ther-uh-pee): This involves placing radioactive implants directly inside (or near) the cancer. Also called internal radiation, this therapy is also used to treat prostate cancer.

Radiation treatments may be recommended as a follow-up treatment when SCC of the skin has the potential to spread. In this case, radiation therapy often follows surgery.

If the skin cancer has grown deep or spread, radiation therapy may help a patient feel more comfortable.

Cryosurgery: This treatment involves using an extremely cold substance, such as liquid nitrogen, to destroy the cancerous cells. Although seldom used to treat SCC, it can be an option for an early cancer when a patient cannot have any type of surgical removal.

Clinical trial for SCC: A clinical trial is a research study. This type of study helps doctors find better treatments for cancer and other diseases. Patients who participate in a clinical trial do so voluntarily. Your dermatologist may recommend that you consider a clinical trial if the treatment could help you.

While your dermatologist may recommend a clinical trial, you make the final decision about whether to participate.

Observation: For some patients, observation may be recommended. Observation means that your dermatologist will watch your cancer over time and only consider treatment if the cancer worsens.

This may be an option for an elderly patient who has a slow-growing SCC of the skin.

Palliative care: Rather than treat the cancer, this care offers relief from the symptoms or stress of having cancer.

How is squamous cell carcinoma of the skin treated when it spreads?

When this cancer spreads beyond the skin, it travels to the lymph nodes or other organs. Once it spreads, a patient has advanced cancer.

If you've been diagnosed with advanced squamous cell skin cancer, your treatment plan may include one or more of the following:

Surgery: When surgery can remove the cancer and you’re healthy enough to have surgery, this may be recommended. After surgery, another treatment, such as radiation therapy or chemotherapy, is often given. This second treatment helps to kill cancer cells.

Radiation therapy: Radiation can target cancer cells in the skin, lymph nodes, or other areas of the body. When a patient has advanced squamous cell skin cancer, radiation therapy is often used along with another treatment.

Immunotherapy: This type of treatment helps strengthen your immune system so that it can fight the cancer. Drugs called immunotherapy medications are given for this purpose. The U.S. Food and Drug Administration (FDA) has approved one immunotherapy medication for the treatment of advanced squamous cell skin cancer. Called cemiplimab-rwlc, this medication is given by an intravenous (IV) infusion. Most patients go to a hospital or cancer treatment center once every 3 weeks to receive this infusion.

In clinical trials, cemiplimab-rwlc shrank the tumors in about half the patients with advanced squamous cell skin cancer. This shrinking lasted 6 months or longer in some patients. A few patients had their tumors disappear completely. Like all medications, immunotherapy drugs have possible side effects and are not right for every patient. Some side effects can be serious.

Chemotherapy: This treatment can help slow the spreading cancer and relieve symptoms. Sometimes, it shrinks tumors. A few patients with advanced skin cancer have had the cancer completely disappear after being treated with two chemotherapy medications. There are many different chemotherapy drugs. The ones used to treat advanced squamous cell skin cancer are usually injected into a vein.

Chemotherapy drugs work by killing fast-growing cells in the body. Cancer cells are just one type of cell that grows quickly. Hair cells and cells in your gastrointestinal (GI) tract also grow quickly and can be killed. When chemotherapy kills these cells, patients develop side effects, such as hair loss and nausea.

Other treatments for advanced squamous cell skin cancer: No single treatment is best for everyone who has this advanced cancer. Your medical team will consider your unique needs before recommending treatment.

Another type of treatment may be recommended. One possibility is targeted therapy. This type of treatment involves taking medication that can zero in and kill cancer cells. Unlike chemotherapy, targeted therapy can kill cancer cells without killing other cells in your body.

For some patients, another treatment may be more appropriate. If your team believes that a medication being studied in a clinical trial could benefit you, your doctor may suggest that you join the clinical trial. Palliative care may be recommended to help improve your quality of life. Researchers continue to study treatment for advanced skin cancer, and their breakthroughs are giving patients hope.

What is the outlook for someone who has squamous cell carcinoma of the skin?

When found early and treated, the cancer can often be removed. When the cancer grows deep or spreads, treatment becomes more difficult.

While many patients can be successfully treated, it’s important to know that this skin cancer can return. You also have a greater risk of developing another SCC of the skin or another type of skin cancer.

That’s why self-care becomes so important after treatment for SCC of the skin. You’ll find the self-care that dermatologists recommend at, Squamous cell carcinoma of the skin: Self-care.


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References
Alam M, Armstrong A, et al. “Guidelines of care for the management of cutaneous squamous cell carcinoma.” J Am Acad Dermatol 2018;78:560-78.

Anadolu-Brasie R, Patel AR, et al., “Squamous cell carcinoma of the skin.” In: Nouri K, et al. Skin Cancer. McGraw Hill Medical, China, 2008: 86-114.

Marrazzo G, Zitelli JA, et al. “Clinical outcomes in high-risk squamous cell carcinoma patients treated with Mohs micrographic surgery alone.” J Am Acad Dermatol 2019;80:633-8.

Ribero S, Stucci LS, et al. “Drug therapy of advanced cutaneous squamous cell carcinoma: Is there any evidence?” Curr Opin Oncol. 2017;29(2):129-35.

Vaidya P, Mehta A, et al. “Concurrent radiation therapy with programmed cell death protein 1 inhibition leads to a complete response in advanced cutaneous squamous cell carcinoma.” JAAD Case Rep. 2019; 5(9): 763–6.

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