Mr. Andy Pay FRCS (Plast), Consultant Plastic Surgeon
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SCC (Squamous Cell Carcinoma)
This is the second most common skin cancer after BCC (Basal Cell Carcinoma) and like most skin cancers, is thought to be mainly attributed to a combination of skin type and UV radiation in the form of sun exposure.
The typical presentation is of a lesion which is scaling, scabbing and crusting. They are often raised from the surface of the skin and are easily knocked and traumatised. They can ooze and bleed and are occasionally painful particularly when accidentally caught on clothing.
Squamous cell carcinomas can occur on any part of the body, but are most common on areas that are exposed to the sun, such as the head and neck (including the lips and ears) and the backs of the hands and forearms. They can also occur where the skin has been damaged by X-rays, and also on old scars, ulcers, burns and persistent chronic wounds. This is sometimes known as a Marjolin’s ulcer.
Risk factors for the development of a Squamous Cell Carcinoma.
Squamous cell carcinomas mainly affect the following groups:
- Older people – even those who have tended to avoid the sun – but younger ones who are out in the sun a lot due to occupation or lifestyle choice, are at risk too.
- Builders, farmers, surfers, sailors and people who often use sun-beds can develop squamous cell carcinomas when they are relatively young.
- Those with a fair skin are more likely to get skin cancers than people with a dark skin.
- Although they are not hereditary, skin type and the tendency to burn often runs in families, so a family history of development of skin cancer may be relevant.
- Anyone who has had a lot of ultraviolet light treatment for skin conditions such as psoriasis will also be at increased risk of getting an SCC.
- Those whose immune system has been suppressed by medication taken after an organ transplant, or by treatment for leukaemia or a lymphoma.
How is an SCC diagnosed?
If your doctor thinks that the lesion on your skin is in need of further investigation, you will be referred to a skin specialist such as myself, who will decide whether or not it really is a squamous cell carcinoma. This can often be done clinically by a specialist who is familiar with the presentation of SCC and who is familiar and trained in the use of a magnifying device called a Dermatoscope to help make the diagnosis. Generally, however, to confirm the diagnosis, a small piece of the lesion (an incision biopsy), or the whole area (an excision biopsy), will be removed under local anaesthetic and examined under the microscope in the laboratory.
How are they treated?
Most SCCs can be cured if they are detected early. There are different treatments depending on a number of factors such as size, site and anatomical location. Also of importance are patient factors such as general health and co-morbidities. Usually the best treatment is for complete surgical excision – this can often be achieved with the initial biopsy. If SCCs are left untreated for too long, a few (less than 5%) may spread to other parts of the body, and this can be more serious.
For further information on SCC, please visit these web pages within the websites of;
British Association of Plastic Reconstructive an Aesthetic Surgeons, (BAPRAS)
British Association of Dermatologists (BAD)