Sinonimi: SCC, Squamous cell carcinoma, Squamous cell cancer, Spinalioma, Epidermal carcinoma, Epidermoid carcinoma, Papillary carcinoma, Verrucous carcinoma, Non-melanoma skin carcinoma
SCC is a kind of skin carcinoma which develops in the epidermis. By order of frequence, SCC is just behind BCC in skin. At an early stage, when it’s non invasive, it is completely curable. At a later stage, invasive stage, it presents with an ability to metastasize to surrounding tissues and internal organs.
Skin SCC develops from damage to the squamous keratinous cells that produce keratin. Genetic predisposition and skin damage from UV overexposure are the primary reasons for developing this type of skin carcinoma. Damage from UV radiation gets accumulated during life, it starts with first exposure to the Sun (from birth) and can eventually lead to development of squamous cell carcinoma, but to other types of skin carcinoma as well..
Which are the first signs of skin SCC?
Appearance of a small pink freckle, or a lesion on the skin like a light or pink nodule, is often a first sign that can be noted. There are usually no symptoms at this stage. Exactly this nonspecific appearance and character at the early stage is the reason why early diagnostics can be done only on persons that undergo regular check ups, or when it’s accidentally discovered during an examination of some other lesion. However, if it continues to further develop, it grows on the outside and on the inside, presenting with first symptoms in the form of an itch.
Skin Sun damage, with the firs signs that indicate initial development of skin SCC
Is there some sex, age or body region specificity?
SCC is a carcinoma that more commonly appears in men than in women. Number of young people affected by it is increasing. Still, the probability of it occurring is greatest after the age of 50. It is usually present on sun-exposed regions of the skin: face, forehead, hands and back, but SCC can develop on any skin region, with specific places being: lower lip, ear lobe and vulva.
Skin SCC is considered as a medium metastatic potential carcinoma. Non-invasive type of skin SCC rarely metastasizes, while the invasive type of skin SCC has a larger potential to metastasize. Diameter-wise, skin SCC with a diameter greater than 4mm has a greater chance of metastasizing than a smaller one.
Skin SCC is completely curable in all cases when it’s diagnosed and treated in a timely manner.
Anyone can get skin SCC, but special risk groups are people with fair skin, red hair, who suffered from intense sunburn before the age of 20, or have used sunbeds to get a tan regularly. More on other risk factors can be seen in the following table
|high risk factors
- Intense sunburn before the age of 20
- Use of sunbeds before the age of 20
- Fair to reddish skin complexion
- Red hair
|medium risk factors
- Intense sun burn after the age of 20
- Use of sunbeds after the age of 20
- Longterm exposure to tars ar arsenic compounds
- Overexposure to radiation, like X-rays in the treatment of some carcinomas
|moderate risk factors
- Longterm immunosuppression, like after an organ transplant
- Old scars, especially after burns
- Chronic wounds, especially ulcus cruris (leg ulcer)
- Previous occurrence of any skin carcinoma
|minimal risk factors
- Young persons under the age of 20
- Persons with skin phototype 5 and 6
Table : Skin Scc Risk Factors
Measures of primary prevention are: protection from UV radiation and protective measures for people in contact with tars and arsenic compounds. Protection from all sources of increased UV radiation presents a basic preventive measure for all people, especially ones with fair skin. Sources of UV radiation are the Sun, sunbeds and different UV lamps aside. The principal danger that UV radiation poses is the development of skin damage which can cause a formation of skin SCC, but other skin lesions as well, whether they are benign or malignant.
Table: Principal measures of Sun protection
|Do not sun tan between the hours of 10am and 4pm
||UV radiation is increased between april and October each year in Serbia
|Use shade as a natural protection
||Keep in mind that parasols are not always adequate protection, especially not next to large reflective surfaces like water or sand
|Protect Your head with a hat or a cap
||The larger the rim, the greater the protection
|Use sleeved garments for protecting Your body
||Even the lightest of clothes is of use
|Treat Sun exposed regions with SPF 15 or higher sunblock creams
||SPF (sun protection factor) creams should be applied every 2 to 3 hours and obligatory after swimming
|Do not use sunbeds as a way of preparing the skin for a vacation
||The tan You get in a sunbed is not adequate protection from the Sun
|Special measures of protection for small children
||Bebe do prve godine zaštititi od sunca u periodu od 10 do 16h.
Secondary prevention and screening
Early detection of skin SCC is considered as secondary prevention. Skin selfexamination and spotting the first signs of skin SCC are the brunt of secondary prevention. Permanent education of the population in conducting these measures is firstly a task for health management, education management and public media.
Skin SCC screening would include a complete examination of the skin, from head to toe, on any person that has skin SCC high risk factors, and it’s obvious that such a feat is impossible to do at this moment, due to disproportionally large number of people that should be examined.
Dermoscopic diagnostics of a squamous cell carcinoma is characterized by an absence of structures that point to a melanocytic lesion, as well as to an absence of characteristic signs that point to a basal cell carcinoma, with the signs that point to a skin SCC being: non-specific pattern with whitish signs of “hyperkeratosis” – uneven surfaces and polymorphic blood vessels around a whitish halo.
When we diagnose a skin SCC, by adequately removing it, we secure a COMPLETE CURING. Other than just being able to dermoscopically diagnose a skin SCC, we can even diagnose the changes that precede it’s development.
There is a large number of different, successful treatments for skin SCC. In general, there are surgical and non-surgical treatments.
- Micrographic surgery
- Laser surgery
Surgical removal by an excision is the basic way of removing a skin SCC. Other methods are used only in cases where a surgical excision is unavailable for any reason. Those reasons can range from health, functional, or esthetic. During the course of the last few years lasers are being more used in the removing of early and low risk lesions of the skin, but that still doesn’t exclude the use of cryosurgery and immunosuppressant creams, like Imiquimod.
Skin SCC excision: This kind of excision is called a radical excision also.
Excision – defect after a radical removal
Flap – defect reconstruction
Result – 6 months after removal
Laser treatment of precancerous lesions
1 year after one treatment
1 year after one treatment
We use a CO2 laser to treat precancerous skin lesions.
Laser treatment is done under local anesthesia, with the use of anesthetic cream, and it’s usually necessary to do 2 to 3 treatments spaced over 4 to 8 weeks.
How to live with skin SCC?
People’s reactions to the notion that they suffer from a carcinoma are different. Reactions range from total vilification, because supposedly “skin carcinomas are not the same degree of danger when compared to other carcinomas”, to different emotional reactions of fear, shock and isolation. However, luckily the largest number of patients realistically accepts the fact that the carcinoma in question is a kind that has a moderate risk of metastasizing, and that by adequately removing it, they are cured for life.
In case of existing chronic stress, look for professional help, and also look at our advice on stress management.
After receiving a histopathological diagnosis, we advise to do a thorough skin examination, from head to toe, for purposes of further adequate follow ups. If there are no other “risky” skin lesions, we advise regular dermoscopic follow up once a year. Other types of analyses such as: Ultrasound, X rays, CT scans or MRI are advised only in cases where there’s a suspicion on existing metastases.
Regular skin selfexamination once a month is recommended for all cases of skin tumors, and more detailed monitoring can be seen in the column Skin and mole monitoring.
Exact number of skin SCC cases are unknown. In our cancer registry for Central Serbia, all non-melanoma skin carcinomas are registered as “other skin carcinomas” (table 1) and that includes SCC. The exact number of skin SCCs can only be presumed, based on the data that WHO provides, which is saying that about 4% of all skin carcinomas are melanomas, about 80% are BCC, about 15% are SCC and about 1% are other rare skin carcinomas. In any case, the least possible number of cases in Serbia cannot be under 1500.
Mortality from skin SCC is also not known. Number of deaths associated with other skin carcinomas, which includes SCC is over 100 per year.(Table 2) .
Table 1: Incidence Rate Of Other Malignant Skin Tumors In Central Serbia
Table 2: Mortality From Other Malignant Skin Tumors In Central Serbia
These indicators point to the fact that measures of primary prevention, screening and early diagnostics are of key importance for a successful fight against all skin carcinomas.
Frequently asked questions
In case it’s not diagnosed in time, or it’s inadequately treated, there is a possibility of developing metastases, and by that, endangering Your life.
What are the first signs that can be notices in SCC development?
One of the first signs is a presentation of light crusts on the skin with signs of sun damage.
What needs to be done when there is a suspicion that there is an SCC suspicious lesion?
Contact Your physician or the nearest skin tumor specialized facility.
Yes. In all cases when it’s diagnosed and treated in a timely manner.
Dermoscopically. Dermoscopy with clinical data presents the most successful diagnostic.
What is the primary principle in treating SCC?
Surgical excision. Radical or adequate removing is a basic principle of successful treatment.
Can SCC be successfully treated without a surgical excision?
Yes. In all cases of early skin SCC, as with all cases when surgery is not available, possible treatments are by laser, nitrogen, electrosurgery and immunosuppressant creams.
Is there a possibility for SCC prevention?
Yes. Measures of primary prevention from getting skin sun damage from UV radiation on persons with risk factors.