Skin Cancer: Squamous Cell Carcinoma Treatment

  • Treatment

    Use sunscreen with SPF 15 or higher, wear protective clothing when in the sun, avoid being out in the midday sun, and check yourself regularly for new or changing skin lesions and non-healing sores.

    Your doctor is the best source of information on the drug treatment choices available to you.

    In cases where surgical removal is impractical, radiation treatment is also effective. Radiation therapy can be very effective, and is occasionally used for difficult cases in which surgery would compromise the function of nearby structures (such as for a lesion on the eyelid or lip). Radiation is also useful in areas where cancer has recurred multiple times, and for elderly or ill patients for whom surgery may not be advisable. Typical radiation regimens are given several times a week for one to four weeks. Radiation may also be used to target lymph nodes if the doctor suspects that the disease has spread. Unfortunately, radiation therapy does not involve sampling tissue to confirm that the treatment was successful. Additionally, there is a long-term increased risk of developing a new skin cancer in the radiated site.

    Phototherapy is another alternative for actinic keratoses. Phototherapy uses red or blue light to destroy actinic keratoses after the patient takes a special oral or topical medication (most commonly aminolevulinic acid) that selectively absorbs these wavelengths. Sunlight must be avoided for a given time around the pre- and post-treatment period. Phototherapy targets current lesions, but does not prevent future lesions from occurring.

    Surgical removal of skin cancer is the treatment of choice. A variety of surgical methods are available. Almost all surgical procedures for SCC are done on an outpatient basis in a doctor’s office using local anesthesia. They involve minimal pain and discomfort during and after the procedure.

    • Simple excision of the lesion. A scalpel is used to excise the cancer as well as a thin border of the normal-appearing tissue to ensure that the entire cancer is removed.
    • Electrosurgery. This method is used for very small and superficial lesions that are located on a flat skin surface such as the torso. The cancer is scraped away with a sharp, ring-shaped instrument called a curette, and the base of the lesion is cauterized with an electric wand.
    • Mohs’ micrographic surgery. This method is used for lesions that occur on areas where tissue conservation is important, such as the eyelid, ear, lip, or nose. This method involves removing the visible tumor, and then removing a very thin layer of surrounding tissue. Each layer is processed in the office and examined under the microscope for residual cancer cells so that the doctor can determine when the entire tumor has been removed.
    • Cryosurgery or laser surgery. Cryosurgery involves freezing the cancer or precancerous lesion with liquid nitrogen to destroy it. Laser surgery also destroys tissue and is sometimes used to treat actinic cheilitis (precancerous lesions on the lips).

    The vast majority of SCCs are curable. Those that have already metastasized have reduced cure rates. Most squamous cell carcinomas are relatively slow-growing, and are discovered while they are still small and can be completely removed. Those that are most likely to metastasize tend to be large, occur on the lip, ear, or in the mouth, or show microscopic features of vascular or nerve involvement. Other factors that indicate more aggressive cancers are those associated with x-ray treatment and those arising within scars or nonhealing wounds. People who have immunosuppressive disorders, such as patients with organ transplants, leukemia, lymphoma, or AIDS, also tend to have more aggressive tumors.

    Follow-up is essential after the treatment of SCC or any of its precursors. Even after the successful removal of an SCC, careful monitoring is important to determine whether or not the cancer has spread, and to monitor for development of a new skin cancer. Most doctors recommend follow-up every three to six months for the first two years after treatment. After that, the risk of metastasis is much lower, but close monitoring should be maintained. Individuals who have had actinic keratosis or skin cancer are at increased risk for developing further skin cancers.

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