Medically reviewed by Dr. A.M. van Coevorden, dermatologist
Squamous cell carcinomathe second most common form of skin cancer
Squamous cell carcinoma is a form of skin cancer that begins in the top layer of the skin. It is the second most common form of skin cancer, with about 15,000 new patients a year in the Netherlands. It can usually be removed well with surgery, but if left longer it can grow deeper and, in rare cases, spread. Timely recognition and treatment are therefore important.
- What is squamous cell carcinoma?
- How do you get squamous cell carcinoma?
- What does it look like?
- Is squamous cell carcinoma contagious?
- How is the diagnosis made?
- What treatments are there?
- Do you need follow-up?
- Can squamous cell carcinoma be cured?
- What can you do yourself?
- Frequently asked questions about squamous cell carcinoma
What is squamous cell carcinoma?
Squamous cell carcinoma of the skin is a form of cancer; carcinoma is the medical term for cancer. It begins in the top layer of the skin and can usually be removed well with surgery. If it remains longer, it can grow deeper and damage underlying tissue. In a very small group of patients it spreads to other parts of the body, almost always first to the nearby lymph nodes. That is why timely recognition and treatment matter. It is the second most common form of skin cancer, with about 15,000 patients a year.
How do you get squamous cell carcinoma?
The main cause is frequent and prolonged sun exposure. It appears mainly where the skin gets a lot of sun, such as the face, the bald scalp and the backs of the hands. People with fair skin are at greater risk than those with dark skin. It is also more common in people with actinic keratoses, rough red spots that are a precancerous stage. Other possible causes are leg wounds that do not heal for a long time (leg ulcer), very long-standing skin diseases, long-term use of immune-suppressing medicines (for example after an organ transplant), medicines that make the skin more sun-sensitive, scars from burns or irradiated areas, and certain wart viruses (human papillomavirus), especially with genital warts.
What does it look like?
A squamous cell carcinoma often looks like a small lump in the colour of the skin or light red, which feels rough and firm. The lump grows slowly and can grow quite large. It often hurts or is tender to the touch, but sometimes not. It can also look like a small wound that slowly grows. It can occur anywhere, but usually on the scalp, ears, face, lips, the underside of the arms, the backs of the hands and the legs.
Is squamous cell carcinoma contagious?
No. Squamous cell carcinoma is a form of skin cancer and cannot be passed from person to person.
How is the diagnosis made?
The doctor can often tell from the spot that it is a squamous cell carcinoma but usually wants to be sure it is not another condition. A small piece of skin is taken under local anaesthetic (a skin biopsy). During the consultation the doctor also checks the rest of the skin for other suspicious spots and feels whether the lymph nodes are enlarged.
What treatments are there?
Surgical removal (excision) is the first choice, usually by the dermatologist under local anaesthetic, sometimes by a surgeon. A margin of healthy skin is included, and the removed piece is always examined under the microscope; if it is not fully gone, further treatment follows.
Micrographic surgery is a special operation in which the removed skin is checked under the microscope the same day, so it is immediately clear whether everything is gone. Less healthy skin is often removed. This matters especially on the face, with unclear borders or on recurrence.
Radiotherapy also gives a good result and is often used only when surgery is not possible; with it, whether everything is gone cannot be checked.
Do you need follow-up?
After treatment your skin is checked regularly for five years, to see whether the carcinoma has not returned or spread, and whether no new spots have appeared. Actinic keratoses, the precursors, are also checked and treated if needed.
Can squamous cell carcinoma be cured?
If the spot is completely gone, problems almost never arise. Some squamous cell carcinomas are more aggressive than others, which the pathologist judges under the microscope. In a small proportion of people it can return, in a smaller proportion spread to the nearby lymph nodes, and very rarely to other organs. People often notice a swelling in or around the scar or in the lymph nodes themselves. If there is spread, treatment takes place in a specialised centre, with more extensive treatment and sometimes medicines. Spread to other organs can cause serious health problems that can be fatal; that risk is fortunately very small.
What can you do yourself?
After treatment, check your whole skin regularly yourself, with extra attention to the treated area. If a lump or wound appears that does not clear within a few weeks, make an appointment promptly and do not wait; pain and rapid growth are reasons to make contact sooner. Also feel for enlarged lymph nodes with flat fingers, in the areas your dermatologist indicates. Avoid sunburn and do not use a sunbed.
Frequently asked questions about squamous cell carcinoma
Is squamous cell carcinoma dangerous?
It is a real form of skin cancer that can grow deeper and, in rare cases, spread. That is why timely treatment matters. Once the spot is fully removed, problems almost never arise.
How do I recognise it?
Often as a rough, firm lump in skin colour or light red that grows slowly, or as a wound that will not heal. Have such a spot assessed, especially with pain or rapid growth.
Does it spread?
In most people no. In a small proportion it can return or spread to the lymph nodes, and very rarely to other organs. That is why five years of follow-up is usual.
What treatment will I get?
Usually cutting out (excision), sometimes micrographic surgery or radiotherapy. The tissue is checked under the microscope to be sure everything is gone.
When should I make contact?
For a lump or wound that does not clear within a few weeks, for pain or rapid growth, or for a swelling in or around the scar or the lymph nodes.