From the Guidelines
Squamous cell carcinoma (SCC) is a common type of skin cancer that develops in the squamous cells, which are flat cells that make up the outer layer of the skin, primarily caused by cumulative ultraviolet (UV) radiation exposure from the sun or tanning beds, as stated in the guidelines of care for the management of cutaneous squamous cell carcinoma 1.
Definition and Causes
SCC typically appears as a firm, red nodule or a flat lesion with a scaly, crusted surface, commonly on sun-exposed areas like the face, ears, neck, hands, and arms. The guidelines highlight that cumulative sun exposure, especially in childhood and youth, is of greatest importance in increasing the risk for cSCC 1.
Treatment and Prevention
Treatment options include surgical excision, Mohs surgery, radiation therapy, cryotherapy, or topical medications like 5-fluorouracil or imiquimod, depending on the tumor's size, location, and aggressiveness, as discussed in the guidelines of care for the management of cutaneous squamous cell carcinoma 1. Prevention involves sun protection measures such as using broad-spectrum sunscreen, wearing protective clothing, avoiding peak sun hours, and regular skin self-examinations to detect changes early.
Key Considerations
The guidelines emphasize the importance of a thorough understanding of the entire spectrum of therapies available for cSCC and the evidence on which each treatment recommendation is based, to select and provide care optimally tailored to individual patients 1. Additionally, the guidelines highlight the need for a clear distinction between advanced age and limited life expectancy in the management of cSCC, as they are not synonymous, and significant medical comorbidities at any age may justify a therapeutic option that prioritizes quality of life 1.
From the Research
Definition of SCC
- Squamous cell carcinoma (SCC) is the second most common non-melanoma skin cancer 2, 3, 4.
- It originates from epidermal keratinocytes or adnexal structures (such as eccrine glands or pilosebaceous units) 2.
Diagnosis of SCC
- Biopsy leads to definitive diagnosis 2.
- New diagnostic imaging techniques such as dermoscopy and reflectance confocal microscopy have increased the diagnostic accuracy in terms of early recognition, better differential diagnosis, more precise selection of areas to biopsy, and noninvasive monitoring of treatments 3.
- Other diagnostic methods include high-frequency ultrasonography, optical coherence tomography, and computed tomography 4.
Treatment of SCC
- Treatment includes surgical excision; Mohs micrographic surgery produces excellent cure rates and spares the maximal amount of tissue 2.
- Other modalities include electrodessication and curettage, cryosurgery, radiotherapy, topical medications, photodynamic therapy, and systemic therapy 2, 4.
- Topical combination therapy with imiquimod, 5-FU, and tretinoin with intermittent, brief cryotherapy can effectively treat small, invasive SCC in select patients who defer surgery 5.
- Combination treatment using both topical 5-fluorouracil cream and imiquimod cream may be considered as an alternative therapeutic strategy for patients who have failed monotherapy with a topical agent for cutaneous squamous cell carcinoma in situ 6.