Squamous Cell Carcinoma Treatment

How it works

Using a scalpel, the surgeon removes the entire tumor along with a “safety margin” of surrounding normal tissue. The margin of normal skin removed depends on the thickness and location of the tumor.

Typically, the patient goes home after the surgery, and the excised tumor goes to the lab. If the lab finds cancer cells beyond the margins, the patient may need to return for more surgery until margins are cancer-free.

When it’s used

For small, early SCCs that have not spread, excisional surgery is frequently the only treatment required.

How it works

Mohs surgery is performed during a single visit, in stages. The surgeon removes the visible tumor and a very small margin of tissue around and beneath the tumor site. The surgeon color-codes the tissue and draws a map correlated to the patient’s surgical site. In an on-site lab, the surgeon examines the tissue under a microscope to see if any cancer cells remain. If so, the surgeon returns to the patient and removes more tissue exactly where the cancer cells are. The doctor repeats this process until there is no evidence of cancer. Then the wound may be closed or, in some cases, allowed to heal on its own.

When it’s used

Mohs surgery is the most effective technique for removing SCCs, sparing the greatest amount of healthy tissue while achieving the highest possible cure rate – up to 97 percent for tumors treated for the first time. It is often recommended for SCCs located in small, cosmetically or functionally important areas around the eyes, nose, lips, ears, scalp, fingers, toes or genitals. Mohs is also used for SCCs that have recurred, and for tumors that are large or growing rapidly, as well as ones with indistinct edges. Learn if Mohs is right for you.

Superficial versus minimally invasive

Superficial SCCs have not penetrated (or invaded) below the topmost layer of the skin (the epidermis), while minimally invasive SCCs have just barely invaded the second layer of skin (the dermis) and have no high-risk characteristics.

How it works

The physician scrapes or shaves off the SCC with a curette (a sharp instrument with a ring-shaped tip), then uses heat or a chemical agent to stop the bleeding and destroy remaining cancer cells.  The procedure may be repeated a few times during the same session until no cancer cells remain.

When it’s used

Curettage and electrodesiccation can be effective for most small, superficial or minimally invasive SCCs.

How it works

The physician uses a cotton-tipped applicator or spray device to apply liquid nitrogen to freeze and destroy the tumor, which eventually falls off, allowing healthy skin to emerge.

When it’s used

Cryosurgery is effective for superficial SCCs, especially for patients with bleeding disorders, implantable cardiac devices or problems tolerating anesthesia.

How it works

The physician directs a beam of intense light at the tumor to target the cancerous cells. Some lasers vaporize (ablate) the skin cancer, while others (nonablative lasers) convert the beam of light to heat, which destroys the tumor.

When it’s used

Laser surgery is not yet FDA-approved for SCC but is sometimes used for superficial SCCs, especially when other techniques have been unsuccessful.

How it works

The physician uses low-energy X-ray beams to destroy the tumor, with no need for cutting or anesthesia. Destruction of the tumor may require several treatments over a few weeks or daily treatments for a specified time.

When it’s used

Radiation therapy is primarily used for SCCs that are hard to treat surgically, and in elderly patients or people in poor health for whom surgery is not advised. For some cases of advanced SCC, especially those with perineural involvement, radiation may be used after surgery, or in combination with other treatments.

How it works

The physician applies a light-sensitizing topical agent and, after allowing a period of time for absorption, directs a strong red or blue light or a pulsed-dye laser at the tumor to activate the topical agent, killing cancer cells while sparing healthy tissue. After the procedure, patients must strictly avoid sunlight and indoor tanning for at least 48 hours, as ultraviolet exposure will increase activation of the medication and may cause severe sunburns. 

When it’s used

PDT can be used for some superficial SCCs on the face and scalp but is not recommended for invasive SCCs. It is most effective for treating actinic keratoses, which can be precursor lesions to SCC.

How it works

5-fluorouracil (5-FU) and imiquimod are creams or gels that can be applied directly to affected areas of the skin to treat superficial SCCs with minimal risk of scarring. Imiquimod activates the immune system to attack cancerous cells, while 5-FU is a topical therapy that targets cancerous and precancerous cells.

When it’s used

While these topical medications are not yet FDA-approved for treating SCCs, they are sometimes used for superficial tumors. The medications are also used preventatively for AKs.

Treating advanced SCCs

More extensive treatment is necessary for SCCs that have spread, are large in size, have penetrated the skin deeply and caused severe local damage or have resisted multiple treatments and recurred. Find out more about these treatment options here.