• Squamous Cell Carcinoma Treatment Options

    Squamous Cell Carcinoma Treatment Options

    Squamous cell carcinomas detected at an early stage and removed promptly are almost always curable and cause minimal damage. However, left untreated, they eventually penetrate the underlying tissues and can become disfiguring. A small percentage even metastasize to distant tissues and organs and can become fatal. Therefore, any suspicious growth should be seen by a physician without delay. A tissue sample (biopsy) will be examined under a microscope to arrive at a diagnosis. If tumor cells are present, treatment is required.

    Fortunately, there are several effective ways to eradicate squamous cell carcinoma. 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 health.

    Treatment can almost always be performed on an outpatient basis in a physician’s office or at a clinic. A local anesthetic is used during most surgical procedures. Pain or discomfort is usually minimal with most techniques, and there is rarely much pain afterwards.

    Mohs Micrographic Surgery
    Using local anesthesia, the physician removes the tumor with a very thin layer of tissue around it. The layer is immediately checked under a microscope thoroughly. If tumor is still present in the depths or peripheries of this surrounding tissue, the procedure is repeated until the last layer examined under the microscope is tumor-free. This technique saves the greatest amount of healthy tissue and has the highest cure rate, generally 98 percent or better. It is frequently used for tumors that have recurred, are poorly demarcated, or are in critical areas around the eyes, nose, lips, and ears. After removal of the skin cancer, the wound may be allowed to heal naturally or be reconstructed using plastic surgery methods.

    Curettage and Electrodesiccation
    Using local anesthesia, the physician scrapes off the cancerous growth with a curette (a sharp, ring-shaped instrument). The heat produced by an electrocautery needle destroys residual tumor and controls bleeding. This technique may be repeated twice or more to ensure that all cancer cells are eliminated. It can produce cure rates approaching those of surgical excision, but may not be as useful for aggressive BCCs or those in high-risk or difficult sites.

    Excisional Surgery
    After numbing the area with local anesthesia, the physician uses a scalpel to remove the entire growth along with a surrounding border of normal skin as a safety margin. The skin around the surgical site is then closed with a number of stitches, and the excised tissue is sent to the laboratory for microscopic examination to verify that all the malignant cells have been removed. The effectiveness of the technique does not match that of Mohs, but produces cure rates around 90 percent.

    Electronic Brachytherapy
    Electronic Brachytherapy is a type of radiotherapy that utilizes a miniaturized high dose rate X-ray source to apply radiation directly to the cancerous site. The goal is to direct the radiation dose to the size and shape of the cancerous area, sparing healthy tissue and organs. Brachytherapy has proven to be a highly successful treatment for cancers of the endometrium, breast and skin. No anesthesia is necessary and is performed typically over eight sessions lasting four weeks (twice per week). These session are less than twenty minutes. Clincial data shows no recurrence. There is no scarring or cosmetic defects. Cure rates are 90-95%.

    Tumor tissue is destroyed by freezing with liquid nitrogen, without the need for cutting or anesthesia. The procedure may be repeated at the same session to ensure total destruction of malignant cells. The growth becomes crusted and scabbed, and usually falls off within weeks. Cryosurgery is effective for the most common tumors and is the treatment of choice for patients with bleeding disorders or an intolerance to anesthesia. This method is used less commonly today, and has a lower cure rate than the surgical techniques–approximately 85-90 percent depending on the physician’s expertise.

    Photodynamic Therapy (PDT)
    PDT can be useful when patients have multiple BCCs. A photosensitizing agent such as Topical 5-aminolevulinic acid (5-ALA) is applied to the tumors at the physician’s office. It is taken up by the abnormal cells. The next day, the patient returns, and those medicated areas are activated by a strong light. This treatment selectively destroys BCCs while causing minimal damage to surrounding normal tissue. PDT is FDA approved for treatment of superficial and nodular BCCs. Cure rates can vary considerably, ranging from 70 to 90 percent. Patients become photosensitive for 48 hours after the treatment and must stay out of the sun.

    Laser Surgery
    The skin’s outer layer and variable amounts of deeper skin are removed using a carbon dioxide or erbium YAG laser. Lasers give the doctor good control over the depth of tissue removed, and are sometimes used as a secondary therapy when other techniques are unsuccessful. Laser treatment has recurrence rates similar to those of PDT. It is not FDA-approved for BCC.

    Topical Medications
    5-fluorouracil (5-FU) and imiquimod, both FDA-approved for treatment of actinic keratoses and superficial basal cell carcinomas, are also being tested for the treatment of some superficial squamous cell carcinomas. Successful treatment of Bowen’s disease, a noninvasive squamous cell carcinoma, has been reported. However, invasive squamous cell carcinoma should not be treated with 5-FU. Some trials have shown that imiquimod may be effective with certain invasive squamous cell carcinomas, but it is not yet FDA-approved for this purpose. Imiquimod stimulates the immune system to produce interferon, a chemical that attacks cancerous and precancerous cells.

    Important Thoughts
    Squamous cell carcinomas usually remain confined to the epidermis (the top skin layer) for some time. However, the larger these tumors grow, the more extensive the treatment needed. They eventually penetrate the underlying tissues, which can lead to major disfigurement, sometimes even the loss of a nose, eye or ear. A small percentage — estimates run from 2 to almost 10 percent – spread (metastasize) to distant tissues and organs. When this happens, squamous cell carcinomas frequently can be life-threatening. About 2,500 deaths result each year in the U.S.

    Metastases most often arise on sites of chronic inflammatory skin conditions and on the ear, nose, lip, and mucosal regions, including the mouth, nostrils, genitals, anus, and the lining of the internal organs.

    Because most treatment options involve cutting, some scarring from the tumor removal should be expected. This is most often cosmetically acceptable when the cancer is small, but removal of a larger tumor often requires reconstructive surgery, involving a skin graft or flap to cover the defect.

    Content courtesy of Skin Cancer Foundation.

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