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dermatologist examining a patient’s arm for squamous cell carcinoma

An In-Depth Look at Squamous Cell Carcinoma

Did you know that squamous cell carcinoma (SCC) is the second most common type of skin cancer, with over one million new cases diagnosed each year in the United States? This month, we’re taking an in-depth look at SCC so you can identify the warning signs, learn the treatment options, and take steps to prevent UV damage so that you won’t be one of the millions who develop SCC this year.


What is squamous cell carcinoma?

There are three layers of the skin, the epidermis, dermis, and hypodermis. One type of cell in the epidermis, which is the topmost layer, is the squamous cell.

Cancer happens because of DNA damage that causes cells in the body to mutate and begin reproducing out of control, which causes tumors. When cancer occurs in the squamous cells, it’s called squamous cell carcinoma.

The most common areas to find squamous cell carcinoma are places that get the most sun exposure, such as the ears, face, neck, and hands. However, SCC can occur anywhere on the body, even in places with little or no UV exposure, such as the genitals.


What causes cancer in the squamous cells?

Like all skin cancers, squamous cell carcinoma is primarily caused by unprotected exposure to UV rays from the sun and tanning beds. In fact, 90% of nonmelanoma skin cancers are associated with UV exposure. When UV rays damage the DNA of squamous cells, they begin to replicate out of control, causing SCC.


Skin cancer risk factors

A cancer risk factor is a behavior or personal characteristic that is correlated with higher incidences of a type of cancer. Keep in mind that having risk factors does not guarantee that you’ll develop SCC, just as a lack of risk factors does not guarantee that you will never develop SCC. Some common squamous cell carcinoma risk factors are:

  • Lifetime exposure to UV rays, including long days spent outside and short bursts like walking from your car to the grocery store
  • A history of previous SCC or other types of skin cancer
  • Fair skin that burns and freckles easily
  • Light hair colors and green or blue eyes
  • A weakened immune system from other illnesses
  • A condition that makes you more sensitive to the sun
  • Skin precancers, such as actinic keratosis – 40% – 60% if squamous cell carcinomas begin as actinic keratosis


Though people with fair skin have the highest risk of getting SCC, people of all skin tones can get any type of skin cancer. In fact, the majority of skin cancers in African Americans occur in the squamous cells.


Signs and symptoms to watch for

With early detection and treatment, squamous cell carcinoma is often curable. However, if left to grow, it can become invasive, disfiguring, and deadly. If you notice any of the following warning signs, schedule an appointment with your dermatologist right away:

  • Red, scaly patches that won’t heal or that heal but come back repeatedly
  • Open sores that won’t heal
  • Rough, thick, wart-like skin
  • Raised growths with a dip in the center


If you ever notice changes in your skin that give you pause, don’t hesitate to schedule an appointment. Remember, with early treatment, SCCs are usually curable.


Treatments for squamous cell carcinoma

There are several treatment options for SCC. The specific combination that will work best for a patient depends upon the size, location, and depth of the tumor, as well as the age and overall healthiness of the patient. You and your dermatologist will work together to create a treatment plan, but it may include one or more of the following methods:


Excision surgery

During excision surgery, the surgeon removes the tumor plus a “margin of safety,” which is a certain amount of skin around the tumor that may also have cancerous cells. Then, the doctor sends the tissue to a lab to see if they got all of the cancerous cells. If any remain, you will need one or more additional surgeries until the margins are clear.


Mohs surgery

Mohs surgery is an in-office procedure similar to excision surgery, but it’s more precise and done in a single day. A Mohs surgeon will remove the tumor and a small amount of surrounding tissue. He or she will then test the tissue on-site and create a detailed map of the skin to identify which cells are healthy and which are cancerous. Then, the surgeon will remove a little more tissue to get more of the cancerous cells and test again.

It may take several rounds to remove all of the cancer, but Mohs surgery has the highest cure rate of all skin cancer treatments because it is so precise. Also, it also preserves more healthy tissue than other surgical methods, so it has outstanding cosmetic outcomes.



Using a cotton-tipped swab or a sprayer, a dermatologist uses liquid nitrogen to freeze and destroy the superficial tumor. Eventually, the tumor will fall off to reveal healthy skin.


Curettage and electrodesiccation

Using a curette (a sharp instrument with a ring-shaped tip), the surgeon removes the squamous cell carcinoma, then uses heat or a chemical agent to stop the bleeding and destroy any remaining cancer cells.


Laser surgery

A dermatologist uses a beam of light to target the tumor. Ablative lasers vaporize the cancer cells, while non-ablative lasers convert the beam to heat to destroy the tumor.



During radiation, a radiologist uses low-energy X-ray beams to destroy the tumor. This method is nonsurgical, but it can take several rounds of treatment to get rid of a tumor.


Topical medications

There are several topical gels and creams that can treat superficial SCC or actinic keratosis. Topical creams have very little risk of scarring, so they are suitable for treating SCCs in visible locations.


An ounce of prevention is worth a pound of cure

We know that 90% of nonmelanoma skin cancers are associated with sun exposure, so the best thing that you can do to reduce your risk of developing squamous cell carcinoma is to protect yourself from the sun.

  • Wear a broad spectrum sunscreen daily – you can still get UV damage when it’s cloudy or through a window
    • Don’t forget to reapply every 2 hours when you’re outside, and more often when swimming or sweating
  • Avoid being outdoors between 10 a.m. and 4 p.m. when the sun’s rays are the strongest
  • Seek shade when possible
  • Wear UPF protective clothing in addition to sunscreen, especially if you’ll be outside for a long time
  • NEVER use a tanning bed! (Did you know that the lights in a tanning bed emit UV radiation that is 10 – 15 times stronger than the sun?)
  • Perform a skin cancer self-exam every month, and see your dermatologist at least once a year for a skin cancer check-up


If you notice a change, schedule an appointment

You are the first line of defense in your skin’s health. When you limit your UV exposure, you reduce your risk of developing squamous cell carcinoma and all other skin cancers. Remember, the sooner you find and treat SCC, the better your chances of curing it. If you notice a change in your skin, schedule an appointment with us right away.


Cumberland SKIN is passionate about skin health. If you have questions about a suspicious spot on your skin this summer, call (615) 235-0325 to schedule your appointment. 

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