Recommendations for Treating Squamous Cell Carcinoma
Squamous cell carcinoma is the second most common type of cancer in the United States, with approximately 700,000 new cases diagnosed each year. It occurs most often on the limbs, head and neck -- areas with a greater exposure to the sun -- but can appear anywhere on the body. The carcinoma usually appears as a crusty or scaly area of the skin, with a red, inflamed base. It can resemble a bump or sore that doesn't heal.
When SCC is treated early, it can be cured. However, when left untreated it can spread to underlying tissues, causing disfigurement. While not common, it can spread to the lymph nodes, blood vessels, nerves, muscles and organs, and can cause death.** Treating squamous cell carcinoma**
The first-ever comprehensive statement on treatment guidelines for squamous cell carcinoma (SCC) was published in November 2015 by the American Society for Dermatologic Surgery Board of Directors. The statement emphasizes the importance of early detection and treatment because "the best chance for curing SCC is in the first treatment of the initial lesion, as all tumor treatment options are less successful for persistent or recurrent tumors than for primary tumors."
The consensus statement was completed in order to provide physicians and patients with a clear understanding of the benefits, risks and problems associated with common treatments for SCC.
According to the ASDS's 2015 consensus statement, Moh's surgery is the most effective treatment for SCC for several reasons:
It has the highest cure rate.
It removes only the affected tissue and preserves the highest amount of unaffected tissue.
It is the most cost-effective type of skin cancer surgery, especially when performed in the doctor’s office.
The removal of the tumors and reconstruction of remaining tissue occur during the same appointment. (An additional appointment is needed for suture removal.)
The authors of the consensus statement also looked at other types of treatment, such as surgical excision, and determined that cure rates were not as high as with Moh’s surgery. Topical treatments were effective but physicians were not as readily able detect that all of the cancer was removed, which could lead to recurrence. Radiation therapy was found to be the most expensive treatment for SCC as it required multiple visits and carries a risk of scarring, inflammation and skin breakdown.
There are, however, a number of factors that can increase the risk of recurrence:
Tumors on the head and neck are more likely to recur and spread to other areas of the body.
The larger the tumor, the higher chance of spreading.
Tumors or lesions more than 4 millimeters in depth have a higher chance of spreading.
Lesions without clear borders might indicate a higher chance of treatment failure.
While Moh’s surgery is the recommended first-line treatment for SCC, the patient’s overall health and psychosocial circumstances should be taken into consideration before deciding on a course of treatment.
Skin Cancer Treatment -- Health Professional Version: National Cancer Institute
Treatment Options -- Squamous Cell Carcinoma: Skin Cancer Foundation