Squamous Cell Carcinoma - Early Signs, Risk Factors, Diagnosis, and Treatment Explained

Squamous cell carcinoma (SCC) is the second most common type of skin cancer, often developing in areas frequently exposed to the sun, such as the face, lips, ears, and hands. While many cases can be treated successfully, SCC can sometimes grow more aggressively than other skin cancers, making early detection especially important. This guide provides clear and trustworthy information about SCC—its symptoms, how it is diagnosed, treatment options, and what you can expect along the way. Written in simple, patient-friendly language, our goal is to help you feel informed, supported, and confident as you take steps to protect your skin and overall health.

What Is Squamous Cell Carcinoma?

Squamous cell carcinoma (SCC) is the second most common type of skin cancer, after basal cell carcinoma. It starts in the squamous cells, which are the flat, scale-like cells that form the top layer of the epidermis (the outermost layer of the skin). SCC is a cancer that is primarily caused by long-term exposure to ultraviolet (UV) radiation from the sun or from tanning beds.

Unlike basal cell carcinoma, SCC has a slightly higher risk of spreading to other parts of the body (metastasis), but this is still a very rare occurrence. When found and treated early, SCC is almost always curable. However, if left untreated, it can grow deep into the skin, causing significant damage and disfigurement, and can be more difficult to treat. This is why early detection and proper treatment are so important.

SCC can also occur on other parts of the body that have squamous cells, such as the lining of the mouth, throat, lungs, or genitals. However, this article will focus on SCC of the skin.

Types of Squamous Cell Carcinoma

While all squamous cell carcinomas start in the same type of cell, they can present themselves in different ways. The appearance of the tumor can give a doctor clues about its growth pattern and how it should be treated. Some of the common types include:

• Cutaneous Squamous Cell Carcinoma: This is the most common type and appears on the skin. It can look like a firm red nodule, a scaly patch, or a sore that doesn't heal.
• Keratoacanthoma (KA): This is a specific type of SCC that is often a fast-growing, dome-shaped tumor with a central crust. It can be difficult to tell the difference between a keratoacanthoma and a regular SCC, but KAs often disappear on their own over time. However, because of the risk of misdiagnosis, they are almost always treated as a regular SCC.
• Bowen's Disease (Squamous Cell Carcinoma in Situ): This is a very early, non-invasive form of SCC. It means the cancer cells are confined to the top layer of the skin and have not spread deeper. It looks like a reddish, scaly patch that can be mistaken for eczema or psoriasis.

What Are the Causes and Risk Factors for Squamous Cell Carcinoma?

The primary cause of squamous cell carcinoma is damage to the DNA of the squamous cells from exposure to ultraviolet (UV) radiation. This damage can come from the sun or from indoor tanning equipment.

Key Risk Factors:

• UV Exposure: This is the single biggest risk factor. Cumulative, long-term exposure to the sun's UV rays, as well as blistering sunburns in childhood, can lead to DNA damage that results in SCC. The risk is also increased by the use of tanning beds.
• Skin Tone: People with lighter skin tones have a higher risk of developing SCC. They have less melanin, which provides some protection from UV damage.
• Age: The risk of SCC increases significantly with age. It is most common in people over the age of 50.
• Actinic Keratosis: Actinic keratosis is a common, rough, scaly patch of skin that is considered a pre-cancerous lesion. Many people with a history of actinic keratosis have a higher risk of developing SCC.
• Previous Skin Cancer: If you have had SCC or any other type of skin cancer before, you have a much greater risk of developing another one.
• Weakened Immune System: A compromised immune system is a major risk factor. This includes people who have had an organ transplant and are taking immunosuppressant medications, and people with HIV/AIDS.
• Human Papillomavirus (HPV): Certain types of HPV are linked to SCC of the genital and anal areas.
• Other Risk Factors: A history of a burn scar, chronic sores, or long-term exposure to certain chemicals like arsenic can also increase the risk.

It is important to remember that people of all skin tones can get SCC, and many people who get it do not have any of these known risk factors.

What Are the Symptoms of Squamous Cell Carcinoma?

The symptoms of squamous cell carcinoma can be subtle and are often mistaken for other common skin conditions. A key characteristic to look for is a spot that does not heal, or that bleeds and then scabs over and then bleeds again.

Common Early Signs:

• A Firm, Red Nodule: A firm, red bump that is often tender to the touch. It may have a crusted or scaly surface.
• A Scaly, Reddish Patch: This is a common sign of Bowen's disease. It can have a raised border and may be mistaken for eczema or psoriasis.
• A Sore That Doesn't Heal: A sore that bleeds, oozes, or crusts over and does not heal within a few weeks. It may heal temporarily and then return.
• A Wart-Like Growth: A firm, rough patch of skin that resembles a wart.

SCC most often appears on sun-exposed areas of the body, such as the face, ears, neck, scalp, shoulders, and arms. If you notice a new or changing spot on your skin, it is crucial to see a dermatologist for a proper evaluation.

How Is Squamous Cell Carcinoma Diagnosed?

Diagnosing squamous cell carcinoma is usually a straightforward process. The diagnosis often begins when a patient notices a suspicious spot and brings it to their doctor's attention.

Diagnostic Steps and Tests:

1. Physical Exam: A dermatologist will perform a thorough skin exam, looking at all of your skin, including areas that are not typically exposed to the sun. They may use a special magnifying tool called a dermatoscope to get a closer look at the lesion.

2. Skin Biopsy: A biopsy is the only way to definitively diagnose SCC. A small sample of the suspicious lesion is removed and sent to a lab to be examined by a pathologist.

• Shave Biopsy: The doctor shaves off the top layers of the lesion with a small blade.
• Punch Biopsy: A small, circular tool is used to remove a deeper sample of the skin.
• Excisional Biopsy: The doctor removes the entire lesion and a small margin of healthy skin around it.

3. Lymph Node Check: Because SCC can spread to nearby lymph nodes, a doctor will feel for any swollen lymph nodes in the area near the tumor. If a lymph node is swollen, a biopsy may be done to check for cancer cells.

Staging and Grading of Squamous Cell Carcinoma

Squamous cell carcinoma is staged to help doctors predict the patient's prognosis and choose the best treatment. The stage is based on the size and location of the tumor and whether it has spread to nearby lymph nodes or distant parts of the body.

Grading: The grade describes how aggressive the cancer cells look under a microscope.

• Low-Grade (Well-Differentiated): The cancer cells look very similar to normal, healthy cells. They tend to grow slowly.
• High-Grade (Poorly Differentiated): The cancer cells look very different from normal cells. They are rapidly dividing and are more likely to grow and spread.

Staging: The most common staging system is a four-stage system.

• Stage 0 (Bowen's Disease): The cancer is confined to the top layer of the skin.
• Stage I: The tumor is small and has a low risk of recurrence.
• Stage II: The tumor is larger or has a higher risk of recurrence.
• Stage III: The cancer has spread to nearby lymph nodes or bone.
• Stage IV: The cancer has spread to distant parts of the body.

What Are the Treatment Options for Squamous Cell Carcinoma?

The treatment plan for squamous cell carcinoma is highly personalized and depends on the size, type, and location of the tumor, as well as the patient's overall health. The good news is that most cases can be treated with a simple outpatient procedure.

1. Surgery

Surgery is the most common and effective treatment for SCC.

• Surgical Excision: The doctor removes the tumor and a margin of healthy tissue around it to ensure all the cancer cells are gone.
• Mohs Micrographic Surgery: This is a specialized surgical technique that is used for SCCs on the face, scalp, or other cosmetically sensitive areas. The surgeon removes the tumor layer by layer and examines each layer under a microscope until no cancer cells are left. This allows the surgeon to remove all of the cancer while preserving as much healthy skin as possible.
• Curettage and Electrodesiccation: The doctor scrapes off the tumor with a curette (a spoon-shaped tool) and then uses an electric current to destroy any remaining cancer cells.

2. Other Local Therapies

• Cryosurgery: The tumor is frozen with liquid nitrogen to destroy the cancer cells.
• Topical Creams: Certain chemotherapy creams or immune-modulating creams can be applied to the skin to treat very superficial SCCs, such as Bowen's disease.
• Photodynamic Therapy (PDT): A special light-sensitive drug is applied to the skin and is then activated by a light source to kill the cancer cells.

3. Medical Treatment (Targeted Therapy and Immunotherapy)

• Targeted Therapy: In the rare case of a very advanced or metastatic SCC, a doctor may use targeted therapy drugs that specifically target a genetic pathway that is often overactive in SCC.
• Immunotherapy: Immunotherapy has revolutionized the treatment of many cancers and is now being used to help the body's immune system fight off advanced SCC.

4. Radiation Therapy

In advanced or hard-to-reach cases (such as SCC in the head and neck or near the eye), advanced radiation options like Proton Beam Therapy can precisely target the tumor while protecting nearby healthy tissues. This may be especially helpful if standard radiation carries higher risk of side effects.

Prognosis and Survival Rates for Squamous Cell Carcinoma

The prognosis (the likely outcome of the disease) for squamous cell carcinoma is excellent. With proper treatment, the cure rate is very high.

• Prognostic Factors: The most important factors affecting prognosis are the size and location of the tumor, the grade, and whether it was completely removed with treatment. SCCs that are on the lips, ears, or genitals have a higher risk of recurrence and a worse prognosis.
• Survival Rates: The 5-year survival rate for localized SCC is around 99%. Even if the cancer has spread to nearby lymph nodes, the 5-year survival rate is around 65%.

It is important to remember that while an SCC diagnosis is not usually life-threatening, a person who has had one SCC has a higher risk of developing another one in the future.

Screening and Prevention of Squamous Cell Carcinoma

There are no routine screening tests for SCC in the general population. The best way to reduce your risk is to practice sun safety and be aware of your skin.

Prevention Strategies:

• Limit UV Exposure: This is the single most important way to prevent SCC. Avoid the sun during peak hours (10 a.m. to 4 p.m.), wear sun-protective clothing, a wide-brimmed hat, and sunglasses.
• Use Sunscreen: Use a broad-spectrum sunscreen with an SPF of 30 or higher every day, even on cloudy days.
• Avoid Tanning Beds: The UV rays from tanning beds are just as harmful as the sun's and can significantly increase your risk of SCC.
• Perform Skin Self-Exams: Regularly check your skin for any new or changing spots, bumps, or moles. Look for any sores that don't heal.

For International Patients: Your Seamless Journey to Apollo Hospitals

Apollo Hospitals is a leading medical destination for international patients seeking high-quality and affordable cancer care. Our dedicated International Patient Services team is here to ensure your entire experience is as smooth and comfortable as possible, from your initial inquiry to your return home. We have extensive experience treating patients with complex conditions, including skin cancers.

Our Services for International Patients Include:

• Travel and Visa Assistance: We will provide you with a visa invitation letter and help with travel arrangements.
• Airport Transfers: We will arrange for a car to pick you up from the airport.
• Personalized Care: A dedicated patient coordinator will be your single point of contact, assisting with hospital admission, language interpretation, and any other needs you may have.
• Accommodation: We can assist you with booking suitable accommodation for you and your family near the hospital.
• Post-Treatment Follow-up: We will stay in touch with you after your return home to ensure a smooth recovery.

Frequently Asked Questions (FAQs) About Squamous Cell Carcinoma

Q1: Is Squamous Cell Carcinoma curable?

A: Yes, squamous cell carcinoma is almost always curable, especially when it is found and treated early. The cure rate is very high with proper treatment.

Q2: What is the survival rate for SCC?

A: The 5-year survival rate for localized SCC is around 99%. Even if the cancer has spread to nearby lymph nodes, the 5-year survival rate is around 65%. It is a very treatable cancer.

Q3: What are the side effects of SCC treatment

A: Side effects vary with the type of treatment. Surgical removal can leave a scar. Cryosurgery can cause swelling and blistering. Topical creams can cause skin irritation. Your medical team will work closely with you to manage these side effects.

Q4: Can SCC come back (recurrence)?

A: Yes, there is a risk of recurrence, especially for larger or more aggressive tumors. This is why regular follow-up appointments and monitoring are crucial. However, the most common type of recurrence is a new SCC in a different spot, which is why regular skin self-exams are so important.

Q5: What is the typical recovery time after treatment?

A: Recovery time depends on the treatment. A simple excision may take a few weeks to heal. Mohs surgery can take a few weeks to a month to heal completely. Your medical team will provide a detailed recovery plan.

Q6: Can a person with SCC get other skin cancers?

A: Yes. People who have had an SCC have a higher risk of developing another SCC, as well as a basal cell carcinoma or a melanoma. This is why sun safety and regular skin checks are so important.

Q7: How is SCC different from basal cell carcinoma?

A: SCC has a slightly higher risk of spreading to other parts of the body than basal cell carcinoma. However, both are very treatable with a high cure rate when found early.

Q8: Is there any way to prevent SCC?

A: The best way to prevent SCC is to practice sun safety by avoiding UV exposure, wearing sun-protective clothing, and using sunscreen every day.

Q9: What does an SCC look like?

A: An SCC can look like a firm, red nodule, a scaly, reddish patch, or a sore that doesn't heal. The key is to look for any new or changing spots on your skin, especially if they don't heal.