From the Guidelines
The most effective treatment for well-differentiated squamous cell carcinoma of the skin on the face is Mohs micrographic surgery (MMS), which offers the highest cure rates and preserves the maximum amount of healthy tissue. This recommendation is based on the guidelines of care for the management of cutaneous squamous cell carcinoma, which suggest that MMS is the preferred treatment for high-risk cSCC, including those located on the face 1. The use of MMS has been shown to result in lower recurrence rates compared to other treatment modalities, such as standard excision and radiation therapy 1.
Key Considerations
- MMS is particularly useful for tumors with high-risk features, such as large size, poor differentiation, and perineural invasion 1.
- The procedure involves meticulous and complete margin assessment, which is essential for ensuring the removal of all cancerous tissue 1.
- While MMS has several advantages, it may not be suitable for all patients, particularly those with aggressive histopathologic growth patterns that are poorly visualized with frozen sections 1.
Alternative Treatment Options
- Standard surgical excision with margins of 4-6mm may be considered for well-differentiated tumors, although this approach may result in higher recurrence rates compared to MMS 1.
- Radiation therapy may be used as an alternative for patients who cannot undergo surgery or as adjuvant therapy for high-risk features, although it is generally avoided in younger patients due to long-term cosmetic concerns.
Post-Treatment Follow-Up
- Patients with a history of SCC should be followed up regularly, every 3-6 months for the first 2 years, and then annually, due to the high risk of developing another skin cancer within 5 years 1.
- Prevention strategies, such as regular use of broad-spectrum sunscreen, protective clothing, and regular skin self-examinations, should be emphasized to reduce the risk of future skin cancers.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Workup of Well-Differentiated Squamous Cell Carcinoma of Skin on Face
- The diagnosis of cutaneous squamous cell carcinoma (cSCC) is primarily based on clinical features 2
- A biopsy or excision and histologic confirmation should be performed in all clinically suspicious lesions to facilitate the prognostic classification and correct management of cSCC 2
- Lymph node ultrasound is highly recommended, particularly in tumours with high-risk characteristics 2
- In the case of clinical suspicion or positive findings upon imaging, a histologic confirmation should be sought either by fine needle aspiration or by open lymph node biopsy 2
- Additional imaging tests, such as CT or MRI imaging, may be required to accurately assess the extent of the tumour and the presence of metastatic spread in large infiltrating tumours with signs of involvement of underlying structures 2
Management of Well-Differentiated Squamous Cell Carcinoma of Skin on Face
- The first line treatment of cutaneous SCC is complete surgical excision with histopathological control of excision margins 2
- A standardised minimal margin of 5 mm is recommended even for low-risk tumours, while an extended margin of 10 mm is recommended for tumours with high-risk pathological features 2
- Mohs micrographic surgery offers the highest cure rates for high-risk SCCs and is particularly useful for SCCs on challenging anatomic sites 3
- Radiation therapy represents a fair alternative to surgery in the non-surgical treatment of small cSCCs in low risk areas 2
- Nonexcisional treatment modalities, such as electrodessication and cryotherapy, in combination with curettage, are effective in treating superficially invasive and in situ squamous cell carcinoma 4
- Topical imiquimod or fluorouracil therapy can be used to treat basal and squamous cell carcinoma, but their use should be limited to patients with small tumors in low-risk locations who will not or cannot undergo treatment with better-established therapies 5