Although SCCs usually remain confined to the epidermis for some time, they eventually penetrate the underlying tissues if not treated. When this happens, they can be disfiguring. In a small percentage of cases, they spread (metastasize) to distant tissues and organs and can become fatal. SCCs that metastasize most often arise on sites of chronic inflammatory skin conditions or on the mucous membranes or lips.

Warning signs of SCC

(a) A wart-like growth that crusts and occasionally bleeds.

(b) A persistent, scaly red patch with irregular borders that sometimes crusts or bleeds.

(c) An open sore that bleeds and crusts and persists for weeks

(d) An elevated growth with a central depression that occasionally bleeds. A growth of this type may rapidly increase in size.

(e) A persistent, scaly red patch with irregular borders that sometimes crusts or bleeds.

(f) An open sore that bleeds and crusts and persists for weeks.

Treatment options
After clinical examination, a biopsy is needed to confirm the diagnosis. This involves removing a piece of the affected tissue and examining it under a microscope. If tumor cells are present, treatment (usually surgery) is required.

Fortunately, there are several effective ways to eradicate SCC. The choice of treatment is based on the type, size, location, and depth of penetration of the tumor, as well as the patient's age and general state of health.

Curettage and electrodesiccation
As with AKs, the growth is scraped off with a curette and the tumor site desiccated with an electrocautery needle. But when treating BCCs or SCCs, the procedure is typically repeated a few times to help assure that all cancer cells are eliminated.

Excisional surgery
Along with the above procedure, this is one of the most common treatments. Using a scalpel, the physician removes the entire growth along with a surrounding border of apparently normal skin as a safety margin. The incision is closed, and the growth is sent to the laboratory to verify that all cancerous cells have been removed.

Radiation
X-ray beams are directed at the tumor. Total destruction usually requires several treatments a week for a few weeks. This is ideal for tumors that are hard to manage surgically and for elderly patients who are in poor health.

Mohs micrographic surgery
The physician removes the visible tumor with a curette or scalpel and then removes very thin layers of the remaining surrounding skin one layer at a time. Each layer is checked

under a microscope, and the procedure is repeated until the last layer viewed is cancer-free. This technique has the highest cure rate and can save the greatest amount of healthy tissue. It is often used for tumors that have recurred or are in hard-to-treat places such as the head, neck, hands, and feet.

Cryosurgery
It is especially useful when a limited number of lesions are present. Liquid nitrogen is applied to the growths with a cotton-tipped applicator or spray device. This freezes them without requiring any cutting or anesthesia. They subsequently blister or become crusted and fall off. Some temporary redness and swelling can occur. In some patients, pigment may be lost.

Laser surgery
Laser is very effective to treat this sort of cases. It gives good control over the depth of tissue removed, much like chemical peels. Laser is also used as a secondary therapy when topical medications or other techniques are failed.

Photodynamic Therapy (PDT)
PDT can be especially useful for lesions on the face and scalp. Topical 5-aminolevulinic acid (5-ALA) is applied to the lesions.

Imiquimod
FDA approved imiquimod for the treatment of genital warts. This topical cream is a promising new treatment for actinic keratosis and Bowen's disease. It causes cells to produce interferon, a chemical that attacks cancerous and precancerous cells.