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Squamous cell carcinoma

This page was reviewed under our medical and editorial policy by
Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on June 1, 2022.

Squamous cell carcinoma (SCC) is one of the most common types of skin cancer. This cancer starts in the flat squamous cells found in the upper part of the epidermis, the skin’s outermost layer. About two out of 10 skin cancers are squamous cell carcinomas, according to the American Cancer Society.

Signs and symptoms

Knowing the signs and symptoms may help you identify squamous cell carcinoma in its most treatable stages.

These include:

  • Sore that won’t heal and has a raised border
  • Rough, reddish, scaly patch of skin
  • Dome-shaped growth
  • Small horn-shaped growth on skin
  • Sore in an old scar
  • Wart-like sore on nails or genitals
  • Brown or black line under fingernail or toenail
  • Sore inside your mouth
  • Single colored mark (it may be red, pink, brown, black, yellow or white)

Squamous cell carcinoma may also itch or feel sore. Some patients report numbness or tingling in the area.

This type of skin cancer typically appears on sun-exposed parts of the body, such as the face, ears, neck, lips or the backs of hands. Sometimes it forms in a scaly patch of skin called actinic keratosis or AK, which is caused by sun exposure.

Risk factors

Exposure to the sun's ultraviolet (UV) rays is the leading cause of squamous cell carcinoma and other skin cancers. The UV rays damage the DNA, or genetic material, in the squamous cells, increasing the risk for cancer.

Other factors that may raise your risk include:

  • History of sunburns or using tanning beds
  • Location of residence: Living at a high altitude or in a very sunny region
  • Weakened immune system
  • Age (older than 50)
  • Gender: Being male
  • Fair skin
  • Previous radiation treatment
  • Precancerous skin conditions
  • Human papillomavirus (HPV)

In people with a darker skin tone, these skin cancers tend to develop in areas that get little or no sun, including the mouth, genitals or anus.

Diagnosis

The best way to stay a step ahead of all types of skin cancer, including squamous cell carcinoma, is to schedule yearly visits with a dermatologist. During a skin check, a dermatologist looks for any abnormal area that differs in color, size, shape or texture from the skin around it.

In addition to doctor visits, monthly self-exams are recommended. Patients who spot something suspicious that’s growing, bleeding or changing should consult with their dermatologist for follow-up. If needed, the doctor may perform a biopsy and send the cells to the lab for analysis to determine if they’re cancerous.

Squamous cell carcinoma is usually diagnosed early and tends to spread slowly. That said, if it isn’t found and treated early, this type of skin cancer can spread to nearby lymph nodes and other parts of the body.

Treatment for squamous cell carcinoma

Squamous cell carcinoma treatment is based on the size and location of the growth, as well as the patient’s overall health.

Surgery

Squamous cell carcinoma is often removed surgically via excision (the doctor cuts out the tumor and stitches up the skin).

Another method, curettage and electrodesiccation, scrapes away cancer cells and uses electricity to kill remaining cancer cells.

Mohs micrographic surgery, a more involved procedure, is often used for aggressive, large or recurrent squamous cell cancers. It may be an option for squamous cell carcinoma that’s spreading along nerves, or on the face or genital area. The surgeon removes the cancer, followed by a thin layer of surrounding skin, which is examined under a microscope for cancer cells. If cancer cells are still present, the surgeon removes another layer. This process continues until no cancer cells are detected.

Cryosurgery

Cryosurgery involves freezing the skin cancer so that it eventually falls off. This may be recommended if the cancer isn’t deep and/or you’re not a candidate for more invasive surgery due to underlying health conditions.

Radiation

Radiation therapy, which uses X-ray energy to kill cancer cells and shrink tumors, may be an option if the cancer is difficult to remove via surgery or you aren’t a candidate for surgery. Several radiation treatments will likely be needed to treat the cancer.

Photodynamic therapy (PDT)

With PDT, the doctor first applies a light-sensitizing topical to the area. Then a laser or light-based device is used to activate the topical agent, with the aim of destroying malignant cells and sparing healthy tissue when possible. PDT can help treat some superficial squamous cell carcinomas on the face and scalp.

Topical medications

Two topical medications, 5-fluorouracil (5-FU) and imiquimod, can be applied directly onto the affected skin as treatment for superficial squamous cell carcinomas. Neither are approved specifically to treat squamous cell carcinoma, but they can be used off-label. Imiquimod stimulates the immune system to fight back against cancerous cells, while 5-FU kills tumor cells on or near the skin’s surface.

Treatment for advanced squamous cell carcinoma

If spread is suspected, your doctor may surgically remove nearby lymph nodes.

Once the tumor and/or lymph nodes are removed, you may need other treatments if the cancer continues to spread, including:

Radiation

If the squamous cell carcinoma is advanced, especially if the cancer has started to spread into the space surrounding a nerve, radiation may be used after surgery or in combination with other treatments.

Immunotherapy

A newer type of cancer therapy, immunotherapy harnesses the power of your immune system to recognize and destroy cancer. Libtayo® (cemiplimab) and Keytruda® (pembrolizumab) works by blocking PD-1, a checkpoint protein on the surface of T-cells in the immune system.

Targeted therapy

Targeted therapy, such as EGFR inhibitors, may help treat advanced squamous cell skin cancer, which can overexpress a protein called EGFR, helping fuel growth. Drugs targeting this protein can shrink some of these cancers. EGFR inhibitors may be used alone or in combination with other treatments for squamous cell carcinoma.

Chemotherapy

Chemotherapy drugs may be an option if the squamous cell skin cancer is spreading. Given intravenously once every few weeks, chemotherapy may slow the spread of the cancer and/or help relieve some symptoms. Sometimes chemotherapy can shrink tumors so that other therapies can be used to treat the cancer that remains.

Squamous cell carcinoma prognosis and survival rate

If caught early, squamous cell carcinoma is highly treatable. While skin cancer is the most common cancer type among U.S. adults, cases are not required to be reported to cancer registries, so exact incidence breakdowns of types like squamous cell carcinoma are not known. However, according to numbers tracked by the Canadian Cancer Society, the five-year relative survival rate (the percentage of people who are alive five years after diagnosis) is 95 percent.

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