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Squamous Cell Carcinoma

a) What is squamous cell carcinoma?

Squamous cell carcinoma (SCC) is the second most common skin cancer behind basal cell carcinoma. This is more aggressive, however, and can spread to other parts of the body. It can be tricky to diagnose on clinical appearance alone. The number of SCCs diagnosed in the world, and in the UK, is increasing each year. They are more common in Caucasians, in the elderly and in the male population.

b) What are the risks of squamous cell carcinoma spreading around the body?

Factors that increase the risk of metastases include:

• Large SCC greater than 2cm in diameter or deeper than 4mm

• SCC after radiation treatment

• SCC recurrence after surgical resection

• Long standing ulceration from Bowen’s disease (skin condition)

• Patients with a poor immune system from certain treatments or diseases

If the cancer has started to spread swelling of the lymph nodes around your ear or under your chin may occur.

c) What are the symptoms of squamous cell carcinoma?

They often appear as a non-healing ulcer with hard raised edges. There may be redness, crusting or bleeding. They commonly occur on the lower eyelid. Decreased vision may occur if the cancer spreads behind the eye.

d) What are the risks of getting squamous cell carcinoma?

Risk factors for this condition include:

• Sun damage

• Fair skin

• Pre-malignant conditions such as Bowens disease, actinic keratosis or keratoacanthomas.

• Poor immune system (e.g. HIV)

e) What tests will I need?

A biopsy will likely be taken. If there is high suspicion of SCC, the abnormal area of skin may be completely removed in theatre. If it is suspected that the SCC has started to spread into the eye or behind the eye we may arrange the following scans:

• CT scan

• MRI scan

• Ultrasound scan

f) Management Treatments include:

• Surgery (surgical excision)

• Radiotherapy

• Chemotherapy cream (5 Fluorouracil)

After surgery, the eyelid is reconstructed to make the eyelid appear and function as normal as possible. This may be carried out as a separate operation.