Squamous Cell Carcinoma
Your biopsy showed a squamous cell carcinoma. A squamous cell is a type of skin cancer, but it is usually not very aggressive. It generally will grow locally and rarely, about 4% of the time, spread inside the body. If left untreated, it will grow larger and deeper over time. This can cause pain, bleeding, and tissue destruction. Therefore, it needs to be removed.
There are several sub-types of squamous cell carcinoma, described below.
Well Differentiated Squamous Cell Carcinoma
Your biopsy did not show any worrisome features of an aggressive cancer. It still needs to be treated, however.
Moderately Differentiated or Poorly Differentiated Squamous Cell Carcinoma
The biopsy showed some features that make it necessary to excise this skin cancer. The cells under the microscope were uglier and more aggressive looking than the average squamous cell carcinoma. This skin cancer needs to be treated in a timely manner.
When possible, squamous cell carcinoma is usually treated with surgical removal. If you have an early squamous cell carcinoma, this can often be performed in your dermatologist’s office while you remain awake. The following explains the types of surgical removal used to treat squamous cell carcinoma, along with other treatment options.
Surgical removal: Three types of surgical removal are used to treat squamous cell carcinoma. The type of surgical removal you receive depends largely on the type of squamous cell carcinoma you have, where it’s located, and how deep it goes.
Here’s what involved with each type of surgical removal:
Excision
In an excision, the area around the skin cancer is numbed like in a skin biopsy with an injection of local anesthesia.
Then, a margin of normal-appearing skin around the area is cut out and the wound is closed with stitches.
In all cases, the tissue removed will be sent to the pathology lab and analyzed to make sure the margins are clear and the spot has been removed.
There is generally little to no wound care required at home. Stitches usually stay in between 10-14 days on the trunk and extremities, depending on the site of the surgery.
Activity like vigorous exercise, tennis, or golf may be limited during that time until stitches come out. In addition, there can be no underwater submersion until the stitches have been removed. This means no swimming or baths until then. Showering after the pressure bandage has been removed, 48 hours after surgery, is fine.
The risks of the procedure are small, but include bleeding, low risk of infection, further required surgery, cancer recurrence, and a scar. The recurrence rate is about 8% for skin cancer excisions.
Mohs Surgery
On some areas of the body, such as an eyelid or your nose, removing an area of normal-looking skin along with the cancer would cause problems. There’s not enough skin in these areas.
Mohs surgery eliminates the need to remove an area of normal-looking skin. This is possible because the surgeon can see where the cancer stops during the surgery.
Click here for further information about Mohs surgery at FDS.
Electrodesiccation and Curettage
In an electrodessication and curettage, or destruction, the wound is basically numbed like a biopsy with an injection of local anesthesia. This surgery is usually performed only when basal cell carcinoma develops on the trunk, an arm, or a leg.
A tool called a curette is used to scrape off the cancer. An electric current in a device called a hyfrecator is used to cauterize the base. The wound heals on its own in four to twelve weeks, depending on the location. For example, it may take about four weeks to heal on the arm and three months on the lower leg, although it may be sooner. The wound heals with a circular pink to white scar.
There is nothing further sent to the laboratory. The area is monitored for recurrency by the doctor.
Activity under water, like in the pool or ocean, is not recommended during the extended healing time. The procedure requires daily wound care and dressings at home. The risks of the procedure are small and include bleeding, low risk of infection, scar, and recurrence of the skin cancer. The recurrence rate is about 10% for this procedure.
Another option at times includes radiation therapy, which is generally not recommended as first-line therapy. Superficial radiation therapy (SRT) is not recommended by us at Florida Dermatology Specialists.
Uncommonly, patients may require consultation with our colleagues in otolaryngology (ENT) or medical oncology for treatment of their squamous cell carcinoma.
For any of the surgical procedures, click here for Preoperative Concerns and Protocols for more information.
If you aren’t sure about having an excision versus a destruction, click here for more information you may find helpful.