Skin Cancer

Squamous cell carcinoma (SCC) is a skin cancer that begins in the squamous cells, which are thin, flat cells that look like fish scales under the microscope. The word squamous came from the Latin squama, meaning "the scale of a fish or serpent" because of the appearance of the cells.

Squamous cells are found in the tissue that forms the surface of the skin, the lining of the hollow organs of the body, and the passages of the respiratory and digestive tracts. Thus, squamous cell carcinomas can actually arise in any of these tissues.

Squamous cell carcinoma of the skin occurs roughly one-quarter as often as basal cell carcinoma. Light-colored skin and a history of sun exposure are even more important in predisposing to this kind of skin cancer than to basal cell carcinoma. Men are affected more often than women. Patterns of dress and hairstyle may play a role. Women, whose hair generally covers their ears, develop squamous cell carcinomas far less often in this location than do men.

Unlike basal cell carcinomas, squamous cell carcinomas can metastasize, or spread to other parts of the body. These tumors usually begin as firm, skin-colored or red nodules. Skin cancer that start out within solar keratoses or on sun-damaged skin are easier to cure and metastasize less often than those that develop in traumatic or radiation scars. One location particularly prone to metastatic spread is the lower lip. A proper diagnosis in this location is, therefore, especially important.

What is BCC?

Basal Cell Carcinomas are abnormal, uncontrolled growths or lesions that arise in the skin’s basal cells, which line the deepest layer of the epidermis (the outermost layer of the skin). BCCs often look like open sores, red patches, pink growths, shiny bumps, or scars and are usually caused by a combination of cumulative and intense, occasional sun exposure.

BCC almost never spreads (metastasizes) beyond the original tumor site. Only in exceedingly rare cases can it spread to other parts of the body and become life-threatening. It shouldn’t be taken lightly, though: it can be disfiguring if not treated promptly.

More than 4 million cases of basal cell carcinoma are diagnosed in the U.S. each year. In fact, BCC is the most frequently occurring form of all cancers also in Cyprus. More than one out of every three new cancers is a skin cancer, and the vast majority are BCCs.

The major causes:

Both long-term sun exposure over your lifetime and occasional extended, intense exposure (typically leading to sunburn) combine to cause damage that can lead to BCC. Almost all BCCs occur on parts of the body excessively exposed to the sun — especially the face, ears, neck, scalp, shoulders, and back. On rare occasions, however, skin cancer develop on unexposed areas. In a few cases, contact with arsenic, exposure to radiation, open sores that resist healing, chronic inflammatory skin conditions, and complications of burns, scars, infections, vaccinations, or even tattoos are contributing factors. 

Who gets it?

Anyone with a history of sun exposure can develop BCC. However, people who are at highest risk have fair skin, blond or red hair, and blue, green, or grey eyes. The tendency to develop BCC may also be inherited. Those most often affected are older people, but as the number of new cases has increased sharply each year in the last few decades, the average age of patients at onset has steadily decreased in Cyprus. The disease is rarely seen in children, but occasionally a teenager is affected. 

Risk of recurrence:

People who have had one BCC are at risk for developing others over the years, either in the same area or elsewhere on the body. Therefore, regular visits to a specialist should be routine so that not only the site(s) previously treated, but the entire skin surface can be examined. BCCs on the scalp and nose are especially troublesome, with recurrences typically taking place within the first two years following surgery. Should a skin cancer recur, the plastic surgeon might recommend a different type of treatment. Some methods, such as Mohs micrographic surgery, may be highly effective for recurrences.

The first step is to confirm the diagnosis of BCC or SCC with biopsy. In this procedure, the skin is first numbed with local anesthesia. A sample of the tissue is then removed and sent to be examined under a microscope in the laboratory to seek a definitive diagnosis. If tumor cells are present, treatment is required. Fortunately, there are several effective methods for eliminating BCC or SCC. Choice of treatment is based on the type, size, location, and depth of penetration of the tumor, the patient’s age and general health, and the likely outcome to his or her appearance.

Using a scalpel, the plastic surgeon removes the entire growth along with a surrounding border of apparently normal skin as a safety margin. The skin around the surgical site is closed with stitches, and the tissue specimen is sent to the laboratory to verify that all cancerous cells have been removed. Cure rates are generally above 95 percent in most body areas. A repeat excision may be necessary on a subsequent occasion if evidence of skin cancer is found in the specimen.

MOHS surgery:

The plastic surgeon removes a thin layer of tissue containing the tumor. While the patient waits, frozen sections of this excised layer are mapped in detail and examined under a microscope, generally in an on-site laboratory. If skin cancer is present in any area of the excised tissue, the procedure is repeated only on the body area where those cancer cells were identified. This technique can save the greatest amount of healthy tissue and has the highest cure rate, 99 percent or better. It is often used as a first treatment in large tumors in cosmetically important areas, and those that have recurred, are poorly demarcated (hard to pinpoint), or are in critical areas around the eyes, nose, lips, and ears, temple, scalp, or fingers.

 

This technique is usually reserved only for small lesions. The growth is scraped off with a curette,(an instrument with a sharp, ring-shaped tip), then the tumor site is desiccated (burned) with an electrocautery needle. The procedure has cure rates generally under 95 percent. In some areas of the body, it is repeated a few times to help assure that all cancer cells are eliminated. Local anesthesia is required. The technique may not be as useful for aggressive skin cancers, those in high-risk sites, or sites that would be left with cosmetically undesirable results. Typically, a round, whitish scar is left at the surgery site.

Tumor tissue is destroyed by freezing. Liquid nitrogen is applied to the growth with a cotton-tipped applicator or spray device, freezing it without requiring any cutting or anesthesia. The procedure may be repeated at the same session to ensure total destruction of malignant cells. The growth subsequently blisters or becomes crusted and falls off, usually within weeks. Temporary redness and swelling can occur, and in most cases, pigment may be lost at the site. Cryosurgery is only effective for small lesions, especially superficial BCC, but has a lower cure rate than the surgical techniques–approximately 85-90 percent, depending on the physician’s expertise.

It is important to note that (unlike Mohs surgery and excisional surgery), curettage and electrodesiccation, cryosurgery, or topical medications all have one significant drawback in common – since no tissue is examined under the microscope, there is no way to determine how completely the tumor was removed.