Squamous Cell Carcinoma: A Skin Cancer Guide

Receiving a diagnosis of squamous cell carcinoma (SCC) can be an overwhelming experience, but it is important to remember that you are not alone. SCC is one of the most common forms of skin cancer diagnosed globally, and because of its visibility, it is frequently caught in its earliest, most treatable stages. This guide is designed to provide you with a comprehensive foundation of knowledge to help you navigate your journey and foster a collaborative relationship with your oncology team.

Overview of squamous cell carcinoma

Squamous cell carcinoma is the second most common form of skin cancer, characterized by the abnormal, accelerated growth of squamous cells. These cells make up the majority of the skin’s upper layers, known as the epidermis. While most SCCs are localized to the skin, this type of cancer is considered more aggressive than basal cell carcinoma because it has a greater potential to grow into deeper layers of skin and, in some cases, spread (metastasize) to the lymph nodes and other organs.

The primary driver of SCC is cumulative, long-term exposure to ultraviolet (UV) radiation, either from the sun or from tanning beds. Because the damage accumulates over decades, SCC is most common in older adults, though it is increasingly seen in younger populations. It typically appears on "sun-exposed" areas — the face, ears, neck, scalp and hands — but it can occur anywhere on the body, including the inside of the mouth or the genitals.

The diagnostic process

Diagnosis begins with a clinical evaluation. Your physician will perform a total body skin exam to check for other suspicious lesions. If a spot is identified as a potential SCC, the following steps are typically taken:

• Skin Biopsy: This is the gold standard for diagnosis. After numbing the area with a local anesthetic, the doctor removes all or part of the growth. A pathologist then examines the tissue under a microscope to confirm the presence of cancer cells and determine the "grade" of the tumor (how aggressive the cells look).
• Lymph Node Examination: Your doctor will physically feel the nearby lymph nodes to check for enlargement or firmness.
• Advanced Imaging: If the tumor is very large, deep or shows aggressive features under the microscope, your oncologist may order a CT scan, MRI or PET scan. These tests help determine if the cancer has moved beyond the skin's surface into the bone or nearby nerves.

Treatment options

The goal of SCC treatment is to completely remove the tumor while preserving as much healthy tissue and function as possible. Your treatment plan will depend on the tumor's size, its location and your overall health.

Surgical interventions

• Mohs Micrographic Surgery: Often considered the most effective technique for SCCs on the face or other sensitive areas. The surgeon removes the tumor layer by layer, examining each layer under a microscope immediately. The process continues until no cancer cells remain. This method offers the highest cure rate and spares the maximum amount of healthy tissue.
• Excisional Surgery: The surgeon removes the entire visible tumor along with a "safety margin" of normal-looking skin. This is a common choice for tumors on the trunk or limbs.

Non-surgical and minimally invasive options

• Electrosurgery (Curettage and Desiccation): For small, superficial SCCs, a doctor may scrape away the tumor with a sharp tool (curette) and then use an electric needle to cauterize the area and kill any remaining cancer cells.
• Radiation Therapy: This uses high-energy X-ray beams to destroy cancer cells. It is often reserved for patients who are not good candidates for surgery or as an "adjuvant" (extra) treatment if there is a high risk that the cancer might return.
• Systemic Therapies: For advanced SCC that has spread, doctors may use immunotherapy, such as Keytruda (pembrolizumab) or Libtayo (cemiplimab). These drugs help your body’s own immune system recognize and attack the cancer cells.

Managing side effects

Every medical intervention carries the potential for side effects. Being proactive about reporting these to your oncologist can significantly improve your quality of life during treatment.

• Scarring and Wound Care: All surgical options will result in some degree of scarring. Proper wound care is essential to prevent infection, which can delay healing and worsen the cosmetic outcome.
• Nerve Damage: If a tumor is deep, surgery or radiation may affect local nerves, leading to temporary or permanent numbness or a tingling sensation in the area.
• Radiation Skin Reactions: Patients undergoing radiation may experience "radiation dermatitis," where the skin becomes red, peeling and sore, similar to a severe sunburn.
• Immunotherapy Side Effects: Because immunotherapy "revs up" the immune system, it can sometimes cause the body to attack healthy tissues, leading to inflammation in the lungs, colon, or endocrine glands.

Conclusion and next steps

While a cancer diagnosis is life-changing, squamous cell carcinoma is highly manageable when addressed by a multidisciplinary team. Your oncology team — which may include a dermatologist, a surgeon, and a radiation oncologist — is there to guide you through these choices. The most important thing you can do is remain an active participant in your care by asking questions and attending all follow-up screenings, as having one SCC increases your risk of developing others.

Editor's note: This article is for informational purposes only and is not a substitute for professional medical advice, as your own experience will be unique. Use this article to guide discussions with your oncologist. Content was generated with AI and reviewed by a human editor.

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