John R. Tkach, M.D.
300 North Willson, Suite 203B
Bozeman, MT 59715
(406) 587-5442

Squamous Cell Carcinoma (Skin Cancer)

Patient Information Sheet

Squamous Cell Skin Cancer is a form of cancer. That's the bad news. The good news is this. Most of the time, if caught and treated early, it is relatively easy to treat with simple surgical excision. People who get Squamous Cell Skin Cancer are also likely to have had Basal Cell Skin Cancer.

Squamous Cell Skin Cancer is the more serious of the two. If left untreated, about 35% or can spread to other areas of the body. Since 1972, I have seen only two people die of metastatic Squamous Cell Skin Cancer. Both were elderly. One man was a farmer with Squamous Cell Skin Cancer on his left ear. It invaded down into the lymph nodes of is neck. The other was a demented lady who had let her cancer on the back of her neck go for 7 years or more. She did not have good support from her family. Radiation therapy and chemotherapy did not save them.

Squamous Cell Cancer is the second most common skin cancer in the U.S. after Basal Cell Skin Cancer. The Skin cancer Foundation estimates that there will be 250,000 cases of Squamous Cell Cancer in the U.S. this year. It has become so common that there is no longer a requirement to report it to the tumor registry.

Normally, the skin grows from a row of cells called the Basal Cell layer of the epidermis. They move outward growing into squamous cells, and undergo some chemical and structural changes, die, and form a protective outer layer of dead skin. This is gradually worn away in such a manner that we do not notice it. It takes about 1 month for a cell to move from the basal layer to the outer dead layer and to be shed.

In Squamous Cell Skin Cancer, the squamous cells have been damaged by the sun or other unknown factors and become malignant. Genes like p53 and other may play a role. I do not think this whole process is fully understood yet.

Sometimes Squamous Cell Skin Cancer begins as a red scaly rash-like spot. It persists. It gets larger and more irritated. It is usually an individual spot. Rarely people will get two Squamous Cell Skin Cancers starting at the same time.

After about 4 months, Squamous Cell Skin Cancer may start to ulcerate and bleed. It bleeds especially after being rubbed with a washcloth. Usually, they become fairly obvious within 6 months. In over 90% of cases, Squamous Cell Skin Cancer is relatively easy to treat if caught early. That's where you and I must work together. It is hard for either of us to do it alone. The sooner Squamous Cell Skin Cancer is treated, the better the result.

Treatment Options

I want to stress that Squamous Cell Skin Cancer is a cancer. It must be treated. It is especially bad to let it go untreated on the eyelid, near the eyes, the ear, and on the nose.

  1. No treatment- this is a mistake.
  2. Excision and suture- most of the time this is the best approach.
  3. Tangential excision followed by electrodesiccation and curettage- You will hear about this, but I do not recommend it for Squamous Cell Skin Cancer. I think people better results with other surgical forms of treatment.
  4. Radiation treatment- I have never seen good results with this treatment of Squamous Cell Skin Cancer. However, some radiation oncologists tell me they have had good results. The official word is that it is 85-95% likely to work.
  5. Liquid Nitrogen- this in inadequate treatment for Squamous Cell Skin Cancer. If an actinic keratosis fails to go away with this treatment, consider the possibility that it is Squamous Cell Skin Cancer and not an actinic keratosis. It may need excision.
  6. Topical 5-fluorouracil cream- is less effective than surgery, but occasionally works well for very superficial Squamous Cell Skin Cancer called Squamous Cell Skin Cancer in situ or Bowen's disease.
  7. Topical Aldara (imiquimod) cream- The reliability of this as a primary treatment has not been established, but it is an appealing approach for very superficial Squamous Cell Skin Cancer or Bowen's disease. It is thought to stimulate the immune system to fight off the cancer, but it may also push the cancer cells into programmed cell death (apoptosis). About 20% of people lack a genetic requirement such as a "Toll 7" receptor. It does not work for them.
  8. Mohs Micrographic Surgery- This is a microscopically, precisely controlled way to remove large and difficult skin cancers. Over the past 20 years, I have seen this specialty grow. In many situations, it is the best treatment. It is never the wrong thing to do.
    The surgeon removes the cancer. He/she marks the outer margins in such a way that 99% to 100 % of the margins can be seen under the microscope. If there is a little cancer left in one spot, the surgeon can remove just that smaller area instead of making a much larger excision. Mohs surgeons call their technique "tissue sparing."
    In Montana, our most highly trained and experienced Mohs surgeons are in Billings at the Billings Clinic. I have been referring patients there 20 years.

Follow Up Visits

While the probability of cure from simple office surgery is very high, it is not 100%. Therefore follow up visits to check for recurrence of cancer are essential. The initial follow up visit is in 3-4 months. If the scar looks OK, follow up visits are then once a year. These visits may seem like a waste of time and money to you, but I assure you they are absolutely necessary if you have had a Squamous Cell Skin Cancer.

In my series of patients, the first follow up visit is the most important. If you make it past 3-4 months without a recurrence, the chances are high that the Squamous Cell Skin Cancer was cured. If we look at thousands of patients of hundreds of doctors (reports of large series), the first 2 years are the important time span. In such series, 75% of recurrences occur in the first 2 years. After the first occurrence of Squamous cell cancer, there is 35% probability of getting a second Squamous cell cancer (not necessarily in the same spot) within five years. It's just hard to see some areas yourself. Also, sometimes Squamous Cell Cancer looks so innocent, it is hard to recognize. So, you can see that the follow up visits are very important.

I suspect that a Squamous Cell Skin Cancer recurring after seeming to be gone is usually actually a new cancer not a recurrence. Some people just seem to have certain areas that are prone to Squamous Cell Skin Cancer. This is another reason follow up visits are important.

Prevention: The most important and effective thing you can do is to protect your skin from the sun by leaving protective clothing, avoiding sunburns, and by using sunscreen. One of the nicest sunscreens I have found is Neutrogena Ultra Sheer Dry-Touch SPF 100.

Learn more about skin cancer on the Skin Cancer Foundation web site.

The information provided in these patient information sheets is offered for general informational and educational purposes only; it is not offered as and does not constitute medical advice. In no way are any of the materials presented meant to be a substitute for professional medical care or attention by a qualified practitioner, nor should they be construed as such.

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