Squamous cell carcinoma:Risk factors,Symptoms,diagnosis and Treatment

Squamous Cell Carcinoma (SCC) is a type of skin cancer and one of the most common forms of skin cancer in the United States, with an increasing incidence rate in the country, particularly among the elderly and those with prolonged sun exposure. Each year, the number of new cases of squamous cell carcinoma amounts to millions.

According to the American Academy of Dermatology (AAD), the number of new cases of squamous cell carcinoma in the United States ranges from one to 1.5 million annually. Squamous cell carcinoma is more prevalent in individuals over the age of 50, but it can occur in younger people as well. The incidence rate is typically higher in males, which may be associated with more frequent outdoor activities and less use of sun protection measures among men. Although individuals with fair skin are at a higher risk, people of all races can develop squamous cell carcinoma.

Risk factors of Squamous Cell Carcinoma (SCC)

Squamous Cell Carcinoma (SCC) has several risk factors that can increase the likelihood of developing this form of skin cancer. These include:

1. Sun Exposure: Prolonged exposure to ultraviolet (UV) radiation from the sun is a leading cause of SCC. The risk is higher for individuals who work outdoors or spend significant time in the sun without proper protection.
2. Skin Type: Fair skin that burns easily and doesn’t tan well is more susceptible to UV damage and, consequently, SCC. However, people of all skin tones can develop SCC.
3. Age: The risk of SCC increases with age, with most cases occurring in people over the age of 50. However, it can occur in younger individuals as well.
4. History of Sunburns: Having a history of severe sunburns, especially during childhood, can increase the risk of SCC later in life.
5. Genetics: A family history of skin cancer, including SCC, can increase an individual’s risk. This may be due to inherited genetic factors or shared environmental and lifestyle factors.
6. Immunosuppression: A weakened immune system, whether due to certain medications, organ transplant, HIV/AIDS, or other conditions, can increase the risk of SCC.
7. Gender: Males are more likely to develop SCC than females, which may be related to differences in outdoor occupational exposure and sun protection habits.
8. Previous Skin Cancer: Individuals who have had SCC or other forms of skin cancer in the past are at a higher risk of developing new skin cancers.
9. Exposure to Toxins: Certain chemicals and substances, such as arsenic and some industrial chemicals, can increase the risk of SCC.
10. Smoking: Tobacco use has been linked to an increased risk of SCC, particularly in the lungs and mouth, but also on the skin.
11. Chronically Wet or Irritated Skin: Skin that is often wet or subject to chronic irritation, such as around the mouth or ears, may be more prone to SCC.
12. Human Papillomavirus (HPV) Infection: Some strains of HPV, a common virus transmitted through skin-to-skin contact, have been associated with an increased risk of SCC, particularly in the genital area and mouth.

Symptoms and signs

Squamous Cell Carcinoma (SCC) typically presents with certain symptoms and signs that can be recognized through visual inspection and sometimes by touch. Here are some of the common symptoms of SCC:

1. Persistent Scaly or Crusted Patches: The most frequent sign of SCC is a rough, scaly patch or a crusty area on the skin that does not heal.
2. Open Sores: SCC may appear as an open sore that bleeds easily and does not heal within a few weeks.
3. Raised, Red Lesions: Sometimes, SCC can manifest as a raised, red nodule or lesion that feels firm to the touch.
4. Induration: The skin in the affected area may become thickened or hardened.
5. A Lump: A small, elevated, and sometimes tender lump may form, which can be a sign of an advanced SCC.
6. Ulceration: As SCC progresses, it may develop into an ulcer that is painful and difficult to heal.
7. Changes in Appearance: The lesion may have a shiny or pearly appearance, and the edges may be uneven or notched.
8. Color Variation: The color of the lesion may vary from pink to red or brown, and it may be darker than the surrounding skin.
9. Diameter: Unlike many benign lesions, SCC lesions are often larger than 1 cm (0.4 inches) in diameter, although they can be smaller.
10. Itching or Burning: The area may be itchy, tender, or painful, although these symptoms are less common.
11. Pigmentation Changes: There may be areas of increased or decreased pigmentation around the lesion.

SCC can resemble other skin conditions, and not all symptoms may be present in every case. If any of these symptoms are noticed, especially if they persist or worsen over time, it is crucial to consult a healthcare professional for a diagnosis. Early detection and treatment of SCC are essential to prevent the cancer from spreading and becoming more difficult to treat.

HOW TO Diagnose?

Squamous Cell Carcinoma (SCC) is typically diagnosed through a combination of clinical examination, patient history, and sometimes, a biopsy. Here’s how SCC is diagnosed:

1. Visual Inspection: A healthcare provider will conduct a thorough visual examination of the skin lesion and the surrounding area. They will look for the characteristic signs of Squamous Cell Carcinoma, such as scaly patches, open sores, raised lesions, and changes in color or texture.
2. Patient History: The healthcare provider will ask about the lesion’s history, including how long it has been present, whether it has changed in size or appearance, and if it has been painful or itchy. They will also inquire about the patient’s history of sun exposure, skin cancer, and other risk factors.
3. Dermoscopy: This non-invasive technique uses a handheld device with a magnifying lens and light source to examine the skin lesion more closely. It can help the healthcare provider to visualize the lesion’s structures and patterns that may be indicative of Squamous Cell Carcinoma.
4. Biopsy: If the lesion appears suspicious, a biopsy will be performed to confirm the diagnosis. There are several types of biopsies, including:
   • Shave Biopsy: A thin layer of the lesion is shaved off with a scalpel.
   • Punch Biopsy: A small, circular instrument is used to punch out a deeper sample of the skin.
   • Excisional Biopsy: The entire lesion is removed along with a surrounding margin of healthy skin.
5. Pathology Examination: The biopsy sample is sent to a pathology lab where a dermatopathologist will examine the tissue under a microscope to look for the presence of cancer cells. The pathologist will provide a diagnosis based on the cellular characteristics and growth patterns typical of SCC.
6. Additional Tests: In some cases, especially if the cancer has spread or if there is a risk of recurrence, additional tests such as imaging scans (CT, MRI, or PET scans) or blood tests may be ordered to determine the extent of the cancer and whether it has metastasized to other parts of the body.

Early detection and diagnosis of SCC are critical for successful treatment. If you notice any suspicious lesions or changes in your skin, it is important to consult a healthcare provider for evaluation. Regular skin checks and professional skin exams, particularly for individuals at high risk, are recommended for the early detection of skin cancers, including SCC.

Treatment plan for Squamous Cell Carcinoma (SCC)

The best treatment plan for Squamous Cell Carcinoma (SCC) depends on several factors, including the cancer’s location, size, depth, whether it has spread, and the patient’s overall health. Here are some of the most common treatment options for SCC:

1. Surgical Removal: This is the most common treatment for SCC. The procedure, known as excision, involves removing the tumor and a surrounding margin of healthy skin. The wound may then be closed with stitches, a skin graft, or a flap.
2. Cryosurgery: This method involves freezing the cancer cells with liquid nitrogen, causing them to die off. It’s typically used for small, superficial SCCs.
3. Electrodesiccation and Curettage: This procedure uses an electric current to destroy cancer cells (electrodesiccation) followed by scraping away the treated tissue (curettage). It’s often used for small, shallow SCCs.
4. Radiation Therapy: Radiation can be used to treat SCC, particularly in cases where surgery is not an option, such as when the cancer is in a difficult-to-reach location or when the patient is not a good candidate for surgery due to health reasons.
5. Photodynamic Therapy (PDT): PDT uses a combination of a special drug and light to kill cancer cells. The drug is activated by light, which causes it to release a type of oxygen that destroys the cancer cells.
6. Topical Medications: In some cases, SCC can be treated with topical creams, such as 5-fluorouracil (5-FU) or imiquimod, which can be applied directly to the skin to kill cancer cells.
7. Chemotherapy: While less common for SCC, chemotherapy may be used if the cancer has spread to other parts of the body. It involves the use of drugs to kill cancer cells throughout the body.
8. Immunotherapy: This treatment uses the body’s immune system to fight cancer. It may be an option for advanced SCC or when other treatments have not been successful.

The choice of treatment is highly individualized and should be made in consultation with a healthcare provider who specializes in skin cancer. The provider will consider the stage of the cancer, the patient’s preferences, and the potential risks and benefits of each treatment option. In many cases, a combination of treatments may be recommended. Regular follow-up appointments and skin checks will be necessary after treatment to monitor for recurrence or new skin cancers.

The cure rate for Squamous Cell Carcinoma

The cure rate for Squamous Cell Carcinoma (SCC) is generally high, especially when the cancer is detected and treated early. The five-year survival rate for localized SCC (Stage 0) is typically over 99%, meaning that the vast majority of people with early-stage SCC can be successfully treated and the cancer will not return or spread within five years. However, the survival rates can decrease as the cancer stage progresses and if the cancer has spread to nearby lymph nodes or other parts of the body.

For Stage I SCC, the five-year survival rate is still very high, usually around 92-96%. Stage II SCC has a slightly lower survival rate, typically ranging from 80% to 90%. For Stage III and IV SCC, where the cancer has spread to lymph nodes or distant organs, the survival rates are lower, and treatment becomes more challenging.

These statistics are averages and can vary widely depending on individual factors, such as the patient’s overall health, the exact location and size of the tumor, and how aggressively the cancer behaves.

Regular skin checks and prompt treatment of any suspicious lesions are crucial for improving the cure rate for SCC. Early detection and treatment can significantly reduce the risk of the cancer spreading and improve the likelihood of a successful outcome.

Preventing

Preventing Squamous Cell Carcinoma (SCC) involves minimizing exposure to risk factors and adopting lifestyle habits that promote healthy skin. Here are some preventive measures:

1. Limit Sun Exposure: Avoid peak sun hours between 10 am and 4 pm when UV rays are strongest. Seek shade, use umbrellas, and wear protective clothing, including long-sleeved shirts, long pants, and wide-brimmed hats.
2. Use Sunscreen: Apply broad-spectrum sunscreen with a high SPF (at least 30) generously and reapply every two hours, or more frequently if sweating or swimming.
3. Avoid Tanning Beds: Ultraviolet radiation from tanning beds can increase the risk of SCC. It’s best to avoid using them altogether.
4. Perform Skin Self-Exams: Regularly check your skin for new growths or changes in existing moles, freckles, or spots. Use a mirror to check hard-to-see areas like the back of your neck and scalp.
5. See a Dermatologist: Have regular skin exams by a dermatologist, especially if you have a history of skin cancer or are at high risk for SCC.
6. Protect Your Skin: Wear protective gloves when working with chemicals or in an environment that can irritate your skin.
7. Quit Smoking: Smoking has been linked to an increased risk of SCC, so quitting can lower your risk.
8. Avoid Chronic Skin Irritation: Address any conditions that cause chronic skin irritation, such as dryness or eczema, to reduce the risk of SCC.
9. Stay Hydrated: Keep your skin hydrated by drinking plenty of water and using moisturizers.
10. Eat a Healthy Diet: A diet rich in fruits and vegetables can provide antioxidants that protect the skin from UV damage.
11. Practice Safe Sex: To reduce the risk of HPV infection, which is associated with an increased risk of SCC, especially in the genital area, practice safe sex and consider HPV vaccination.
12. Be Aware of Medications: Some medications can increase sensitivity to the sun. If you’re taking such medications, be extra vigilant about sun protection.

By following these preventive measures, you can significantly reduce your risk of developing Squamous Cell Carcinoma. Remember that early detection and treatment are key to preventing the cancer from becoming more serious. If you notice any changes in your skin, don’t hesitate to consult a healthcare professional.