Squamous Cell Carcinoma

UT Southwestern Medical Center's specialized skin cancer experts deliver skilled care to patients with all stages of squamous cell carcinoma. Our patients have access to the most advanced treatments and clinical trials that aren't available at every hospital.

UT Southwestern is home to the only National Cancer Institute-designated comprehensive cancer center in North Texas. Our experienced team offers a unique level of skill and expertise – as well as innovative, science-based therapies – to people with squamous cell carcinoma.

Advanced Treatment for a Common Skin Cancer

Squamous cell carcinoma – also called squamous cell cancer – is one of the most common types of skin cancer, accounting for approximately 20 percent of all skin cancer cases.

One of the three primary types of cells that make up the skin (epidermis), squamous cells are flat. They are located near the top of the epidermis and are continually shed as new squamous cells develop.

Program Highlights

UT Southwestern’s Comprehensive Melanoma and Skin Cancer Program specialists offer patients a unique level of expertise and experience and the most innovative and advanced therapies.

Our experts diagnose and treat all types of skin cancer – from the most common to the very rare – and deliver the advanced screening, precise diagnostics, and pioneering treatments that are leading to better-than-ever patient outcomes. UT Southwestern’s team works closely with patients to develop tailored care plans that are based on each person’s unique condition, overall health, and treatment goals and preferences.

Highlights of our program include:

• An integrated, multidisciplinary team that includes dermatologists, surgical and radiation oncologists, medical oncologists, pathologists, and radiologists – all of whom take a personalized, evidence-based approach to skin cancer diagnosis and care
• A focus on screening, early detection, and accurate diagnoses – all key to successful skin cancer treatment
• The most sophisticated diagnostic tools available, including highly specialized dermatopathology testing and in-house molecular profiling
• Expertise in all types of surgery to remove all types of skin cancer, including Mohs surgery, tumor excision, and regional lymph-node dissection 
• Leadership in the use of stereotactic radiosurgery – including tools such as the Gamma Knife and CyberKnife – to treat some cases of skin cancer
• Immunotherapies, such as immune checkpoint inhibitors, which stimulate the immune system to target and kill skin cancer cells
• Targeted therapies, which use drugs to target abnormal proteins in tumor cells
• Opportunities for patients to enroll in clinical trials aimed at improving the diagnosis and treatment of skin cancer via promising new protocols that are not yet available to the public
• A comprehensive variety of cancer support services

Symptoms

Squamous cell carcinomas often arise on sun-exposed skin – such as that of the face, lips, ears, and backs of hands – but also can develop in scars, sores, and the genital area.

These skin cancers tend to grow quickly and, if left untreated, can spread to deeper layers of skin, the lymph nodes, and other parts of the body. It’s important that squamous cell carcinomas are entirely removed to prevent recurrence in the same area.

Often starting as colored spots on the skin, squamous cell carcinomas can appear as:

• Rough or scaly red patches that might crust or bleed
• Raised growths or lumps that might have a lower area in the center
• Open sores with oozing or crusted areas that don’t heal or that heal and return
• Wart-like growths

Risk Factors

As with all types of skin cancer, sunlight and tanning-bed exposure are key risk factors for squamous cell carcinomas. Other risk factors include:

• Fair skin: Caucasians – particularly those with skin that tends to freckle or burn – are at much greater risk of developing skin cancer than African-American and Hispanic people.
• Gender: Men are at higher risk than women for developing squamous cell carcinoma.
• Advancing age: People are at higher risk for developing squamous cell carcinoma as they get older.
• Prior skin cancer: People who have previously had squamous cell carcinomas or other types of skin cancer are at greater risk for developing new ones in other areas.
• Smoking: People who smoke are more likely to develop squamous cell carcinoma, particularly on the lips.
• Weakened immune system: Certain medical conditions such as organ transplant and drugs weaken the immune system, increasing people’s risk for developing cancer.
• Radiation exposure: People who have undergone cancer radiation treatment are at elevated risk for developing skin cancer in the exposed area.
• Psoralens and ultraviolet light (PUVA) therapies: Used to treat psoriasis, these therapies can increase patients’ risk of squamous cell carcinoma.
• Xeroderma pigmentosum (XP): People with this very rare inherited condition frequently develop many skin cancers.

Diagnosing and Staging Squamous Cell Carcinoma

Diagnosis

UT Southwestern’s skin cancer specialists typically evaluate and diagnose squamous cell carcinoma by conducting a skin biopsy. If a spot on the skin appears to be cancerous or precancerous, a small sample of the suspicious tissue is removed for microscopic evaluation by a dermatopathologist.

Staging

Our physicians determine squamous cell carcinoma’s stage – the severity and extent to which it has metastasized beyond the primary location – by considering these factors:

• Extent of the tumor (T): Refers to the tumor’s location, size, and whether it has grown into nearby structures or tissues
• Spread to nearby lymph nodes (N): Refers to whether the cancer has metastasized to lymph nodes near the tumor
• Spread to distant sites (M): Refers to whether the cancer has metastasized to other parts of the body

Numbers or letters after T, N, or M provide more details about each of these factors of the squamous cell carcinoma. That information is then combined with the following to determine the cancer’s overall stage:

• Stage 0 (in situ): Pre-carcinoma that has the potential to become carcinoma
• Stage I: Early, localized disease with no squamous cell carcinoma in the lymph nodes
• Stage II: Fairly early, fairly localized disease that is slightly more advanced than stage I, with no squamous cell carcinoma in the lymph nodes
• Stage III: Disease that has spread to areas in the skin near the primary location or the lymph nodes near the squamous cell carcinoma
• Stage IV (metastatic): Disease that has spread via the lymph nodes or the blood stream to distant parts of the body – most commonly the lungs, liver, bones, and brain

Treatments

UT Southwestern offers a number of advanced therapies for people with squamous cell carcinoma. They include surgery, nonsurgical local therapies, and radiation therapy.

Surgery

Surgery is often the first line of treatment for squamous cell carcinoma, and it might be performed in conjunction with other therapies.

The incision and scar size, patient recovery time, and whether the surgery is performed as an inpatient or outpatient procedure all depend upon the cancer’s size, depth, and location.

UT Southwestern offers squamous cell carcinoma surgeries that include:

• Traditional tumor excision: Called wide excision, this surgery involves removal of the tumor and a bit of normal surrounding tissue to check for carcinoma cells. The surgery margin of surrounding tissue varies by the cancer location.
• Curettage and electrodesiccation: Usually used for superficial squamous cell carcinomas, curettage and electrodesiccation involves removing the cancer cells with a tool called a curette and then destroying any remaining cells with an electrode. The procedure sometimes must be performed more than once.
• Mohs surgery: Used most often in non-melanoma skin cancers, this outpatient procedure removes skin cancer one layer at a time and can be used as an alternative to wide excision surgery. As each layer is removed, it’s examined under a microscope. If the margins are cancer free, the surgery is completed. This process allows surgeons to spare as much tissue as possible.
• Sentinel lymph-node biopsy: This biopsy of the adjacent lymph nodes is often performed during tumor excision surgery to see if the cancer has spread. Our surgeons will determine if patients need this.
• Reconstructive surgery: UT Southwestern surgeons can sometimes use reconstructive surgery to prevent or treat scarring or disfigurement after skin cancer treatment, especially when a tumor is large. We also offer immediate local tissue reconstruction after Mohs surgery.

Nonsurgical Local Therapies

• Cryotherapy (cryosurgery): Nitrogen applied to the squamous cell carcinoma freezes and kills the cancer cells. The procedure often is performed more than once.
• Photodynamic therapy (PDT): A liquid drug applied to the squamous cell carcinoma turns into a chemical that makes the tumor cells highly sensitive to certain kinds of light. A special light focused on the tumor then destroys the cancer cells.
• Laser treatment: Sometimes used to treat presquamous cell carcinoma (in situ), a beam of laser light is used to target and destroy the precancerous cells.
• Chemical peel: Used sometimes to treat superficial squamous cell carcinomas, a bit of trichloracetic acid applied directly to the tumor kills the cancer cells.

Radiation Therapy

Radiation therapy uses external radiation – delivered by beams of high-energy X-rays – to target and destroy squamous cell carcinoma cells and prevent them from growing.

UT Southwestern offers both traditional radiation therapy and stereotactic radiosurgery to treat squamous cell carcinoma that has spread to the brain or other organs that can’t be treated with surgery or when a patient isn’t healthy enough for surgery. It might also be used after surgery to kill tumor cells left behind.

Our stereotactic radiosurgery tools include the Gamma Knife, which uses beams of highly focused gamma rays from hundreds of different angles that converge at the tumor, and the CyberKnife, a linear accelerator mounted on a robotic arm that moves around the head to focus multiple beams of radiation into the tumor.

UT Southwestern physicians and physicists are recognized as worldwide leaders in these sophisticated treatments.

Support Services

UT Southwestern’s Harold C. Simmons Comprehensive Cancer Center offers a comprehensive range of support services to help our patients and their loved ones through skin cancer treatment and beyond.