VIRGINIA BEACH DERMATOLOGY ASSOCIATES, PLLC.

SQUAMOUS CELL CARCINOMA

Squamous cell carcinomas are the second most common skin cancer. Only the basal cell carcinoma is more frequent.

In some ways, the squamous cell carcinoma may be more significant than the basal cell since it is much more capable of metastasizing (spreading to other organs).

Squamous cell carcinomas are cancers of the squamous layer of the body, whether it is of the skin or other lining surface such as the mouth, bronchi, esophagus or vagina. Squamous cell carcinomas of the skin are far more common than internal squamous cell carcinomas.

A squamous cell carcinoma of the skin is a cancer of the epidermal layer lying above the basal cell layer.

Although squamous cell carcinomas often remain confined to the epidermis for long periods of time, they eventually invade into the underlying dermis. Occasionally they may metastasize to other organs.

Like the basal cell carcinoma , squamous cell carcinomas usually occur on the sun-exposed areas. However, their distribution is different. The Squamous cell carcinoma arises on the scalp, back of the hands, and upper surface of the ear. Basal cell carcinomas are uncommon in these locations.

WHO GETS SQUAMOUS CELL CARCINOMAS?

Like the basal cell carcinoma, people who are fair skinned, and blue eyed are the most likely to develop SCC ( Squamous cell carcinoma).

Of course, sun exposure is tied up in this equation. Anyone, whose occupation forces them to be in the sun for extended periods of time such as farmers, fishermen, or construction workers, is at increased risk.

WHAT CAUSES SQUAMOUS CELL CARCINOMAS?

Besides sun exposure, there are other reasons squamous cell carcinomas occur.

They may develop following X Ray treatment or certain chemical exposures. Tar and arsenic have long been associated with squamous cell carcinomas.

Burn sites and chronic ulcers may be the seat of these malignancies.

People whose immune system is suppressed are at risk. Such suppression may be intentional (to control a disease or prevent organ rejection) or unintentional (AIDS or other diseases.)

Occasionally, squamous cell carcinomas may arise on normal skin without an apparent reason.

PRECANCERS

There are a number of precancerous conditions that may presage the squamous cell carcinoma.

Actinic Keratosis: An extremely common lesion. Most squamous cell carcinomas begin as these rough, scaly bumps. They may be pink, yellow or even brown. The percentage of actinic keratoses which eventuate in squamous cell carcinomas is disputed among dermatologists. The actinic keratosis means that at least some of the epidermal cells are atypical. The difference is that in the squamous cell carcinoma those atypical cells have invaded into the epidermis.

Bowen’s Disease: These appear as persistent pink, red or brown patches. Since they look like eczema or psoriasis diagnosis may be delayed for years. Fortunately, it usually takes years before they turn into squamous cell carcinomas. However, once Bowen’s Disease turns into a Squamous cell carcinoma they tend to be much more deadly.

Leukoplakia: Marked by white patches on the lips, tongue or inside of the mouth.

WHAT DO SQUAMOUS CELL CARCINOMAS LOOK LIKE?

There are two main appearances to squamous cell carcinomas. The first is the thickened, rough, crusty pink or yellow bump. These are the type that usually arises from an actinic keratosis.

The second type is the red, inflamed ulcer or open sore. This type tends to be more aggressive. This variety usually develops without a precancer.

A persistent patch with irregular borders that occasionally bleeds or crusts is another less common picture.

Any change in a pre-existing lesion or the development of a new growth should propel a patient to visit their physician. Same goes for a non-healing open sore.

Better yet, if you have a lesion you suspect is a precancer such as an actininc keratosis you should see your physician. These lesions can be treated easily… preventing the development of a cancer.

TREATMENT

In most cases, a biopsy will have confirmed your physician’s impression that you have a squamous cell carcinoma.

It is important to realize that the biopsy is not meant to remove the lesion. It is only a sample of the lesion which is then sent to the laboratory where a pathologist will determine whether you have a squamous cell carcinoma.

Treatment will follow.

Most squamous cell carcinomas are treated by surgical excision. Your physician will remove the tumor and some surrounding normal tissue. The pathologist will again examine this tissue to decide whether the whole cancer is gone.

Electrodesiccation and Curettage is very effective for small squamous cell carcinomas. The physician scrapes the tumor away with a sharp ring-shaped instrument called a curette. An electric needle burns the scraped area killing even more tumor cells and stopping the bleeding. This is repeated two or three times.

Cryosurgery is used occasionally .In this technique the tumor is subjected to liquid nitrogen freezing.

Radiation also has its place. X-ray beams are aimed at the tumor to destroy it.

This is a very good treatment for the elderly and debilitated.

Laser is a new treatment. The tumor is vaporized. The advantage is that it leaves a bloodless field for the surgeon.