Squamous Cell Carcinoma

Cancer rates are on the rise worldwide, but not all forms of the disease are created equal. Squamous cell carcinoma (SCC), a type of skin cancer, is often overshadowed by its more notorious counterpart, melanoma. However, as the second most common form of skin cancer, SCC deserves our attention.

What is squamous cell carcinoma?

SCC originates in the squamous cells, which make up the outer layer of the skin and line various organs. These cells play a crucial role in protecting our bodies from environmental damage, but when they undergo malignant changes, they can lead to SCC.

Initially, SCC may appear as a small, firm, red nodule or a flat sore with a scaly crust. If left untreated, it can grow larger and invade nearby tissues, causing more severe health issues. It's important to note that while SCC is primarily associated with sun exposure, it can also develop in areas not commonly exposed to sunlight, such as the genital area or inside the mouth.

Early detection and treatment are critical for SCC. Regular skin checks and being aware of any changes in your skin can help catch this cancer in its early stages when it's most treatable.

Causes and risk factors

The primary cause of SCC is prolonged exposure to ultraviolet (UV) radiation from the sun or tanning beds. UV radiation can damage the DNA in skin cells, leading to uncontrolled cell growth and the development of cancerous cells.

In addition to UV exposure, several other factors increase the risk of developing SCC, including:

• Fair skin: Individuals with light skin, hair, and eyes have less melanin, which provides some protection against UV radiation. Consequently, they are at a higher risk of developing SCC.
• Age: The risk of SCC increases with age, likely due to accumulated sun exposure and the skin's decreasing ability to repair itself over time.
• Weakened immune system: People with weakened immune systems, such as organ transplant recipients or those with certain autoimmune disorders, are more susceptible to skin cancers like SCC.
• History of skin cancer: If you have previously had skin cancer, your risk of developing SCC increases.
• Chronic skin conditions: Conditions such as actinic keratosis (thick, scaly patches caused by sun damage) and certain genetic disorders can also heighten the risk of SCC.

Understanding these risk factors is crucial for prevention. Regular check-ups with a dermatologist and practicing sun safety can help reduce your chances of developing SCC.

Symptoms and types of squamous cell carcinoma

SCC can manifest in various ways, depending on its location and stage. The most common symptoms include:

• A firm, red nodule
• A flat sore with a scaly crust
• A new growth or a change in an existing mole
• A sore that bleeds or doesn't heal

These symptoms can occur on sun-exposed areas like the face, ears, neck, and hands, but they can also appear in areas not typically exposed to sunlight, such as the genitals or mouth.

There are several subtypes of SCC, each with unique characteristics:

• Keratinizing SCC: This is the most common form, originating from keratinocytes (cells that produce the protein keratin). It can be further categorized into well-differentiated, moderately differentiated, and poorly differentiated based on how much the cancer cells resemble normal keratinocytes.
• Non-keratinizing SCC: This subtype arises from squamous cells that do not produce keratin. It is often found in mucosal surfaces, such as the lining of the mouth and throat.
• Desmoplastic SCC: This rare subtype is characterized by a fibrous stroma (connective tissue) surrounding the tumor. It is often more aggressive and can be difficult to detect in its early stages.
• Invasive SCC: When SCC spreads beyond the original site into surrounding tissues, it is referred to as invasive SCC. This stage requires more aggressive treatment.

If you notice any of these symptoms, consult a healthcare professional. Early diagnosis and treatment are crucial for better outcomes.

Diagnosing squamous cell carcinoma

Diagnosing SCC typically involves a thorough examination by a healthcare professional, often a dermatologist. During the visit, the doctor will assess the skin, review the patient's medical history, and inquire about any concerning symptoms.

If SCC is suspected, a biopsy is usually performed. This involves removing a small sample of the affected skin and sending it to a laboratory for analysis. The lab will examine the sample under a microscope to confirm the presence of cancerous cells and determine the specific type of SCC.

In some cases, additional tests may be necessary to assess the extent of the cancer and whether it has spread to nearby lymph nodes or other organs. These tests may include imaging studies like X-rays, CT scans, or MRIs.

Early detection and accurate diagnosis are crucial for successful treatment. Regular skin checks and timely consultations with healthcare professionals can significantly improve the chances of identifying SCC in its early stages.

Treatment options for squamous cell carcinoma

The treatment for SCC largely depends on the size, location, depth, and whether it has spread to nearby tissues. Common treatment options include:

• Surgical excision: This involves removing the SCC along with a margin of healthy skin. The excised tissue is then examined to ensure all cancerous cells have been removed. This method is often effective for localized SCC and can minimize the risk of recurrence.
• Mohs micrographic surgery: This specialized surgical technique is particularly useful for SCCs located on the face, ears, and other sensitive areas. During Mohs surgery, thin layers of cancerous skin are removed and examined for cancer cells. This process continues until no more cancer cells are detected, ensuring complete removal while preserving as much healthy tissue as possible.
• Curettage and electrodessication: For superficial SCCs, curettage (scraping off the tumor) followed by electrodessication (using electrical currents to destroy remaining cancer cells) can be effective. This method is less invasive and often performed in outpatient settings.
• Radiation therapy: If SCC cannot be surgically removed or if the patient is not a candidate for surgery, radiation therapy may be recommended. This treatment uses high-energy X-rays or other particles to kill cancer cells and shrink tumors.
• Chemotherapy: In cases of advanced SCC that has spread beyond the skin, systemic chemotherapy may be considered. This treatment involves using drugs to target and kill cancer cells throughout the body.
• Immunotherapy: For patients with advanced SCC, immunotherapy drugs like pembrolizumab (Keytruda) and cemiplimab (Libtayo) can help the immune system recognize and attack cancer cells more effectively.
• Targeted therapy: Targeted therapies, such as vismodegib (Erivedge) and sonidegib (Odomzo), specifically target the molecular pathways involved in the growth of certain types of SCC, particularly basal cell carcinoma. These treatments may be an option for patients with advanced or metastatic SCC.

Managing squamous cell carcinoma

Living with SCC can be challenging, but several strategies can help manage the condition and improve quality of life:

• Regular follow-ups: After treatment, it's crucial to maintain regular follow-up appointments with healthcare providers. Monitoring for signs of recurrence or new skin cancers is essential for early intervention and effective management.
• Sun protection: Given that sun exposure is a major risk factor for SCC, it's vital to practice sun safety. This includes using broad-spectrum sunscreen with a high SPF, wearing protective clothing, and seeking shade during peak sun hours.
• Healthy lifestyle: Adopting a balanced diet, engaging in regular exercise, and avoiding tobacco can help boost the immune system and overall health. These lifestyle choices may also reduce the risk of developing other types of cancer.
• Support networks: Connecting with support groups, both in-person and online, can provide valuable emotional support and practical advice for managing SCC. Sharing experiences with others facing similar challenges can be empowering and reassuring.
• Pain management: For those experiencing discomfort due to SCC or its treatment, discussing pain management options with healthcare providers is essential. This may include medications, physical therapy, or alternative therapies like acupuncture.

Protecting yourself from squamous cell carcinoma

Many SCC cases are preventable through effective sun protection strategies. Consider the following tips to reduce your risk:

1. Use sunscreen with a high SPF and broad-spectrum protection
2. Wear protective clothing, including wide-brimmed hats and long-sleeved shirts
3. Seek shade during peak sun hours (10 am to 4 pm)
4. Avoid tanning beds
5. Stay vigilant and report any changes in your skin to a healthcare professional

By incorporating these practices into your daily routine, you can significantly lower your risk of developing SCC and other forms of skin cancer.

Conclusion

Squamous cell carcinoma may not be as widely recognized as other types of skin cancer, but its prevalence and potential consequences make it a significant public health concern. For the best skin cancer treatment in India, American Oncology Institute is recognized as the top multi-disciplinary oncology hospital known for its expertise and advanced care.