SCC often develops on skin that has been exposed to sun or tanning beds for years. The face, ears, lips, backs of hands, arms and legs are common places for SCC to form.

Signs/symptoms include the following:

• A bump or lump on the skin that may feel rough. As it grows, it may become dome-shaped or crusty and may bleed.
• A sore that doesn’t heal or heals and returns.

• Flat, red, scaly patch that grows slowly. This is known as Bowen’s disease or squamous cell carcinoma in situ which is considered an early stage of SCC.

• In rare cases, SCC begins under a nail, growing and destroying the nail. 

While most SCC has no symptoms, occasionally, they can be painful.

SCC is most common in fair-skinned people who have spent years in the sun. But, people of all races and skin colors can get SCC.

Your risk of developing SCC increases with the following:

• Certain physical features
• Fair or light-colored skin
• Blue, green or gray eyes
• Natural blond or red hair
• Inability to tan
• Significant sun exposure during work or play without using sunscreen or covering up with clothing
• Use of tanning beds or sun lamps or history of many PUVA treatments for psoriasis
• Diagnosed with actinic keratosis (AKs). In adults over the age of 40, about 40-60% of SCC begin in an AK. Signs of AKs include red or pink dry scaly spots that may or may not be painful or sensitive, constantly dry scaly lips or horn-like growth.
• Exposure to cancer-causing chemicals (tar, arsenic, some insecticides or herbicides) or long-term exposure to x-rays
• Smoking
• A weakened immune system such as in organ transplantation, AIDS or leukemia/lymphoma
• A chronic ulcer that has been present for many years
• Some types of human papillomavirus (HPV)
• Medical conditions such as xeroderma pigmentosum, epidermolysis bullosa or albinism

The only way to diagnose squamous cell carcinoma (SCC) or any type of skin cancer is with a skin biopsy. Your dermatologist can perform this procedure during an office visit.

A skin biopsy should not cause anxiety. To perform a skin biopsy, your dermatologist will numb the suspected growth then remove part of it with a scalpel, punch  or razor blade. Your dermatologist will send this to a laboratory to be looked at under a microscope. The findings will be communicated in a biopsy report.

If the biopsy report states that you have a SCC, your dermatologist will consider many factors to determine which treatment is best for you.  These factors include location, size and whether it has spread.

There are many  ways to treat SCC:

• Excision. This is a surgical procedure that your dermatologist can often perform during an office visit. It involves numbing the area to be treated and cutting out any remaining tumor. Like the skin biopsy, this removed skin is examined under a microscope to ensure that the entire tumor has been removed.
• Electrodesiccation and curettage. Once the area to be treated is numbed, this treatment involves scraping away the tumor followed by applying electricity to destroy any remaining cancer cells. This treatment is best used for early SCC such as Bowen’s disease or SCC in situ.
• Mohs micrographic surgery. Named for the doctor who developed this surgery, Mohs (pronounced moes) is a surgery performed by a specialist to remove certain skin cancers. It offers the highest cure rate for difficult-to-treat SCC. Your dermatologist will tell you if Mohs is right for you.  With Mohs surgery, the surgeon will cut out the tumor plus a small amount of normal-looking skin surrounding the tumor. While you wait, the Mohs surgeon uses a microscope to determine if there are leftover cancer cells. If cancer cells remain, the surgeon will continue to remove small amounts of skin and look at them under the microscope. This continues until the surgeon no longer sees cancer cells.
• Radiation. This treatment is reserved for patients with SCC who are not able to have surgery or when surgery may not be the best choice. Radiation may also be used in addition to other treatments, especially when the tumor is at a higher risk of spreading.
• Photodynamic therapy (PDT). This treatment uses light to remove early skin cancers. A solution is applied to make skin cancer cells more sensitive to light. After a few hours, the treated skin is exposed to blue light. The light activates the solution and kills the skin cancer cells.
• Prescription creams. Creams that contain a drug, such as imiquimod or 5-fluorouracil, can be used to treat early SCC such as Bowen’s disease or SCC in situ. The medicated cream is applied at home as directed by the dermatologist.

With treatment, most SCC are cured but early treatment is recommended.  When allowed to grow, SCC can grow deep, destroying tissue and even bone. In some cases, SCC spreads to the lymph nodes and other parts of the body. This may cause serious health problems.

• Ferrucci LM, Cartmel B, Molinaro AM et al. “Indoor tanning and risk of early-onset basal cell carcinoma.” J Am Acad Dermatol  10.1016/j.jaad.2011.11.940. (Article in Press).
• Grossman D, Leffell DJ. “Squamous cell carcinoma.” In: Wolff K et al. Fitzpatrick’s Dermatology in General Medicine, 7th edition. USA. McGraw Hill Medical; 2008, p. 1028-36.
• Habif TP, Campbell JL, Chapman JGH et al. “Bowen’s disease,” In: Dermatology DDxDeck. China; 2006.
• Riddel C, Rashid R, Thomas V. “Ungual and periungual human papillomavirus associated squamous cell carcinoma: A review.” J Am Acad Dermatol 2011;64:1147-53.
• Grossman D, Leffell DJ. “Squamous cell carcinoma.” In: Wolff K et al. Fitzpatrick’s Dermatology in General Medicine, 7th edition. USA. McGraw Hill Medical; 2008, p. 1028-36.
• Habif TP, Campbell JL, Chapman JGH et al. “Squamous cell carcinoma,” In: Dermatology DDxDeck. China; 2006.
• Leibovitch I, Huilgol SC, Selva D et al. “Cutaneous squamous cell carcinoma treated with Mohs micrographic surgery in Australia I. Experience over 10 years.” J Am Acad Dermatol 2005;53:253-60.
• Grossman D, Leffell DJ. “Squamous cell carcinoma.” In: Wolff K et al. Fitzpatrick’s Dermatology in General Medicine, 7th edition. USA. McGraw Hill Medical; 2008, p. 1028-36.
• Habif TP, Campbell JL, Chapman JGH et al. “Squamous cell carcinoma,” In: Dermatology DDxDeck. China; 2006.
• Leibovitch I, Huilgol SC, Selva D et al. “Cutaneous squamous cell carcinoma treated with Mohs micrographic surgery in Australia I. Experience over 10 years.” J Am Acad Dermatol 2005;53:253-60