From the Guidelines
Suspected squamous cell carcinoma should generally not be removed in primary care. The recommended approach is to refer patients with suspected squamous cell carcinoma to a dermatologist or specialist for proper evaluation, biopsy, and treatment 1. While some primary care physicians with specialized training and experience may perform biopsies of suspicious lesions, complete removal of squamous cell carcinoma typically requires specialized techniques such as Mohs micrographic surgery, excision with appropriate margins, or other modalities like radiation therapy depending on the size, location, and characteristics of the tumor.
According to the guidelines of care for the management of cutaneous squamous cell carcinoma, standard excision with a 4‑to 6‑mm margin of uninvolved skin around the tumor and/or biopsy site to a depth of the mid‑subcutaneous adipose tissue with histologic margin assessment is recommended for low‑risk primary cSCC 1. However, this procedure is best performed by specialists who can ensure complete removal while minimizing recurrence risk and preserving function and cosmetic outcomes.
Primary care physicians play a crucial role in early detection, risk assessment, and appropriate referral, but definitive treatment is best handled by specialists who can determine the most appropriate treatment approach based on tumor characteristics, patient factors, and follow-up requirements. The British Association of Dermatologists' guidelines for the care of patients with actinic keratosis also support referral to specialist care when lesions are likely to be squamous cell carcinoma, such as when they are bleeding, painful, or thickened 1.
Key considerations for referral include:
- Lesions that are likely to be squamous cell carcinoma
- Lesions that are bleeding, painful, or thickened
- Multiple or relapsing lesions
- Lesions in immunosuppressed patients
- Lesions that fail to respond to standard treatments.
In summary, referral to a specialist is the recommended approach for suspected squamous cell carcinoma, rather than removal in primary care, to ensure optimal outcomes and minimize recurrence risk 1.
From the Research
Suspected Squamous Cell Carcinoma Removal in Primary Care
- The removal of suspected squamous cell carcinoma in primary care is a complex issue, and the available evidence does not provide a clear answer 2, 3, 4, 5, 6.
- Histopathology and correct surgical excision remain the gold standard for the diagnosis and treatment of squamous cell carcinoma, but this is typically performed in a specialist setting rather than primary care 2.
- There are various treatment options available for squamous cell carcinoma in situ, including surgical and non-surgical methods, but the evidence does not suggest that these can be easily performed in primary care 3.
- The diagnosis of cutaneous squamous cell carcinoma usually involves clinical manifestations and dermoscopic features, with biopsy and histopathology used to confirm the diagnosis, which may not be feasible in primary care 5.
- Imaging plays a central role in the staging of the disease, but its exact role in primary care is not fully clarified 5.
- The American Society of Clinical Oncology has developed guidelines for the diagnosis and management of squamous cell carcinoma of unknown primary in the head and neck, but these are focused on specialist care rather than primary care 6.