Squamous cell carcinoma

definition

The term squamous cell carcinoma describes a form of malignant skin cancer that originates in the superficial skin cells. It occurs particularly frequently in areas that have been exposed to UV radiation for a long time or are subject to permanent mechanical irritation. The carcinoma can theoretically be localized in any place that is built up as a squamous epithelium. This includes the entire surface of the skin as well as the mucous membrane in the mouth and in the genital region.

Squamous cell carcinoma looks normal at first: it usually appears as a grayish-yellowish deposit on the skin that can be covered with cornea. Over time, squamous cell carcinoma often develops into a wart-like outward growth or a permanently sore, flat area.

The reasons

The most common cause of squamous cell carcinoma is UV radiation, i.e. exposure to the sun. Another known but less common risk factor is constant skin irritation.Both cause damage to the skin that the body can fail to repair in the long term. As a result, tumor cells can develop in these areas, which eventually multiply into an ulcer.

Squamous cell carcinomas therefore predominantly occur in areas that are exposed to strong sunlight or are constantly irritated in the same way as in chronic skin wounds. As with most other types of cancer, other risk factors are a long-term weakened immune system (e.g. due to HIV) and nicotine consumption.

The localization

Squamous cell carcinoma of the nose

The face is often exposed to the sun and is therefore one of the most common sites of squamous cell carcinoma: About 90% of all squamous cell carcinomas occur on the face. The areas that naturally receive more sunlight, i.e. the lower lip and the nose, are particularly at risk.

To protect against the development of squamous cell carcinoma, care should always be taken to ensure that these areas have a sufficient sun protection factor.

Also read the article: Skin cancer on the face.

Squamous cell carcinoma of the scalp

Like the face, the scalp is one of the areas of the body that is often exposed to sunlight. This is especially true if the hair is cut short and headgear is rarely worn.

On the scalp, diagnosis is sometimes made more difficult by the fact that the resulting squamous cell carcinoma is covered by hair and is therefore only recognized later than in other parts of the body.

The symptoms of squamous cell carcinoma

Detecting squamous cell carcinoma in its early stages can be difficult, especially for the layperson. It usually appears initially as a grayish-yellowish area that is often cornified. Alternatively, squamous cell carcinoma can look like a small open wound that won't heal. These areas can feel hardened or knotty due to the tendency to keratinize.

Rapid growth is typical of squamous cell carcinoma: If an affected person notices that the suspicious area of ​​skin changes or enlarges within weeks, this can be an indication of squamous cell carcinoma. In addition, these tumors often have an increased tendency to bleed because they are supplied by numerous blood vessels. If the area starts to bleed unusually easily, the affected person should also pay attention and see a dermatologist as soon as possible.

For more information, see: The symptoms of skin cancer.

The diagnosis

A dermatologist should always be consulted if there is any suspicious area of ​​skin that could be squamous cell carcinoma. Through experience and practice, the latter can usually already express a suspicion of what is causing the suspicious area.

In order to confirm the suspicion, a biopsy is usually taken, i.e. a sample from the skin tissue concerned. This tissue sample is then examined microscopically in the laboratory. If the tissue shows the characteristics of squamous cell carcinoma, the diagnosis is confirmed.

How can you recognize skin cancer? Find out more here.

The treatment

The treatment of squamous cell carcinoma is primarily curative, i.e. healing-oriented. Due to the superficial growth on the skin, the ulcer can usually be easily removed as part of an outpatient procedure. The excised material is then usually sent to a laboratory to make sure it was indeed the suspected squamous cell carcinoma.

If surgical removal is not possible, a number of other methods can be used that destroy the tumor tissue. These include, for example, mechanical methods such as icing or curettage (scraping), which can be carried out under local anesthesia. Chemotherapeutic agents applied locally as ointments or creams can also be used.

In larger centers, photodynamic therapy is sometimes used: The region to be treated is made light-sensitive with an ointment and then irradiated with certain light (which is harmless to the rest of the body). The treating dermatologist decides which therapy option is appropriate in the individual case.

The articles might interest you:

• Skin cancer treatment

Irradiation for squamous cell carcinoma

Radiation is a common form of therapy for cancer, but is rarely used for squamous cell carcinoma. It is one of the various treatment options that can be considered if, for some reason, surgical removal is not possible without complications. The tumor can then be irradiated in a targeted manner in order to prevent the cancer cells located there from growing and thus to destroy the tumor.

Radiation is sometimes used as a therapy even if the squamous cell carcinoma has spread. This is usually done in combination with a chemotherapeutic agent.

Metastases in squamous cell carcinoma

In medicine, metastasis is understood as the spreading of cancer cells to other areas and organs of the body, where they settle and cause secondary ulcers (metastases).

Squamous cell carcinoma is by definition a malignant, i.e., malignant, tumor and can therefore theoretically metastasize. In reality, however, a spread of squamous cell carcinoma is rare and observed very late in the course of the disease. This may come as a surprise, since this type of cancer is characterized by rapid growth in size - however, squamous cell carcinoma usually grows outward and on the surface of the skin without penetrating into the depths of the tissue or vascular structures.

Prognosis

The term “malignant”, which is used to describe squamous cell carcinoma, may at first give rise to thoughts of a poor prognosis. However, this is not entirely true: Due to the superficial location and the low probability of spreading, the tumor can usually be recognized in the early stages and removed without complications. This should be followed by regular checks in order to identify and remove further tumors as early as possible.

It is more difficult if metastasis has already taken place, i.e. the formation of daughter ulcers. Since squamous cell carcinoma spreads late, as already described, in this case a late stage can be assumed. The prognosis then depends on various factors such as the size, number and location of the subsidiary ulcers. A general survival or cure rate cannot be given in this case and should therefore be discussed with the attending physician.

Life expectancy

If the squamous cell carcinoma was detected early enough and, accordingly, could be completely surgically removed, the life expectancy of the affected person is not shortened by the cancer.

In the very rare case of metastasis, life expectancy can be limited: As described above, life expectancy then depends largely on the characteristics of the daughter ulcers.