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Carcinoma, Squamous Cell

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Synonyms of Carcinoma, Squamous Cell

Disorder Subdivisions

General Discussion

Squamous cell carcinoma (SCC) is the second most common skin cancer with between 200,000 and 250,000 cases reported each year. It is a malignant cancer that usually develops from the epidermis and/or the mucous lining of the body cavities (epithelium), but may occur anywhere on the body. SCC most often affects individuals who are exposed to large amounts of sunlight. Susceptibility is related to the amount of melanin pigment in the skin, and light-skinned persons are most vulnerable. With appropriate treatment, it is usually curable.

Symptoms

Squamous cell carcinoma may develop anywhere on the skin or mucous membranes. It is characterized by a red papule or plaque with a scaly or crusted surface. Most cases appear on sun-exposed areas of the body, but some occur in other areas such as the mouth. In some cases, the bulk of the lesion may lie below the skin, eventually ulcerating and invading the underlying tissue. It is estimated that in about two-thirds of the cases of lesions on the tongue or mucous membranes of the body, the disorder has not spread before it was diagnosed.

SCC is suspected whenever a small, firm reddish-colored skin lesion or growth or bump appears on the skin. It may also be a flat growth with a curly and crusted surface. Most often these growths are located on the face, ears, neck, hands and/or arms, but such SCC growths may occur on the lips, mouth, tongue, genitalia or other area.

Clinicians have concluded that extensive sun damage to the skin may cause "precancerous conditions". Some of these include actinic keratosis, leukoplakia and Bowen's disease. Actinic (sometimes called solar) keratoses consist of rough, scaly growths that range in color from brown to red. These growths may grow as large as one-inch in diameter and are more frequently found in older people. When actinic keratosis affects the lips (usually the lower lip), it is known as actinic cheilitis. Leukoplakia arises most often as white patches on the tongue or in the mucous membrane of the mouth. It is usually caused by smoking or by the persistent irritation of the gums because of ill-fitting dentures.

For more on Bowen's disease, see Related Disorders, below.

Causes

The most common causes of squamous cell carcinoma are radiation from the sun and arsenic exposure. Skin that has been damaged by exposure to certain chemicals (carcinogens), heat, radiation, chronic skin ulcers or chronic draining sinuses is also susceptible to SCC. It may develop on normal tissue or it may develop on preexisting patches of precancerous tissue (leukoplakia).

Affected Populations

Squamous cell carcinoma is a common form of skin cancer that affects men and women equally. Individuals who are chronically exposed to sunlight or arsenic are at higher risk of being affected. The Bowen's disease form of this disorder affects both males and females. However, women are more apt to be affected when the disease is found in the genital area.

Related Disorders

Symptoms of the following disorders can be similar to those of squamous cell carcinoma. Comparisons may be useful for a differential diagnosis;

Basal cell carcinomas may appear as crusted lesions that have ulcerated or as small, firm nodules that have a shiny appearance. As with Bowen's disease, the lesions may resemble localized dermatitis or psoriasis. In most cases, basal cell carcinoma first appears as a small elevation of the skin (papule) that grows larger. Within months the elevation may develop a "pearly" border with a slight indentation in the center and abnormally dilated capillaries (telangiectasias). The lesion may continue to grow and may periodically bleed and crust over. Basal cell carcinomas rarely spread to other parts of the body, but invade underlying areas if not treated.

Bowen's disease is a precancerous form of squamous cell carcinoma that is confined to where it is originally found on the body. It seldom metastasizes. Bowen’s disease appears as a solitary or multiple lesion that consists of a reddish brown, scaly or crusted patch on the skin. Lesions are slightly thickened and resemble psoriasis or dermatitis. Bowen's disease may be caused by chronic sun exposure or arsenic exposure. It is believed that Bowen's disease lesions that appear on the genitals may be caused by the human papilloma virus and therefore may be infectious. (For more information on this disorder, choose "Bowen" as your search term in the Rare Disease Database.)

Malignant melanomas may appear in mucous membranes, the skin, eyes or on pigment cells. Their shape, size and color may vary greatly from case to case. Many melanomas arise from moles. Symptoms may include a mole that has changed in size, and/or level of elevation; appears inflamed; and/or has appeared to "spread" to the surrounding area. (For more information on this disorder, choose "Malignant Melanoma" as your search term in the Rare Disease Database.)

Standard Therapies

Diagnosis
A biopsy is essential for the diagnosis of SCC.

Treatment
Treatment of squamous cell carcinoma depends upon the size, site and potential aggressiveness of the lesion. Methods of treatment include:

Curettage and desiccation is an in-office procedure that uses a special spoon-like instrument (curette) to scoop out the cancerous cells and tissue. This is followed by the application of an electric current to kill the remaining cells (desiccation). Surgical excision is a method of cutting out of the tumor and stitching up of the remaining tissue. Radiation therapy is used if the skin cancer is located in an area difficult to treat surgically. Microscopically controlled excision (Mohs surgery) involves the repeated cutting out of small pieces of tissue that is then examined microscopically. Repeated application of this technique minimizes the removal of healthy tissue and is cosmetically more satisfying, especially if carried out with a plastic surgeon as part of the medical team. The outlook for small squamous cell lesions that are removed early and completely is excellent.

Investigational Therapies

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government website.

For information about clinical trials being conducted at the National Institutes of Health (NIH) in Bethesda, MD, contact the NIH Patient Recruitment Office:

Tollfree: (800) 411-1222
TTY: (866) 411-1010
Email: prpl@cc.nih.gov

nformation on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.

For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:

Tollfree: (800) 411-1222
TTY: (866) 411-1010
Email: prpl@cc.nih.gov

For information about clinical trials sponsored by private sources, contact:
www.centerwatch.com

There is a tremendous amount of clinical trial activity on squamous cell carcinoma, with more than 100 studies listed (2005) on www.clinicaltrials.gov. Many of the investigational treatments involve chemotherapies, combinations of drugs, and drug comparisons to treat squamous cell carcinoma in its various stages and locations on the human body.

Two drugs have earned orphan status for treating squamous cell carcinoma. Intradose was designated an orphan drug in 2000 and is produced by Matrix Pharmaceuticals. Proxinium was designated an orphan drug in 2005 and is produced by a Canadian pharmaceutical company, Viventia Biotech, Inc.

Organizations related to Carcinoma, Squamous Cell

References

TEXTBOOKS
Beers MH, Berkow R., eds. The Merck Manual, 17th ed. Whitehouse Station, NJ: Merck Research Laboratories; 1999:321-24; 691-93; 758; 843.

Berkow R., ed. The Merck Manual-Home Edition.2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2003:672; 764-65; 1238-39.

Larson DE. ed. Mayo Clinic Family Health Book. New York, NY: William Morrow and Company, Inc; 1996:1004-06.

Kasper, DL, Fauci AS, Longo DL, et al. Eds. Harrison's Principles of Internal Medicine.
16th ed. McGraw-Hill Companies. New York, NY; 2005:497-98.

REVIEW ARTICLES
Veness MJ. Treatment recommendations in patients diagnosed with high-risk cutaneous squamous cell carcinoma. Australas Radiol. 2005;49:365-79.

Lane JE, Kent DE. Surgical margins in the treatment of nonmelanoma skin cancer and mohs micrographic surgery. Curr Surg. 2005;62:518-26.

Dixon AJ, Hall RS. Managing skin cancer -- 23 golden rules. Aust Fam Physician. 2005;34:669-71.

Maier T. Korting HC. Sunscreens -- which and what for? 2005;18:253-62.

Tran KT, Lamb P, Deng JS. Matrikines and matricryptins: Implications for cutaneous cancers and skin repair. J Dermatol Sci. 2005;40:462-67.

Boukamp P. UV-induced skin cancer: similarities -- variations. J Dtsch Dermatol Ges. 2005;3:493-503.

Boukamp P. Non-melanoma skin cancer: what drives tumor development and progression? Carcinogenesis. 2005;26:1057-67.

FROM THE INTERNET
Grund S. Squamous cell cancer. Medical Encylopedia. MedLine Plus. Update Date: 8/16/2004. 3pp.
www.nlm.nih.gov/medlineplus/ency/article/000829.htm

Skin Cancer (PDQ): Treatment Health Professional Version. National Cancer Institute. Last Modified: 04/01/2005. 11pp.
www.nci.nih.gov/cancertopics/pdq/treatment/skin/healthprofessional/allpages/print

Skin Cancer (PDQ): Screening Health Professional Version. National Cancer Institute. Last Modified: 12/16/2005. 6pp.
www.nci.nih.gov/cancertopics/pdq/screening/skin/healthprofessional/allpages/print.

Report last updated: 2008/04/20 00:00:00 GMT+0