Squamous Cell Carcinoma

What is Squamous cell carcinoma?

A squamous cell carcinoma or squamous cell cancer is the second most common type of skin cancer. Squamous cell cancer develops in the squamous cells that make up the middle and outer layers of the skin. Squamous cell carcinoma (SCC) is a slow-growing cancer of the skin and is not life-threatening. But it is very aggressive and it can spread to other tissues, bones, and nearby lymph nodes, where it may cause serious complications.

Squamous cell carcinomas of the skin result from prolonged exposure to ultraviolet (UV) radiation. This form of skin cancer often affects the face, nose, ears, lips, shoulders, scalp, back of the hands, lower legs, and chest area. Avoiding UV light helps reduce the risk of squamous cell carcinoma.

Basal cell carcinoma most often occurs on sun-exposed skin, such as the scalp, the backs of hands, ears, lips, face, neck, and shoulders. But SCC can occur anywhere on your body, including inside your mouth, the bottoms of your feet, and on your genitals.

Symptoms of Squamous cell carcinoma of the skin

Squamous cell carcinoma (SCC) can vary in its appearance, but most usually appear as:

  1. A red, raised patch
  2. Dome-shaped bump
  3. A firm, red nodule
  4. A rough, scaly patch on the lip
  5. They can appear as an ulcer.
  6. SCCs can be sore or tender
  7. The new sore or raised area on an old scar
  8. Flat sore with a scaly crust
  9. Sore with a red, inflamed base
  10. Rough patch or red sore inside the mouth
  11. The scaly or crusty raised area of skin
  12. Wartlike sore on or in the anus or on your genitals

Cause of Squamous cell carcinoma

The main cause is too much exposure to ultraviolet light from the sun or other sources. This changes the DNA of skin cells keratinocytes in the outer layer of the skin. DNA mutation leads to unchecked growth of skin cells thus causing SCC. Ultraviolet light damage can cause SCC directly. Bowen’s disease and actinic keratosis may also be caused due to UV radiation exposure. These can change into SCC if they are not treated.

Squamous Cell Carcinoma and Mohs Sugery
Squamous cell carcinoma and Mohs Surgery

Risk Factors of Squamous cell carcinoma

The following groups of people are at greater risk of developing SCC:

(1) Age:

Older age people are more likely to develop SCC.

(2) Gender:

Males have a greater risk of developing squamous cell carcinoma.

(3) Family History:

A family history of skin cancer may also be a risk factor. Congenital nevi (moles present at birth) may also develop into SCC.

(4) Use of tanning beds:

The use of indoor tanning beds increases the risk of squamous cell carcinoma (SCC). Tanning beds and bulbs are dangerous to the skin.

(5) Exposure to Chemicals:

  1. Long-term exposure to chemicals such as arsenic in the water
  2. Exposure to coal tar
  3. Exposure to industrial compounds
  4. Use of tobacco

(6) Personal history of precancerous skin lesions:

Having the following conditions increases your risk of squamous cell carcinoma of the skin:

  • A history of sunburns
  • Actinic keratosis
  • Bowen’s disease
  • Precancerous skin lesions

(7) Previous history of skin cancer:

If you’ve had a previous diagnosis of skin cancer (of any type), then you are much more likely to develop it again.

Having one or more blistering sunburns as a child or teenager increases your risk of developing squamous cell carcinoma

(8) Fair Skin:

If you have the following conditions then there is an increased chance of developing squamous cell carcinoma:

  1. Albinism
  2. Fair-skin
  3. Blonde or red hair
  4. Dysplastic nevi (atypical moles)
  5. Xeroderma pigmentosum
  6. If you freckle or sunburn easily
  7. Having less pigment (melanin) in your skin
  8. Light-colored or blue, green, or gray eyes

(9) Weakened immune system:

The following people have an increased risk of skin cancer:

  1. People with weakened immune systems
  2. Patients who have undergone organ transplants
  3. People who take medications that suppress the immune system
  4. People with reduced immune systems (Immunosuppressed individuals)
  5. Patients with Inherited diseases of the immune system or acquired conditions

(10) Inherited DNA conditions / Rare genetic disorders:

  • HIV or AIDS
  • Bowen’s disease diagnosis
  • Human papillomavirus (HPV) infection
  • People who have leukemia or lymphoma
  • People with xeroderma pigmentosum which causes extreme sensitivity to sunlight
  • Certain human viral wart viruses can also be a risk factor.

(11) Excessive sun exposure:

Exposure to UV light from the sun increases the risk of developing squamous cell carcinoma of the skin. Squamous cell cancer of the skin is prevalent in the following:

  1. People who live in countries near to the equator
  2. People who spend a lot of time in the sun
  3. Repeated exposure to radiation
  4. Outdoor workers, such as builders, farmers
  5. Who doesn’t cover the skin with clothing or sunblock
  6. People who have had a lifetime of frequent sun exposure
  7. Spend time outside; exposed to the Ultra Violet Rays
  8. People who have had significant cumulative ultraviolet light exposure
  9. Military personnel, construction workers who work in a harsh sunny environment

Cure Of Squamous cell carcinoma

Squamous cell carcinoma of the skin is usually not life-threatening. It can be cured when found and treated early. About 95-98 percent of squamous cell carcinomas can be cured if they are treated early. It can be aggressive and if left untreated, squamous cell carcinoma can grow large or spread to other parts of your body. There are several effective treatments to cure an SCC that has not spread.

Prevention of squamous cell carcinomas of the skin

Most squamous cell carcinomas of the skin can be prevented. To protect yourself from SCC, you must:

  • (1) Spend time in the shade
  • (2) Wear protective clothing
  • (3) Reduce ultraviolet exposure
  • (4) Examine your skin often for new skin growths
  • (5) Keep babies and young children out of direct sunlight
  • (6) Protect your skin with dark tightly woven clothing
  • (7) With the help of mirrors, check your face, neck, ears, and scalp
  • (8) Use a broad-brimmed hat that protects your face, neck, and ears
  • (9) Examine any changes in existing moles, freckles, bumps, and birthmarks
  • (10) Also examine your genital area and between your buttocks with the help of a mirror
  • (11) Apply plenty of sunscreen 15 to 30 minutes before going out in the sun
  • (12) Check your skin regularly and examine changes if any
  • (13) Use sunglasses that block both types of UV radiation — UVA and UVB rays
  • (14) Avoid the sun during the middle of the day between about 10 a.m. and 3 p.m.
  • (15) Avoiding sunlight can reduce Vitamin D levels so take Vitamin D supplement tablets
  • (16) Tanning beds emit UV rays and can increase your risk of skin cancer so avoid tanning beds
  • (17) For people in North America, the sun’s rays are strongest so schedule outdoor activities for other times of the day
  • (18) Treat actinic keratosis and Bowen’s disease if you have any, as these diseases increase the risk of squamous cell carcinoma
  • (19) Use sunglasses with a high protection SPF (SPF 30 or more) to protect against UVB, and the UVA circle logo and/or 4 or 5 UVA stars to protect against UVA.

Are squamous cell carcinomas hereditary?

Is squamous cell cancer inherited?

No, they are not hereditary, but some of the risk factors, such as sunburn, are inherited. Many other hereditary diseases and genes are also associated with an increased risk of squamous cell carcinomas.

Conversion of squamous cell cancer into melanoma

The majority of skin cancers are basal cell carcinomas and squamous cells carcinomas that are unlikely to spread to other organs of the body. However, malignant melanoma tends to spread to other parts of the body. These cancers may be fatal if not treated in the early stages.

The danger of squamous cell carcinoma

If squamous cell carcinoma is found in its early stages then it can be cured easily. Cutaneous squamous cell carcinomas are easily treated surgically. Risky squamous cell cancers of the skin can kill. About 2% of people with squamous cell cancer die because of it.

Squamous cell cancer can be aggressive when it is metastasized. It can invade deeper layers of skin, nerves, blood vessels, and surrounding lymph nodes. This cancer can spread if left untreated, especially in people who have a weak immune system. Untreated squamous cell carcinoma of the skin can destroy nearby healthy tissue.

Squamous Cell Carcinoma Survival Rate

The squamous cell carcinoma survival rate is very high. The sex and age of the patients don’t influence survival significantly. Even if cancer has spread to nearby lymph nodes, it may be effectively treated through a combination of therapy (surgery and radiation). Once squamous cell carcinoma has spread beyond the skin, less than half of people live five years.

The 5-year survival rates for patients are:

  1. Stage I disease = 62%
  2. Stage II disease = 80%
  3. Stage III disease = 42%
  4. Stage IV disease = 19%

Growth of squamous cell carcinoma

Squamous Cell Carcinoma (SCC) is generally a slow-growing tumor and grows without showing any physical symptoms. However, some forms of SCC cancer may be fast-growing, when the lesions are large especially. They may bleed and cause irritation or discomfort.

Itching nature of Squamous cell carcinoma

There is a general complaint among skin cancer patients that skin cancer itches.

The prevalence of itching with squamous cell carcinoma is 46.6% which is the highest among other types of skin cancers.

Pain is a common feature of cancer with an estimated prevalence rate of 52% to 77%. Fatigue, tiredness, weakness, or exhausting feelings, affects most people during cancer treatment. Squamous cell carcinomas may appear as flat reddish or brownish patches in the skin that might be painless or cause pain. They also cause pain when bleeding.

Spreading of Squamous cell carcinoma:

If you are suffering from SCC, your healthcare provider may recommend tests or imaging such as CT or PET-CT scan. Your doctor may test lymph nodes near the tumor to see if cancer has spread beyond the skin.

SCC occurs on skin that is exposed to sunlight or other UV radiation. The earliest form of squamous cell cancer is called Bowen disease (or squamous cell carcinoma in situ). Squamous cell carcinoma in situ does not spread to surrounding tissues, as it is still in the outermost layer of the skin.

Stages of squamous cell carcinoma

Squamous cell carcinoma is usually very slow to metastasize. Squamous cell carcinoma stages represent the size of a tumor and how far it has spread. If an SCC does require staging, oncologists will evaluate several factors. The characteristics and stages of squamous cell cancer include:

  1. The size of the tumor such as greater than 2 mm in thickness
  2. Whether cancer has spread to lymph nodes or distant organs
  3. Invasion into the tiny nerves in the skin
  4. Whether cancer has invaded the bones
  5. How the cells appear when viewed under a microscope
  6. Location whether it developed on an ear or lip, making it a high-risk lesion
  7. Whether the tumor has invaded the dermis or subcutis layers of the skin

Stage 0 squamous cell carcinoma of the skin

  1. Cancer is only present in the epidermis.
  2. It is called carcinoma in situ.
  3. It has not spread deeper to the dermis.
  4. Stage 0 Cancer is only present on the top layer of the skin.

Stage I (stage 1 squamous cell carcinoma)

  1. Stage 1 Cancer has grown deep into the skin but has not spread to nearby lymph nodes.
  2. It has one or fewer high-risk features.
  3. The cancer is less than 2 centimeters, about 4/5 of an inch across.

Stage II (stage 2 squamous cell carcinoma)

  1. Stage 2 Cancer has grown deep into the skin and displays one or more high-risk features.
  2. It has not spread to nearby lymph nodes or healthy tissues.
  3. The cancer is larger than 2 centimeters across.

Stage III (stage 3 squamous cell carcinoma)

  1. Stage 3 Cancer has grown into lymph nodes but has not spread to any organs other than the skin.
  2. Cancer has spread into facial bones or 1 nearby lymph node, but not to other organs.

Stage IV (stage 4 squamous cell carcinoma)

  1. Stage 4 – Cancer has spread into distant parts of the skin.
  2. Cancer can be any size.
  3. It may also have spread to bones or other organs in the body.
  4. Cancer has spread (metastasized) to 1 or more lymph nodes that are larger than 3 cm.
  5. Stage 4 squamous cell carcinoma cancer has spread to one or more distant organs, such as the lungs, liver, and brain.

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