Squamous cell carcinoma (SCC) is a common skin cancer originating in the flat squamous cells of the skin’s outer layers. While many SCCs are treatable, some forms are aggressive, requiring a more intensive approach due to their potential for deeper invasion and spread. This article aims to provide a clear understanding of aggressive squamous cell carcinoma for the general public.
What Makes Squamous Cell Carcinoma Aggressive
Certain features classify squamous cell carcinoma as aggressive, indicating a higher potential for local destruction and distant spread. Rapid growth, where the lesion expands noticeably over a short period, is a common indicator. The tumor’s ability to invade deeply into underlying tissues also contributes to its aggressive nature.
Another characteristic is perineural invasion, where cancer cells spread along nerve pathways. Lymphovascular invasion involves cancer cells entering lymphatic or blood vessels, providing a route for them to travel to other parts of the body. Poor differentiation, a term used by pathologists, indicates that the cancer cells look less like normal skin cells under a microscope, suggesting a more aggressive biological behavior.
Several risk factors are associated with aggressive forms of SCC. These include compromised immune systems (e.g., organ transplant recipients), chronic inflammation (e.g., long-standing scars, burns, or ulcers), and certain rare genetic syndromes. Additionally, SCCs in specific anatomical locations like the ear, lip, nose, eyelids, or genitalia are often considered higher risk due to their proximity to nerve pathways and lymphatic drainage.
Identifying the Signs
Recognizing the signs of an aggressive squamous cell carcinoma can prompt timely medical evaluation. Such lesions often exhibit rapid growth, changing noticeably in size or shape over weeks or months. A non-healing sore that persists despite typical wound care, or one that repeatedly scabs and reopens, warrants concern.
The lesion may also bleed easily, even with minor trauma, or develop a persistent crust that does not resolve. As the tumor invades deeper or affects nerves, individuals might experience new pain or numbness in the affected area. These indicators can differentiate aggressive SCC from benign skin conditions and signal the need for immediate medical attention.
Diagnosis and Staging
Healthcare professionals diagnose aggressive squamous cell carcinoma through a systematic process beginning with a thorough clinical examination. If a lesion appears concerning, a biopsy is performed to obtain tissue for pathological analysis. Common biopsy types include punch biopsies (small core), shave biopsies (superficial slice), or excisional biopsies (entire lesion).
A dermatopathologist, a specialist in skin pathology, then examines the tissue under a microscope. This review assesses the tumor’s characteristics, such as its depth of invasion, cellular differentiation, and the presence of perineural or lymphovascular invasion. These microscopic findings are important for confirming the diagnosis and determining the tumor’s aggressive potential.
Once diagnosed, the cancer is staged to determine the extent of the disease, often using systems like the American Joint Committee on Cancer (AJCC) staging system. This process involves assessing the tumor’s size and local spread (T category), nearby lymph node involvement (N category), and distant metastasis (M category). Imaging techniques (CT, MRI, or PET scans) may be employed to evaluate spread to lymph nodes or other organs, providing a comprehensive picture for treatment planning.
Treatment Options
Treating aggressive squamous cell carcinoma involves a multimodal approach tailored to the tumor’s characteristics and the patient’s overall health. Surgical removal remains a primary treatment option. Wide local excision removes the tumor along with a margin of healthy tissue to ensure all cancerous cells are gone. Mohs micrographic surgery is a specialized technique often used for high-risk SCCs, especially on the face, where thin layers of tissue are removed and immediately examined until no cancer cells remain, preserving healthy tissue.
Radiation therapy is frequently employed, either as a primary treatment for tumors difficult to remove surgically or as an adjuvant therapy after surgery to eliminate any remaining cancer cells. This therapy uses high-energy rays to destroy cancer cells. For advanced or metastatic aggressive SCC, systemic therapies become necessary.
Chemotherapy, while less commonly used as a sole agent for SCC, may be considered in certain advanced cases. Targeted therapies, such as epidermal growth factor receptor (EGFR) inhibitors, may be an option if cancer cells express specific molecular targets. Immunotherapy has shown effectiveness for advanced SCC, particularly drugs like cemiplimab and pembrolizumab (PD-1 inhibitors). These medications work by boosting the body’s own immune system to recognize and attack cancer cells. The selection of treatment modalities is highly individualized, considering the tumor’s stage, location, and the patient’s overall health status.
Prognosis and Long-Term Care
The prognosis for aggressive squamous cell carcinoma is influenced by several factors, including the stage at which it is diagnosed, the tumor’s anatomical location, and the patient’s immune status. Early detection and comprehensive treatment lead to better outcomes. Tumors that have spread to lymph nodes or distant sites present a more challenging prognosis.
Diligent follow-up care is important for individuals treated for aggressive SCC. This involves regular skin examinations by a dermatologist, typically every three to six months initially, to monitor for any signs of recurrence or new lesions. Patients are also advised to perform regular self-skin examinations at home.
Continued sun protection, including wearing protective clothing, seeking shade, and using broad-spectrum sunscreen with an SPF of 30 or higher, is a permanent aspect of long-term management to prevent new skin cancers. Depending on the extent of treatment, some individuals may require supportive care or rehabilitation to manage side effects or functional impairments from surgery or radiation therapy.