Squamous Cell Carcinoma

Medical Dermatology

Skin Conditions

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Squamous cell carcinoma (SCC) is the second most common cancer of the skin. Squamous cell carcinoma is a tumor that arises in the outer layer of the skin. More than 250,000 new SCCs are diagnosed every year in the U.S. alone. Middle-aged and elderly persons, especially those with fair complexions and frequent sun exposure, are most likely to be affected. If treated in a timely manner, it is uncommon for skin squamous cell carcinoma to spread to other areas of the body. Squamous cell carcinomas often arise from small rough red growths called actinic keratoses.

Ultraviolet light exposure (sun or indoor tanning parlors) greatly increases the chance of developing skin cancer. Persons with light skin who sunburn easily are at highest risk, although anyone can get squamous cell carcinoma. With increasing age, the risk of developing skin cancer also increases. Heavy sun exposure and severe sunburns as a child may especially increase the likelihood of skin cancer.

A squamous cell carcinoma generally appears as a crusted or scaly area of the skin, with a red, inflamed base, usually on sun exposed skin. Squamous cell carcinoma can present as a growing tumor, a non-healing ulcer, or just as a crust. Any worrisome skin lesions, especially those that are not healing, are growing, bleeding, or changing in appearance, should be evaluated by a dermatologist. A skin biopsy for microscopic examination is usually necessary to confirm the diagnosis.

These skin cancers can be locally destructive. If left untreated, squamous cell carcinoma can destroy much of the tissue surrounding the tumor. This is especially problematic around vital structures such as eyes, noses and ears. In certain aggressive types of squamous cell carcinoma, especially those on the lips and ears, or those that are left untreated, the tumor can spread to the lymph nodes and other organs. Approximately 2,500 deaths each year in the United States are from SCC metastasis.

Dermatologists use a variety of different surgical treatment options depending on location of the tumor, size of the tumor, microscopic characteristics of the tumor, health of the patient, and other factors. Most treatment options are relatively minor office-based procedures that require only local anesthesia. Surgical excision to remove the entire cancer is the most commonly used method. "Mohs" micrographic surgery, a more involved method requiring specialized training by dermatologic surgeons, can be used to remove the whole tumor while sparing as much normal skin as possible. Other dermatologic surgery treatments include laser surgery, cryosurgery with liquid nitrogen, radiation therapy, and electrodessication and curettage, which involves alternately scraping and burning the tumor in combination with low levels of electricity.

Ultraviolet light avoidance is the primary form of prevention and is important at all ages. Outdoor activity should be avoided between late morning and early afternoon, tanning parlors should be shunned, and wide brimmed hats should be worn along with other protective clothing. Sunscreens with SPF 15 or higher and UVA block should be applied regularly even for a brief exposure to sunlight. It is critical to protect our children and teach them sun safe behavior.