Squamous Cell Carcinoma (SCC)
Squamous cell carcinoma, the second most common skin cancer after basal cell carcinoma, afflicts more than 200,000 Americans each year. It arises from the epidermis and resembles the squamous cells that comprise most of the upper layers of skin. Squamous cell cancers may occur on all areas of the body including the mucous membranes, but are most common in areas exposed to the sun.
Although squamous cell carcinomas usually remain confined to the epidermis for some time, they eventually penetrate the underlying tissues if not treated. In a small percentage of cases, they spread (metastasize) to distant tissues and organs. When this happens, they can be fatal. Squamous cell carcinomas that metastasize most often arise on sites of chronic inflammatory skin conditions or on the mucous membranes or lips.
What Causes It
Chronic exposure to sunlight causes most cases of squamous cell carcinoma. That is why tumors appear most frequently on sun-exposed parts of the body: the face, neck, bald scalp, hands, shoulders, arms, and back. The rim of the ear and the lower lip are especially vulnerable to the development of these cancers.
Squamous cell carcinomas may also occur where skin has suffered certain kinds of injury: burns, scars, long-standing sores, sites previously exposed to X-rays or certain chemicals (such as arsenic and petroleum by-products). In addition, chronic skin inflammation or medical conditions that suppress the immune system over an extended period of time may encourage development of squamous cell carcinoma.
Occasionally, squamous cell carcinoma arises spontaneously on what appears to be normal, healthy, undamaged skin. Some researchers believe that a tendency to develop this cancer may be inherited.
Who Gets It ?
Anyone with a substantial history of sun exposure can develop squamous cell carcinoma. But people who have fair skin, light hair, and blue, green, or gray eyes are at highest risk. Those whose occupations require long hours outdoors or who spend extensive leisure time in the sun are in particular jeopardy. Dark-skinned individuals of African descent are far less likely than fair-skinned individuals to develop skin cancer. More than two thirds of the skin cancers that they do develop, however, are squamous cell carcinomas, usually arising on the sites of preexisting inflammatory skin conditions or burn injuries. Precancerous Conditions Certain precursor conditions, some of which result from extensive sun damage, are worth noting. They are sometimes associated with the later development of squamous cell carcinoma. They include:
- Actinic, or solar, keratosis. Actinic keratoses are rough, scaly, slightly raised growths that range in color from brown to red and may be up to one inch in diameter. They appear most often in older people.
- Actinic cheilitis. A type of actinic keratosis occurring on the lips, it causes them to become dry, cracked, scaly, and pale or white. It mainly affects the lower lip, which typically receives more sun exposure than the upper lip.
- Leukoplakia. These white patches on the tongue or inside of the mouth have the potential to develop into squamous cell carcinoma.
- Bowen’s disease. This is now generally considered to be a superficial squamous cell cancer that has not yet spread. It appears as a persistent red-brown, scaly patch which may resemble psoriasis or eczema. If untreated, it may invade deeper structures.
Regardless of appearance, any change in a preexisting skin growth, or the development of a new growth or open sore that fails to heal, should prompt an immediate visit to a physician. If it is a precursor condition, early treatment will prevent it from developing into a squamous cell carcinoma. Often, all that is needed is a simple surgical procedure or application of a topical chemotherapeutic agent.
Squamous cell carcinomas occur most frequently on areas of the body that have been exposed to the sun for prolonged periods. Usually, the skin in these areas reveals telltale signs of sun damage, such as wrinkling, changes in pigmentation, and loss of elasticity.
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