How to Treat Squamous Cell Carcinoma: Finding Your Best Option

A scaly patch of skin may seem harmless until it worsens. Maybe you know someone who spent years working outdoors with little sun protection and later grew an attention-grabbing splotch under the eye that turned into a persistent sore.

Or perhaps you’ve heard of somebody on steroids for a long time who now worries about having red, bleeding lumps on both sun-exposed and covered areas. While easy to overlook, these changes may be warning signs of skin cancer, particularly squamous cell carcinoma.

Understanding how to treat squamous cell carcinoma allows patients to take charge and make informed choices about their care. So, in this article, we discuss how the disease arises, how doctors detect it, and what the best approaches are for its treatment and prevention.

What Should You Know About Squamous Cell Carcinoma of the Skin?

Squamous cell skin carcinoma, also known as “squamous cell skin cancer,” is a type of malignant tumor affecting the epidermis, the skin’s outer layer. The typical cells making up the epidermis are called “keratinocytes,” which are arranged like bricks in a wall to shield deeper tissues from infection, dehydration, and injuries.

Young keratinocytes are round, actively dividing cells that ensure continuous skin renewal. As they mature, these cells flatten and create a tough surface barrier that resembles overlapping scales under a microscope. The term “squamous” comes from squamosus, a Latin word meaning scaly.

Actively growing cells are vulnerable to DNA damage, which may cause cancer if not corrected immediately. Consequently, the epidermis is prone to the development of malignancies, including squamous cell carcinoma. Basal cell carcinoma, or basal cell cancer, is a tumor that affects the deeper portions of the epidermis.

Squamous cell carcinoma lesions have various forms. Patients may describe them as open sores, wart-like growths, cauliflower-like lumps, horn-like projections, or red, thickened patches, depending on the type.

In later stages, these tumors can look like wounds that don’t heal, often bleeding with the slightest touch. Without treatment, squamous cell skin cancer may grow deeper or spread to lymph nodes and other areas, including vital organs.

In many cases, these tumors appear in sun-exposed areas, sometimes starting as dry, rough spots known as actinic keratosis—an early sign of sun damage. However, in individuals with profoundly weakened immunity, certain types of warts, a personal or family history of skin cancer, or previous cancer treatments, the lesions can also appear in less exposed areas, such as the mouth and genitals.

Risk factors for squamous cell skin carcinoma include the following, which are all linked to persistent or recurrent DNA damage in skin cells:

• Chronic, excessive UV exposure
• Physical traits that indicate reduced natural sun protection, such as fair skin, red hair, and blue eyes
• Rare inherited conditions that raise skin cancer risk, such as xeroderma pigmentosum
• A significantly impaired immune response, which increases the risk of squamous cell carcinoma 65 to 250 times
• Exposure to chemical pollutants, including arsenic and some carbon-based compounds found in insecticides and industrial chemicals
• Warts caused by high-risk human papillomavirus (HPV) infection, which are often sexually transmitted or linked to suppressed immunity, especially after an organ transplant
• Chemotherapy
• Ionizing radiation, including exposure during cancer treatment or work in certain places, such as nuclear power plants
• Chronic inflammation, such as in cases of non-healing wounds and burns

Squamous cell carcinoma is more common in adults older than 60, as DNA damage builds up over time. The risk is greater at high altitudes and in places near the equator due to increased UV exposure. Men are affected more often than women since they spend more time outdoors.

How Serious Is Squamous Cell Skin Cancer?

As with any tumor type, squamous cell carcinoma of the skin is a concern that warrants prompt attention but is highly treatable if caught early. Beginning lesions are confined to the skin and respond well to treatment. However, advanced or invasive squamous cell carcinoma penetrates deeper structures like fat, muscle, or bone and can spread widely, making therapy less effective.

Squamous cell carcinoma spreads more slowly than the rare, aggressive mole-like cancer melanoma but is far more common. Roughly 1 in 20 people with squamous cell carcinoma of the skin may see it spread to the lymph nodes or more remote sites over 5 years. However, due to its high prevalence, this nonmelanoma skin cancer can cause as many, if not more, deaths than melanoma despite being less aggressive.

How Is Squamous Cell Cancer of the Skin Detected?

Skin cancer is most often first spotted by patients themselves, though doctors also detect a significant number of cases incidentally. Individuals who routinely monitor their skin are more likely to catch changes early and seek timely care. Family members can help, but people who live alone or seldom examine their skin are more likely to experience delays in diagnosis.

During your dermatologist visit, you will be asked about your medical and family history, lifestyle, and any skin changes you’ve noticed. A full skin exam follows, where your doctor assesses the skin blemish that concerns you the most and checks for distant spread. Your specialist may use a dermatoscope (or dermoscope), which is a handheld magnifying device that helps them examine lesions for cancerous features.

If a spot appears potentially serious, additional tests may be needed. Noninvasive imaging techniques like reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) allow for a detailed look at abnormal cells without needing a skin biopsy. Dermatologists correlate the results of these tests with their dermatoscopic findings for a more accurate diagnosis.

A biopsy may be necessary if the specialist suspects a deeper or more aggressive tumor, such as melanoma. If the results confirm squamous cell carcinoma affecting deeper tissues, an imaging tool, such as an ultrasound, CT scan, MRI, or PET scan, may be used to determine the extent of spread.

What Do Dermatologists Recommend for Squamous Cell Carcinoma Treatment?

Treatment options vary from patient to patient. First, the dermatologist will look for high-risk tumor characteristics, which signal a greater chance of recurrence, spread, or resistance to treatment. High-risk tumors may have one or more of the following features:

• Extension beyond the subcutaneous fat
• Diameter of at least 2 centimeters
• Lymph node involvement
• Occurrence of similar lesions in areas far away from the primary tumor, including vital organs like the lungs, liver, and brain
• Evidence of rapid tumor growth seen under a microscope
• Appearance in areas where cancer is more likely to spread, such as the center of the face, along nerves, and the groin

A history of skin cancer, severe immune problems, or treatment for any malignancy can also make the tumor more aggressive and harder to treat.

Next, the skin specialist will consider the following factors:

• Conditions that make some treatments risky or difficult to tolerate, such as advanced age, serious health problems like heart disease or uncontrolled diabetes, and medication allergies
• Growth in cosmetically or functionally sensitive spots like the face and fingers
• A family history of skin cancer, which can make radiation therapy a poor choice
• Personal preference, as some individuals may want to avoid surgery

As with any skin cancer type, surgical removal is the most recommended treatment option for squamous cell carcinoma. This procedure may be accomplished through wide excision or Mohs micrographic surgery.

Wide excision removes the tumor along with a small margin but doesn’t check for hidden cancerous cells during the session. That’s why this treatment has a significant risk of recurrence.

Meanwhile, Mohs surgery removes the lesion stepwise, examining each piece under a microscope to ensure no cancer cell remains afterward. The procedure takes out only diseased cells while sparing as much healthy tissue as possible. Of all squamous cell carcinoma treatment options, Mohs surgery has the highest cure rate and the best cosmetic and functional outcomes, being able to maintain both appearance and function, especially in delicate areas.

However, the Mohs technique requires specialized training, making it unavailable in some geographic locations. Fortunately for patients in LA, BHSkin Dermatology’s board-certified skin experts perform Mohs surgery as part of their routine services.

Patients may also consider alternative surgical treatments. Curettage with electrodesiccation scrapes away cancer cells before applying heat to destroy the remaining tissue. Laser ablation eliminates abnormal cells using high-intensity light. Cryosurgery freezes the tumor with liquid nitrogen. However, these methods carry a greater risk of recurrence and lower cure rates.

If you want to understand the differences between Mohs surgery and excision, you can read our in-depth comparison in one of our previous articles. For a broader look at all squamous cell carcinoma treatment options, we encourage you to visit our full guide.

Can Squamous Cell Carcinoma Be Treated Without Surgery?

For individuals with slow-growing squamous cell carcinoma types, non-surgical treatments are sometimes an option. These alternatives include radiation therapy, photodynamic therapy, topical medications, immunotherapy injections, systemic chemotherapy, targeted therapy, and electrochemotherapy.

Radiation therapy may be considered for removing the primary lesion if patients cannot undergo surgery due to advanced age, underlying health issues, or cancer growth in an anatomically complex site. This treatment may also help eliminate residual cancer cells, particularly in cases of incomplete wide excision.

The decision to pursue radiation therapy may also depend on patient preference. However, this option isn’t suited for individuals with a family history of cancer or malignancies that return after prior radiation treatment. Radiotherapy can also cause skin reactions, pigmentation issues, and spider veins, which can persist for a long time and produce cosmetic problems in young patients.

Photodynamic therapy involves using a photosensitizing agent on the lesion before exposing it to enhanced blue or red light. Topical chemotherapy entails applying imiquimod or 5-fluorouracil on the tumor at the recommended dose and duration. These treatments not only target the main tumor but also help eliminate invisible cancerous and precancerous cells in the surrounding skin when applied over a larger area.

Certain chemotherapy or immunotherapy drugs, including methotrexate, 5-fluorouracil, bleomycin, and interferon, may be injected into superficial skin cancer lesions when surgery isn’t an option. If the tumor doesn’t completely shrink by this method, surgical excision should be reconsidered due to the risk of an undetected invasive squamous cell carcinoma.

Systemic chemotherapy uses oral or injectable drugs to treat widespread or hidden cancer. Agents traditionally given for systemic squamous cell carcinoma treatment include doxorubicin, cisplatin, and paclitaxel, but they have largely been replaced by targeted therapies due to their severe side effects.

Targeted therapy drugs work by attacking specific weaknesses in cancer cells, making them more precise than traditional chemotherapy. Agents approved by the FDA for systemic squamous cell carcinoma treatment include cemiplimab, pembrolizumab, cetuximab, and panitumumab. These drugs may be used to treat widespread squamous cell carcinoma when surgery or radiation isn’t feasible.

Cemiplimab and pembrolizumab help the immune system fight cancer effectively for long periods and are usually preferred over cetuximab and panitumumab, which intervene with cancer growth but may stop working over time. However, cemiplimab and pembrolizumab can cause hypertension, diarrhea, nausea, fatigue, rash, and constipation, making cetuximab and panitumumab more suitable for patients who cannot tolerate those side effects.

Electrochemotherapy applies electrical pulses to a target area (for example, the arm) to enhance the effectiveness of chemotherapy drugs like cisplatin and bleomycin against skin cancer. This treatment is an alternative for inoperable lesions to slow their progression.

Note that treatments for widespread disease, such as targeted therapy and electrochemotherapy, often do not provide a cure but only help control symptoms. These options may be offered to improve comfort and quality of life for patients.

Ongoing research explores the potential benefits of HPV vaccination for HPV-positive squamous cell carcinoma. While studies indicate enhanced clinical response in immunocompromised patients with advanced disease, the optimal vaccine formulation hasn’t been established.

What Steps Can You Take to Prevent Squamous Cell Skin Cancer?

Excessive UV exposure is the most significant cause of squamous cell carcinoma, making UV protection the most effective deterrent. Although the role of HPV vaccination in squamous cell skin cancer prevention remains controversial, it may be considered for individuals with poor immune status.

In patients with a history of skin cancer, the risk of recurrence is highest within the first 2 years after diagnosis, making this period crucial for monitoring. Vigilance is key, with monthly self-skin exams recommended in addition to UV protection.

Individuals who are skin cancer-prone may also benefit from oral supplementation with the anti-inflammatory vitamin nicotinamide. Oral retinoids like acitretin, isotretinoin (Accutane), and etretinate, as well as the oral chemotherapy drug capecitabine, may also be considered in this patient group. Everyone else should perform routine self-skin checks and see a dermatologist for a thorough skin cancer screening at least once a year.

Navigating Squamous Cell Carcinoma Treatment

No two cases of squamous cell carcinoma are exactly alike. The disease develops due to various factors, such as immune status and lifestyle, which differ for everyone. Treatments include surgical and non-surgical options, with Mohs surgery being the preferred approach. However, management plans must be tailored to each patient’s unique circumstances.

UV protection remains the cornerstone of prevention, given the condition’s strong link to UV exposure. However, extra precautions may be worth considering for people with HPV infection or poor immunity.

As always, skin cancer care demands specialized medical expertise. To get optimal results, don’t settle for anyone less than a board-certified dermatologist to help you choose a precise, effective, and safe treatment strategy designed for your individual needs.

Superior Skin Cancer Treatment Right in the Heart of Sunny LA

New research from LA beach communities links changes in squamous cell carcinoma trends to beach-related habits. For instance, more women are being diagnosed with this condition, catching up with men in numbers. Additionally, though typically a head and neck cancer, squamous cell carcinoma is now detected more often on the limbs and trunk in these communities—no surprise because bikinis aren’t exactly SPF-rated!

These trends highlight the importance of skin protection and early detection, especially for people basking in the SoCal sun year-round. But with BHSkin Dermatology’s experts by your side, there’s no need to panic.

At BHSkin Dermatology, our skincare specialists are some of the best in the Golden State. Our board-certified dermatologists have spent years serving the diverse skincare needs of LA residents, providing both preventive solutions and advanced treatments. Visit our Glendale or Encino clinic or use our telederm portal for your initial consultation.

Book your appointment today!

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Author: Don Mehrabi

Don Mehrabi, MD, FAAD, is LA's leading board-certified dermatologist is the president of BHSkin Dermatology and proud father of 3 wonderful children. He treats patients in both Encino-Tarzana and Glendale. This blog builds on medical studies combined with Dr. Mehrabi's first-hand experiences from his practice.