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Squamous Cell Carcinoma. The Second Most Common Malignant Skin Lesion



Of the 3 types of skin cancer, squamous cell carcinoma (SCC) is a malignant cancer with a twist. It develops from precancerous conditions such as Bowen's Disease, Actinic Keratosis, Actinic Cheilitis and Leukoplakia.

It doesn't just affect the outer most layer of the skin, but also in the tissues that surround the internal organs (endothelium). That means SCC is not just limited to presenting as a typical skin cancer as it can develop inside the mouth, windpipe (esophagus), bladder and tubes involved in the elimination of urine (urinary tract), prostate gland in men, lungs and genitals. However, the most common areas are those that have been over-exposed to the sun for example, top of the ear, lower lip (gets more sun than the top lip), face, scalp (especially if bald), neck, arms, legs and peripherals.

Squamous Cell Carcinoma

Squamous skin cancer is mainly caused by excessive UV radiation that damages and changes the genetic material within the skin cells (DNA), eventually forming a squamous tumor. These skin lesions can look like raised bumps or nodules or may look like painful, scaly and crusty red patches that commonly become ulcerated. It is unusual for someone in their 50's to develop a skin lesion as it mainly affects adults in the 70+ age range, that have skin that sunburns easily, lighter hair colour and lighter eye colour (light green & grey). It is also more prevalent in men.

For squamous cell carcinoma to affect someone in the younger age range, it is suspected that other factors may have occured -

  1. Long term damage and over-exposure from UV rays from either direct sunlight, tanning beds or medical x-rays.

  2. Exposure to cancer-causing (carcinogenic) chemicals such as (but not limited to) arsenic, tar and ash.

  3. Damaged Immune System (immune system suppression) eg, transplant anti-regection drugs or from HIV.

  4. Chronic ulcers that do not heal and areas of major scarring.

  5. HPV (human papillomavirus/wart virus) that is responsible for cervical cancer is also a risk factor and normally affects the fingers and anogenital area (also the throat (oropharynx) and lungs).

Typically an early squamous cell carcinoma can go unnoticed as there are few symptoms other than slight itching maybe, or the area may feel scaly and raised. If the skin lesion is on the lip though, you may experience intermittent bleeding as it fails to heal.

The good news is that a squamous cell carcinoma is easily treated if caught early. The method of treatment is fairy dependant on the size of the skin lesion, its location on the body and how deep it has penetrated. Common methods of removal are -

  1. CRYOSURGERY - Freezing with liquid nitrogen if it is a low risk carcinoma.

  2. ELECTRODESSICATION & CURETTAGE - During this procedure, the surgeon gently peels away cancer cells from the affected area with an instrument known as a curette. Then, a fine electrical needle is used to destroy the remaining cancer cells by dessication (drying up). It is possible that this method may leave a scar.

  3. SURGERY - Most commonly the carcinoma is removed by surgery which is an effective method if it has penetrated deeply. Once it is removed, the skin is brought together and stitched or stapled.

  4. MOHS SURGERY - This technique can be used on delicate areas such as the nose, eye, ears and lips where tiny layers of skin are removed one by one, until the cancer cells are cleared.

  5. RADIOTHERAPY - Occasionally, if your general health is not one hundred percent, the remaining option may be radiotherapy.


Summary

Squamous cell carcinoma are generally symptom free. A squamous tumor ranges in appearance, from red scaly patch to a painful ulcer. Tumors usually appear on areas exposed to extreme UV damage. SCC's grow quite slowly but can spread to other organs if left untreated. Lesions on the lower lip often arise due to smoking or alcohol. Risk of Sqamous Cell Carcinoma spreading is much higher if it has developed from a scar site or on the lower lip.



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