Squamous Cell Carcinoma
What is squamous cell carcinoma?
Squamous cell carcinoma (SCC) or cutaneous squamous cell carcinoma (CSCC) is the second most common form of skin cancer after basal cell carcinoma. It starts in squamous cells in the outer layer of your skin, the epidermis. Usually, squamous cell carcinomas form on areas of your skin that receive the most sun exposure like your head, arms and legs. Cancer can also form in areas of your body where you have mucous membranes, which are the inner lining of your organs and body cavities like in your mouth, lungs and anus.
What are the types of squamous cell carcinoma?
There are different types of squamous cell carcinoma based on where and how much cancer is in your body:
- Cutaneous: Cancer that only affects the top layer of your skin (in situ) or cancer that’s spread beyond the top layer of your skin.
- Metastatic: Cancer that’s spread to other parts of your body beyond your skin.
Who does squamous cell carcinoma affect?
Squamous cell carcinoma can affect anyone. You’re most at risk if you:
- Have long-term sun exposure or sun damage to your skin at a young age.
- Have a pale complexion, blue or green eyes, blonde or red hair.
- Are 65 years of age or older.
- Have a weak immune system or received an organ transplant.
- Had chemical exposure (cigarettes, arsenic).
People assigned male at birth (AMAB) are about two times more likely to develop squamous cell carcinoma. People over the age of 50 are most likely to get SCCs, but the incidence has been rising in people younger than 50.
How common is squamous cell carcinoma?
Over 1 million people receive a squamous cell carcinoma diagnosis in the U.S. each year. The rate of SCC has risen about 200% over the past 30 years.
Symptoms and Causes
What are the symptoms of squamous cell carcinoma?
Symptoms of squamous cell carcinoma include skin changes like:
- A rough-feeling, bump or growth, which might crust over like a scab and bleed.
- A growth that’s higher than the skin around it but sinks down (depression) in the middle.
- A wound or sore that won’t heal, or a sore that heals and then comes back.
- An area of skin that’s flat, scaly and red that’s larger, about 1 inch (2.5 centimeters).
What are the signs of squamous cell carcinoma?
There are cancerous bumps, marks or lesions that form on your skin that can be a sign of squamous cell carcinoma, including:
- A bump or lump that can feel dry, itchy, scaly or have a different color from the skin around it (actinic keratosis).
- A lesion on your lower lip where the tissue becomes pale, dry and cracked (cheilitis). This may have a burning sensation when you’re exposed to the sun.
- White or pale spots in your mouth, on your tongue, gums or cheeks (leukoplakia).
Where on my body can I get squamous cell carcinoma?
You can have squamous cell carcinoma on any part of your body, but it’s most common on your:
- Mouth, tongue and throat (oral carcinoma).
- Face, lips, nose, ears, eyelids and scalp.
- Stomach (esophageal or epidermoid carcinoma).
- Hands, arms and legs.
- Anal cavity.
What causes squamous cell carcinoma?
A mutation to the p53 gene causes squamous cell carcinoma. The most common way that your p53 gene mutates is from ultraviolet (UV) exposure from the sun, or from using indoor tanning beds.
The p53 gene provides instructions for your cells to divide and replicate to replace cells when they reach the end of their lifespan. Your p53 gene is a tumor suppressor, which means that the gene controls how much and how often your cells should create new cells. Too many cells create tumors, which can be cancerous.
A mutation to the p53 gene means that your cells don’t have the instructions they need to do their job correctly. As a result, your squamous cells divide and replicate too often, causing tumors (bumps, lumps or lesions) to form in and on your body.
Does squamous cell carcinoma spread?
Cutaneous squamous cell carcinoma rarely spreads to other parts of your body (metastasize). If this does happen, it occurs slowly and can be life-threatening if left untreated. If you notice changes to your skin, contact your healthcare provider immediately.
Diagnosis and Tests
How is squamous cell carcinoma diagnosed?
Your healthcare provider will physically examine the area of your body where you have symptoms, looking specifically at the size, shape and location of the lump or lesion. Your healthcare provider will also ask questions to learn more about your medical history and your symptoms, which could include:
- When did you notice the lump or lesion on your skin?
- Did this lump change in size from when you first noticed symptoms?
- Is it painful or itchy?
What tests diagnose squamous cell carcinoma?
After your physical exam, your healthcare provider might offer tests to confirm a diagnosis, which could include:
- Skin biopsy: Removing a small sample of the affected tissue to examine it under a microscope.
- Imaging tests (CT scan or MRI): Your healthcare provider will use an imaging test to identify the size of your carcinoma underneath your skin and to see if it spread to other parts of your body, especially your lymph nodes.
What are the stages of squamous cell carcinoma?
Your healthcare provider will assign a stage to your diagnosis to identify how much cancer is in your body. Stages help them choose the treatment that’s right for you. There are five stages of squamous cell carcinoma:
- Stage 0: Cancer is only in the top layer of your skin (epidermis). This is also called squamous cell carcinoma in situ.
- Stage I (1): Cancer is in the top and middle layers of your skin (epidermis and dermis).
- Stage II (2): Cancer is in the top and middle layers of your skin and moves to target your nerves or deeper layers of skin (epidermis, dermis and subcutis).
- Stage III (3): Cancer has spread beyond your skin to your lymph nodes.
- Stage IIIV (4): Cancer has spread to other parts of your body and your organs like your liver, lungs or brain.
Management and Treatment
How is squamous cell carcinoma treated?
Treatment for squamous cell carcinoma focuses on removing cancer from your body. Your treatment options vary based on the size, shape and location of your cancer and could include:
- Cryosurgery: Freezing the cancer cells to destroy them.
- Photodynamic therapy (PDT): Using blue light and light-sensitive agents to remove cancer from your skin.
- Curettage and electrodesiccation: Scratching off the cancerous lump with a spoon-like instrument (curette), then burning the area with an electric needle.
- Excision: Cutting the cancer out of your skin and stitching your skin back together.
- Mohs surgery: Removing layers of skin affected by cancer, most common for facial cancers.
- Systemic chemotherapy: Using powerful medicines to destroy cancer cells in your body.
What medications treat squamous cell carcinoma?
If you have invasive squamous cell carcinoma or if treatment to remove your cancer surgically isn’t right for you, your healthcare provider could offer medicine to treat your diagnosis. Medicines could include:
- Skin creams containing imiquimod or 5-fluorouracil help treat squamous cell carcinoma that’s in the top layer of your skin (epidermis).
- Cemiplimab-rwlc (Libtayo®) is immunotherapy to treat advanced forms of squamous cell carcinoma.
- Pembrolizumab (Keytruda®) is immunotherapy to treat squamous cell carcinoma that isn’t treatable with surgery.
What are the side effects of the treatments for squamous cell carcinoma?
The most common side effect of squamous cell carcinoma treatment is cosmetic changes to your skin, like scarring, after your healthcare provider removes the cancer from your body.
If you take immunotherapy drugs to treat your cancer, talk to your healthcare provider about the side effects of the drugs.
How soon after treatment will I feel better?
The amount of time your body needs to heal after treatment varies for each person. The size shape and location also affect your healing time after treatment. On average, most people will recover within two to four weeks after treatment to remove cancer from their body. Your healthcare provider will meet with you a few weeks after treatment to make sure your body is healing properly and to make sure treatment was successful at removing cancer.
How can I prevent squamous cell carcinoma?
While you can’t prevent all types of squamous cell carcinoma, you can take steps to reduce your risk by:
- Avoiding excessive sun exposure.
- Avoid using tanning beds.
- Using sunscreen when you’re outdoors.
- Wearing protective clothing and accessories from the sun, including sunglasses, hats and clothing with UPF protection.
- Stopping smoking.
- Avoid exposing yourself to chemicals without wearing personal protective equipment.
If you notice changes to your skin, contact your healthcare provider or visit a dermatologist for a professional skin exam.
Outlook / Prognosis
What can I expect if I have squamous cell carcinoma?
Most cases of squamous cell carcinoma have a positive prognosis and an excellent survival rate if you receive an early diagnosis. Early detection and treatment prevent the tumor from growing and damaging other parts of your body.
If your healthcare provider removes your cancer, there’s a chance it can return in the future. Make sure to follow up with your healthcare provider to verify you’re cancer-free. It’s also important to protect your skin from UV rays when outdoors.
When should I see my healthcare provider?
Contact your healthcare provider if:
- You have any skin changes that worry you, including a new lump, mole or a sore that doesn’t heal, or changes to a mole or spot you’ve had for some time.
- You need to schedule your annual skin check appointment with your dermatologist.
- You have any side effects or complications related to your treatment for squamous cell carcinoma, like pain, bleeding or itching.
What questions should I ask my doctor?
- What stage of squamous cell carcinoma do I have?
- Do I need surgery to remove cancer from my body?
- Do I need to see a dermatologist?
- Are there side effects to the treatment?
Frequently Asked Questions
What is the difference between squamous cell carcinoma and basal cell carcinoma?
Both squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) are types of skin cancer that you can get from too much sun (ultraviolet ray) exposure. An overproduction of either squamous or basal cells causes both conditions. Squamous cell carcinomas can form on your skin (epidermis) in the same way BCC does, but SCC can also form where you have mucus membranes on your body, which includes the inside of your mouth, throat, lungs and genitals.
What is squamous cell carcinoma in situ?
Squamous cell carcinoma in situ is also known as Bowen disease. The term “in situ” means that the cancer cells are only in the top layer of your skin (epidermis). The most common places to find Bowen disease is on sun-exposed areas of your skin, but the condition can also appear on the skin near your anal cavity and genitals, like on your labia or vulva (vulvar cancer).
A note from Cleveland Clinic
It can be scary finding a new lump on your skin that leads to a cancer diagnosis. But treatment for squamous cell carcinoma is effective at removing cancer from your body. Take steps to prevent squamous cell carcinoma by protecting yourself from the sun’s UV rays. Call your healthcare provider if you find any new lumps or bumps on your skin, and get them examined and treated immediately.
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