Squamous cell carcinoma of the skin
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Squamous cell carcinoma is a type of skin cancer that begins in squamous cells in the epidermis, the outer layer of the skin. It typically develops on parts of the skin that obtain the most sun exposure, such as the head, arms, and legs. It is the second most prevalent form of skin cancer.
Squamous cells can be found throughout the body, and squamous cell carcinoma can develop anywhere with squamous cells. Cancer can also develop in areas of the body with mucous membranes, which are the inside linings of the organs and body cavities, such as the mouth, lungs, and anus.
There are two forms of squamous cell carcinoma depending on the location and the amount of cancer present in the body:
- Cutaneous: A cancer that affects only the top layer of the skin (in situ) or cancer that has progressed beyond the top layer of the skin.
- Metastatic: Cancer that has spread beyond the skin to other places of the body.
Squamous cell carcinoma of the skin is caused by a mutation to the p53 gene. The mutation happens due to extended exposure to ultraviolet (UV) radiation, which can come from sunshine or tanning beds or lamps.
Squamous cell carcinoma of the skin is rarely fatal, but it can be aggressive. If left untreated, it can become large and spread to other parts of the body. Treatment options generally include surgery, special procedures, and medications.
Symptoms
Skin changes can appear anywhere in the body even the insides of the mouth, bottoms of the feet, and on the genitals. Squamous cell carcinoma of the skin is most common on the scalp, backs of the hands, ears, or lips. These areas are at a high risk due to frequent exposure to the sun.
Squamous cell carcinoma symptoms include skin changes such as:
- A firm red nodule
- A rough–feeling lump or growth that may crust over like a scab and bleed
- A growth that is higher than the surrounding skin yet dips down at the center
- A wound or sore that will not heal, or a sore that heals but returns
- A bigger region of flat, scaly, and red skin, about 1 inch
- A rough and scaly patch on the lip that can progress to form an open sore.
- A patch that is red, sore, or rough inside the mouth.
- A patch that is raised and red or a sore resembling a wart on or inside the anus or on the genital area.
If you have a sore or scab that hasn’t healed for over two months, or a flat patch of scaly skin that persists, it is recommended to schedule an appointment with a doctor. Additionally, if you notice any new lump, mole, or changes to an existing mole or spot on your skin, it is important to seek medical attention.
Causes
Squamous cell cancer is caused by a p53 gene mutation. The most prevalent cause of p53 gene mutation is ultraviolet (UV) exposure from the sun or indoor tanning beds. The DNA of a cell includes the instructions that inform the cell what to do. The p53 gene instructs the cells to divide and reproduce to replace cells that have reached the end of their lifespan.
A p53 gene mutation means that the cells lack the instructions they require to function properly. As a result, the squamous cells divide and reproduce excessively frequently, resulting in the formation of tumors such as bumps, lumps, or lesions, in and on the body. Squamous cell carcinoma of the skin develops when the DNA of the flat, thin squamous cells in the middle and outer layers of the skin changes or mutates.
However, sun exposure does not explain skin cancers that originate on skin that is not normally exposed to sunlight. This suggests that other variables may increase the likelihood of skin cancer.
Risk factors
Several factors can contribute to one’s risk of developing squamous cell carcinoma of the skin, such as:
- Fair skin: Squamous cell carcinoma of the skin can occur in people of any skin color. Nevertheless, individuals with less melanin in their skin are at a higher risk because they have less natural protection against harmful UV radiation.
People with blond or red hair, light–colored eyes, and freckles are more susceptible to squamous cell carcinoma compared to people with darker complexion.
- Prolonged sun exposure: Having long–term sun exposure or solar damage or UV light at an early age can raise the risk of squamous cell carcinoma.
- Use of tanning beds: Squamous cell carcinoma is more likely to develop in people who use indoor tanning beds.
- History of sunburns: People who sunburn easily are more likely to develop squamous cell carcinoma, especially when one has suffered sunburn as a child or adolescent.
- History with precancerous skin lesions: The chance of developing squamous cell carcinoma of the skin is greater in people with a precancerous skin lesion, such as actinic keratosis or Bowen’s disease.
- History of skin cancer: Recurrence of squamous cell carcinoma of the skin is possible to those who had it before.
- Weakened immune system: Immunocompromised people such those who had organ transplants, leukemia, or lymphoma are at a higher risk of developing skin cancer.
- Rare genetic disorder: A condition that causes extraordinary sensitivity to sunlight known as xeroderma pigmentosum, can potentially result in acquiring skin cancer.
Diagnosis
To diagnose a squamous cell carcinoma of the skin the doctor may inquire about the symptoms. Test and procedure may include:
- Physical examination: The doctor may perform a thorough inspection of the skin for symptoms along with asking about the patient’s medical history.
- Biopsy: A skin biopsy is the removal of a tiny sample of tissue to be examined under a microscope. The type of skin biopsy depends on the specific situation. The doctor will utilize a tool to remove away some or all the suspicious skin lesion to confirm a squamous cell carcinoma of the skin diagnosis.
- Imaging tests: An imaging test will be used to determine the size of the carcinoma beneath the skin and whether it has spread to other parts of the body, particularly the lymph nodes. This is usually done through CT scan or MRI.
Treatment
The specific treatment of squamous cell carcinomas of the skin is determined by the size, location, and aggressiveness of the tumor, as well as one’s personal preferences. The treatment focuses on eradicating cancer from the tissues of the body. Most squamous cell carcinomas of the skin can be eliminated with simple surgery or, in rare cases, with a topical medication.
- Treatments for very small skin cancers: Less invasive treatments are available for low–risk, small skin cancer, such as:
- Curettage and electrodessication (C and E): This treatment is frequently utilized for tiny or very superficial squamous cell skin tumors. The procedure involves scratching the malignant lump with a spoon–like tool or curette, followed by burning the region with an electric needle.
- Laser therapy: This option is commonly recommended for very superficial skin lesions since it usually comes with minimal injury to surrounding tissue and a lower risk of bleeding, swelling, and scarring. The procedure uses a strong light beam that vaporizes growths.
- Cryosurgery: This is a treatment that uses severe cold to freeze and kill abnormal cells. The procedure usually uses substances such as liquid nitrogen to achieve this intense cold. After the C and E procedure, freezing may be done. This is often used to treat superficial skin lesions. Most people recover quickly and with little pain from the procedure.
- Photodynamic therapy: Photodynamic therapy is a treatment for superficial skin cancers that involves the use of photosensitizing drugs and light. This therapy starts with the application of a liquid drug on the skin that sensitizes cancer cells to light. Then, a specific type of light is directed onto the treated area to destroy the cancer cells.
- Treatments for larger skin cancers: Larger squamous cell carcinomas and those that spread deeper into the skin and may require more invasive treatment, such as:
- Simple excision: In some cases, the doctor may advise wide excision. This entails removing additional normal skin around the tumor. In simple incision, the doctor usually removes malignant tissue as well as a border of good skin around it. Skin reconstruction may be done to minimize scarring.
- Mohs surgery: This is a precise, outpatient procedure to remove high–risk skin cancer while preserving healthy tissue to ensure that the entire tumor is removed while avoiding taking too much healthy skin from the surrounding area. This is done through layer–by–layer excision, inspecting each layer under a microscope until no abnormal cells remain.
- Radiation therapy: This procedure is usually recommended for people who are unable to undergo surgery, or at a high risk of cancer recurrence. To kill cancer cells, radiation therapy employs high–energy beams such as X–rays and protons.
- Treatments for skin cancer that spreads beyond the skin: These drug treatments are often prescribed when the squamous cell carcinoma spreads to other parts of the body:
- Chemotherapy: If squamous cell carcinoma spreads to the lymph nodes or other regions of the body, chemotherapy can be administered. Chemotherapy is a widely used cancer treatment. It uses medications to kill cancer cells and halt tumor growth. It could be combined with other cancer treatments including targeted drug therapy and radiation therapy. Chemotherapy is typically administered intravenously.
- Targeted drug therapy: Targeted medication therapy is frequently used in conjunction with chemotherapy. It targets specific weaknesses seen in cancer cells. Cancer cells can be killed by blocking these weaknesses.
- Immunotherapy: Immunotherapy may be used for advanced squamous cell carcinoma of the skin or when other therapies are not suitable. Since cancer cells release proteins that blind immune system cells, the body’s disease-fighting immune system may fail to battle cancer. Immunotherapy works by disrupting that process. Immunotherapy is a cancer-fighting medicine that boosts the immune system.
