If caught early, most squamous cell carcinomas are curable and cause minimal damage. However, the larger and deeper a tumor grows, the more dangerous and potentially disfiguring it may become, and the more extensive the treatment must be.
If left untreated, SCCs may spread (metastasize) to local lymph nodes, distant tissues and organs and can become life-threatening. Therefore, any suspicious growth should be seen by a physician without delay. The doctor takes a tissue sample (biopsy), which is examined under a microscope to arrive at a diagnosis. If tumor cells are present, the physician uses the biopsy results and other factors to determine which treatment is right for you.
Fortunately, there are several effective ways to eradicate squamous cell carcinoma. The physician chooses the treatment based on the tumor’s type, size, location and depth of penetration, as well as the patient's age and general health.
The patient can almost always receive treatment on an outpatient basis in a physician's office or at a clinic. Most surgical procedures call for a local anesthetic, and pain or discomfort is usually minimal during and after the procedure.
Mohs surgery is the gold standard for treating many SCCs (as well as many basal cell carcinomas and some melanomas). This includes those in cosmetically and functionally important areas around the eyes, nose, lips, ears, scalp, fingers, toes or genitals. Mohs is also recommended for skin cancers that are large, aggressive or growing rapidly, that have indistinct edges or that have recurred after previous treatment. Learn more about Mohs surgery and find out if it’s right for you.
The physician uses a scalpel to remove, or excise, the entire cancerous tumor along with a surrounding border of presumably normal skin as a safety margin. The physician bandages the wound or closes the skin with stitches and sends the tissue specimen to a lab to verify that all cancerous cells have been removed. If the lab finds evidence of skin cancer beyond the safety margin, the patient may need to return for another surgery. For tumors discovered at an early stage that have not spread beyond the tumor margin, excisional surgery is frequently the only treatment required.
Excisional surgery can be used for squamous cell carcinomas as well as basal cell carcinomas and melanomas. For tumors discovered at an early stage that have not spread beyond the tumor margin, excisional surgery is frequently the only treatment required.
Curettage and Electrodesiccation (Electrosurgery)
This technique is usually reserved for small squamous cell carcinoma lesions. Using local anesthesia, the physician scrapes off part or all of the lesion with a curette (an instrument with a sharp, ring-shaped tip), then burns the tumor site with an electrocautery needle to stop the bleeding and kill any remaining cancer cells. The physician typically repeats this procedure a few times (often at the same session), scraping and burning a deeper layer of tissue each time to help ensure that no tumor cells remain. The technique can produce cure rates approaching those of surgical excision for superficially invasive squamous cell carcinomas without high-risk characteristics. However, it is not recommended for any invasive or aggressive SCCs, those in high-risk or difficult sites, such as the eyelids, genitalia, lips and ears, or any other sites (especially those around the face) that would be left with cosmetically undesirable results, since the procedure leaves a sizable, hypopigmented scar.
This procedure is used for superficial SCCs. The physician destroys the tumor tissue by freezing it with liquid nitrogen, using a cotton-tipped applicator or spray device. Later, the lesion and surrounding frozen skin may blister or become crusted and fall off, usually within weeks. There is no cutting or bleeding, and no anesthesia is required, though the patient may experience some mild stinging. The physician may repeat the procedure several times at the same session to help ensure destruction of all malignant cells. Redness, swelling, blistering and crusting can occur following treatment, and in dark-skinned patients, some pigment may be lost. Inexpensive and easy to administer, cryosurgery may be the treatment of choice for patients with bleeding disorders or intolerance to anesthesia. However, it has a lower overall cure rate than the surgical methods. Depending on the physician's expertise, the five-year cure rate can be quite high with selected, superficial squamous cell carcinoma; but cryosurgery is not often used today for invasive SCC because it may miss deeper portions of the tumor and because scar tissue at the cryotherapy site might obscure a recurrence.
Laser therapy is not yet approved for SCC but is sometimes used for superficial SCCs, above all when other techniques have been unsuccessful. It gives the physician good control over the depth of tissue removed. The physician uses a beam of light of a specific wavelength to destroy certain superficial SCCs, without causing bleeding. The physician may remove the skin’s outer layer and/or variable amounts of deeper skin, so local anesthesia may be needed. The risks of scarring and pigment loss are slightly greater than with other techniques.
Some lasers (such as CO2 lasers) vaporize (ablate) the skin cancer, while others (nonablative lasers) convert the beam of light to heat, which destroys the tumor.
The physician uses low-energy X-ray beams to destroy the tumor, with no need for cutting or anesthesia. Destruction of the tumor may require several treatments over a few weeks or daily treatment for a month. Average cure rates are about 90 percent, since the technique does not provide precise control in identifying and removing residual cancer cells at the margins of the tumor. The technique can involve long-term cosmetic problems and radiation risks, as well as multiple visits. For these reasons, though this therapy limits damage to adjacent tissue, it is mainly used for tumors that are hard to treat surgically, as well as patients for whom surgery is not advised, such as the elderly or those in poor health. In some more advanced cases of SCC, radiation may be needed after surgery, sometimes combined with other treatments.
Photodynamic Therapy (PDT)
PDT may be used for some superficial SCCs on the face and scalp but is not recommended for invasive SCC. The physician applies a light-sensitizing topical agent to the lesion and the area surrounding it. The patient waits for an hour or more to let this absorb into the skin. The doctor then uses a strong blue or red light or laser to activate this medicated area. This selectively destroys the lesion while causing minimal damage to surrounding healthy tissue. Some redness, pain, peeling, flaking and swelling can result. After the procedure, patients must strictly avoid sunlight for at least 48 hours, as ultraviolet exposure will increase activation of the medication and may cause severe sunburns.
5-fluorouracil (5-FU) and imiquimod, both FDA-approved for treatment of actinic keratoses and superficial basal cell carcinomas, are also sometimes used off-label (without FDA approval) for superficial squamous cell carcinoma. However, they should not be used for the treatment of invasive SCCs. Imiquimod stimulates the immune system to produce interferon, a chemical that attacks cancerous and precancerous cells, while 5-FU is a topical form of chemotherapy that has a direct toxic effect on cancerous cells.
Treatments for Recurrent and Advanced Squamous Cell Carcinoma
Squamous cell carcinomas usually remain confined to the epidermis (the top skin layer) for some time. However, the larger these tumors grow, the more extensive the treatment needed. They eventually penetrate the underlying tissues, which can lead to major disfigurement, sometimes even the loss of a nose, eye or ear, and they sometimes result in nerve or muscle injury.
“Advanced” is a broad term for SCCs that may have spread extensively or have resisted multiple treatments and recurred. These include locally advanced SCCs — primary tumors that are very large, or have burrowed down into nearby subcutaneous tissue, muscles or along nerves — as well as tumors that have metastasized to the nearby lymph nodes or other parts of the body. About 50,000 cases a year, or about 1 out of every 20 cases, either become locally advanced or spread (metastasize) to distant tissues and organs. When this happens, SCCs can become life-threatening.
Metastases most often arise on sites of chronic inflammatory skin conditions and on the ear, nose and lip.
For SCCs that recur, become locally advanced or metastasize, the doctor may use a combination of treatments, including surgery, radiation and immunotherapy. First, however, he or she may recommend an evaluation by a multidisciplinary team of specialists. The team, which may include your dermatologist or Mohs surgeon, plus additional physicians and surgeons from other specialties, can discuss the various treatment options that could be considered, including participation in a clinical trial.
In September of 2018, the FDA approved a new intravenously infused drug called cemiplimab-rwlc (Libtayo®) as a treatment for patients with metastatic SCC — specifically squamous cell carcinoma of the skin, or cutaneous SCC (CSCC) — and those with locally advanced, unresectable CSCC who are not candidates for curative surgery or radiation. Cemiplimab-rwlc is the first and only treatment specifically approved for advanced CSCC in the U.S. Harnessing the power of the immune system to battle the cancer, it is known as a checkpoint blockade immunotherapy. By blocking a receptor called PD-1 (programmed death-1), which normally keeps the immune system in check, cemiplimab-rwlc allows the immune system’s T cells to attack the tumor in force.
Cemiplimab-rwlc was approved based on the combined data from a multicenter phase 2 study and a multicenter phase 1 study, which found that out of a combined 108 patients, more than 47 percent responded to the drug, with 4 percent experiencing a complete response (complete remission). Some patients who had failed other therapies had CRs, including one patient with metastases to the brain. Only three responders went on to progressive disease.
If you have advanced CSCC, it’s important to stay up to date on clinical trial developments with your doctor or team, and stay optimistic.