skin cancers
Squamous cell carcinoma
Squamous cell carcinoma (SCC) is another common type of skin cancer.
The majority of invasive SCCs develop in solar keratoses. Solar or actinic keratoses are common small scaly lesions arising on the face, ears and hands of white skinned people who have spent many years outdoors.
Invasive SCCs vary in size from a few millimetres to several centimetres in diameter. Usually they grow slowly over months or years. Some SCCs appear as sores that fail to heal.
Luckily, SCC is not usually a threat to life as secondary spread (metastasis) is uncommon. SCCs on the lip or ear seem to be the sites most likely to metastasise, so ulcers or lumps in these areas should be taken particularly seriously.
Treatment of BCCs and SCCs
The treatment of a BCC or SCC depends on its type, size and location, the number to be treated, and the preference of the doctor and patient. Broadly speaking there are two methods of treatment: Non Surgical and Surgical.
Non Surgical methods:
As these lesions only rarely spread it can be possible to treat them with non surgical methods. The advantage of these treatments is that they avoid surgery.
Unfortunately due to the nature of the methods, complete treatment cannot be confirmed and as such the cure rate varies from 60 -90 %. They are not suitable to all forms of BCC or SCC.
It is important to remember that Non surgical does not mean non scarring.
- Shave, curettage, & cautery. Removal of just the top layers of the skin. The wound usually heals within a few weeks without needing stitches. Unfortunately the scarring from this treatment can be worse than with surgery.
- Photodynamic therapy. The tumour is treated with a photosensitising chemical in a cream (e.g. Metvix) or lotion, and exposed to light several hours later. Up to 85% superficial BCCs are cured, with excellent cosmetic results.
- Imiquimod cream. This is applied to superficial BCCs three to five times each week (Monday to Friday) for six to sixteen weeks. The imiquimod results in an inflammatory reaction, maximal at three weeks. Up to 85% of suitable BCCs disappear, with minimal scarring.
- Cryotherapy (freezing). Liquid nitrogen is applied to small superficial lesions. A blister forms, crusts over and heals within several weeks. A permanent white mark usually results from this treatment.
- Radiotherapy (X-ray treatment). This is less commonly used to treat BCCs and SCCs than in the past. It may be a suitable way to eradicate skin cancer on the face in the elderly. The best cosmetic results are achieved by multiple ‘fractions’, e.g. weekly treatments for several weeks.
Surgery
This is the most appropriate treatment for large nodular, infiltrative and BCCs and SCCs.
Depending on the location, size and patient preference, the surgery can be
undertaken in the office.
Scars usually heal well and fade over a period of 6-12 months.
Large lesions or lesions where there is a deficiency of skin, may require a flap or graft to repair the defect after excision.
For a graft, a layer of skin is taken from another part of your body and placed over the wound. New blood vessels then grow into the graft. A flap involves moving adjacent skin into the defect from an area of relative excess to close the wound.
Mr Bloom will decide which the most appropriate method of closure is in your particular case.
Cure rates are in the order of 99%. The specimen is routinely sent for histological confirmation of complete excision.