SCC is the second most common type of skin cancer (after BCC – internal link). Sometimes SCC is grouped together with BCC and called “non-melanoma skin cancers” because these types of skin cancer behave very differently to melanomas.

These skin cancers arise most commonly in sun damaged sites such as the face, ears, forearms and backs of the hands, though they can occur anywhere in the body. They usually appear as a scaly or crusty skin-coloured lump, which may ulcerate. Sometimes the lumps are tender or painful to touch.

The biggest risk factor for SCC development is high cumulative sun exposure and they are most likely to occur in people with fair skin types. Individuals with organ transplants or who take medications to suppress the immune system are also at high risk.

SCCs may arise from normal looking skin or from areas previously affected by sun spots (actinic keratosis – internal link) – if sunspots are left untreated they have a risk of developing into SCCs. The name for early SCCs that are superficial and have not spread beyond the top layer of skin is Bowen disease. Bowen disease should be treated to prevent it from developing into an invasive SCC.

Prevention is better than cure; using good sun protection measures is your best option to prevent SCCs (sunscreen/photo-protection internal link).

Because they have some potential to spread to other parts of the body including the lymph nodes SCCs require treatment. Because other lesions may have similar appearances to SCCs, a biopsy under local anaesthetic may be necessary to confirm SCC before treatment is started.

Treatment at The Skin Hospital
There are many treatment options and choice will depend on a number of factors including the type of SCC, size, location and patient-related factors.

  • Bowen disease
    • Cryotherapy (freezing with liquid nitrogen) can be used on the affected area and to a small margin of surrounding normal skin. The treated area might be left a lighter colour (hypopigmentation).
    • Photodynamic therapy (PDT) – an ointment can be applied to the area with a surrounding margin of normal skin, this is preferentially absorbed by the damaged skin and using a laser or non-laser light then activates the ointment to destroy the Bowen disease.
    • 5-Flurouracil 5% cream (efudix) can be applied at home twice a day for 3-6 weeks. The dermatologist may review progress after 3 weeks to determine duration of use.
    • Surgery may be considered, the following methods can be used under local anaesthetic:
      • Curettage & cautery – the skin cancer is scraped off and then cauterised to stop the bleeding and destroy any remaining abnormal cells. Stitches are not required.  
      • Excision – the skin cancer is cut out.
  • Other SCCs
    • Surgery is usually the best option – curettage & cautery and excision can be used (see Bowen disease). If the SCC is very large, recurrent, an aggressive sub-type or affecting an area such as the central part of the face, Mohs surgery may be the best option. Mohs surgery can be carried out at both of our Skin Hospital sites by any of our trained Mohs surgeons (link to Mohs surgery & list of Mohs surgeons).
    • Radiotherapy (treatment using X-rays) is also an option, especially if surgery is thought not to be appropriate. The Skin Hospital can refer you to a radiotherapy specialist.

SCCs are common in Australia and all of our specialists are skilled in recognising and treating SCCs (link to specialist list). If specialist surgery is required, individuals can be referred on to one of our skin cancer surgery specialists.

Further Information from trusted websites about SCC:
http://www.dermnetnz.org/lesions/squamous-cell-carcinoma.html
http://www.bad.org.uk/library media/documents/Squamous%20Cell%20Carcinoma%20Updated%20Jan%202012%20-%20Lay%20reviewed%20Dec%202011.pdf

Authors: Dr Charlotte Thomas & Dr Sarvjit Sohal, last updated 29 September 2015

 

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