Treatment for Squamous Cell Carcinoma
The choice of treatment is based on a variety of factors including size and location of the lesion, type of tumor, and age of the patient.
SCC in-situ can be eradicated by curettage and desiccation, a procedure used to scrape out and burn all the cancer cells. Invasive SCC that is small and not deep (superficial) can be treated using this procedure as well.
Small and large SCC can be excised (cut out). With surgical excision, a margin of healthy appearing tissue is removed along with the tumor to reduce the risk for recurrence. The skin is removed through the third layer, the subcutaneous fat, and is usually sutured (stitched) closed. In most cases, results are cosmetically acceptable. The excised tissue is sent to a pathologist to check the margins (i.e., the side and deep edges of the tissue) to ensure that all the cancer has been removed. Occasionally, cancer cells are found in the margins and a second, similar procedure is performed to remove remaining cancer cells.
A specialized form of surgery (called Mohs micrographic surgery) may be performed, especially when the tumor is large, has poorly defined edges, or develops on areas of the body where the scar outcome is more important (e.g., on the face). Mohs surgery involves removing the tumor with a relatively small margin of healthy appearing tissue.
While the patient waits, the surgeon examines all the edges thoroughly to determine if and where any cancer cells remain. When more tissue needs to be taken, the surgeon removes a portion only in the area of the cancerous cells, thus excising as little of the healthy skin as possible. When the procedure is complete, the wound is closed and repaired to minimize scarring. The recurrence rate for skin cancer removed by Mohs micrographic surgery is about 2 percent while the recurrence rate associated with traditional excision varies from 5 to 10 percent.
Radiation therapy is an effective option for many tumors, especially large lesions on the nose, lips, and eyelids, and for patients unable to undergo surgical excision. Radiation destroys tumor cells along with some surrounding healthy tissue. The scar is usually lighter and forms a depression.
Cryosurgery, treatment of skin lesions with liquid nitrogen, may be used in some cases. The wound created by the procedure usually heals within 4 weeks and the resulting scar is similar to that made by curettage and desiccation.
SCC that has spread to lymph nodes or distant sites (metastasized) can be treated using surgery and additional radiation or chemotherapy. An oncologist is usually consulted at this point.