Squamous cell carcinoma

Squamous cell carcinoma (squamous epithelioma or spinocellular epithelioma), is the second most common skin cancer after basal cell carcinoma. Forming in the spinous layer of the epidermis, it can arise in any area of the body, but most commonly appears on the lower lip, earlobes, scalp, nose, back of the hands and genitals.

Description

Squamous cell carcinoma is more likely to develop in areas that are always exposed to the sun, or areas that have been damaged by previous burns, scars, or chronic inflammatory skin conditions. The evolution of this carcinoma is generally rapid and, when invasive, can trigger metastases.

Causes

The most frequent cause of squamous cell carcinoma is prolonged and unprotected exposure to ultraviolet radiation, compounded by sunburn. People with very fair skin and green or blue eyes, and those who work or play sports outdoors for many hours are at higher risk. Other predisposing factors include exposure to substances such as mineral oils, combustion products, arsenic, and x-rays. Organ transplantation and subsequent pharmacological immunosuppression are also important risk factors.

Symptoms

Squamous cell carcinoma usually begins as an erythematous lesion covered with scales or crusts, and most frequently appears on skin areas exposed to ultraviolet rays. In advanced stages, the carcinoma can cause undefined margin ulcerations that may crust and bleed.
A much less common variant of squamous cell carcinoma is verrucous carcinoma, which causes painless, cauliflower-shaped lesions. It can occur in any mucous membrane of the head and neck, and is not infiltrative.

Diagnosis

Squamous cell carcinoma is generally not difficult to diagnose. The dermatologist will give a diagnosis following an examination of the size, shape, color and consistency of the lesion.
In its early forms, however, squamous cell carcinoma can often be confused for actinic keratosis. In the case of a suspicious-looking lesion, the specialist can perform a biopsy (removal of a small portion of tissue) and order subsequent histological examination to confirm the nature of the lesion.

Treatment

The treatment of this type of carcinoma is usually surgical. However, before making any decision, the dermatologist will determine the most suitable treatment depending on the location, type, and size of the lesion, as well as the age and general health of the patient.
Alternatives to surgery include:

• curettage
• electrodessication
• topical treatment
• photodynamic therapy

After the removal of this carcinoma, around one third of people will develop another in the same area or nearby. In most cases, such recurrences occur within the first five years after removal. It is, therefore, crucial to undergo periodic dermatological check-ups to monitor any growths or changes.

Prevention

If diagnosed and treated early, squamous cell carcinoma is almost always curable. If neglected, however, it can invade the surrounding soft tissues, cartilage, bones, vessels and nerves, leading to serious complications.
Some preventative measures to reduce the risk of squamous cell carcinoma include:

• expose yourself to the sun responsibly through the use of protective clothing, sunglasses, hats and apply a natural mineral photo reflector to the parts that remain uncovered. Avoid exposure to sunlight during the hottest hours of the summer months, that is, between 11 a.m. and 4 p.m;
• avoiding burning, or the use of sunbeds and UV lamps
• regularly examining the entire surface of the body, including the scalp, and notifying a doctor if a new lesion appears. Seeking medical attention if a skin lesion:

1. has irregular edges
2. oozes or bleeds
3. changes in color
4. grows rapidly
5. causes itches