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Non-Melanoma Skin Cancers (NMSC): Basal Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC)

Principles of Squamous Cell Carcinoma Management

The diagnosis of SCC is based on biopsy; a superficial biopsy may reveal only an in situ (epidermal) component and may miss the invasive component that is underlying or adjacent to the area of biopsy. Close clinical follow-up is necessary.

Initial therapy

First-line therapy: Surgical excision

  • Surgical excision with 3 to 5 mm margins. Pathologic evaluation of the margins should be performed for adequacy of resection.
  • Careful palpation of regional lymph nodes before surgery is required.

Alternative therapy

  • Destructive measures (curettage and electrodesiccation or cryotherapy) may also be curative, but do not provide margins for pathologic confirmation of adequacy of resection.
  • For lesions not easily excised, or in patients who are not good surgical candidates, radiation therapy may be used.
  • Patients with multiple and/or clinically aggressive lesions may require systemic retinoid therapy (acitretin, such as Soriatane) for chemoprophylaxis of future recurrence or development of primary lesions. Referral to a dermatologist or oncologist is recommended.

Subsequent therapy

  • Close clinical follow-up, with careful examination of the surgery site, draining lymph nodes, and the rest of the patient’s exposed skin should be performed.
  • As these lesions are usually found on sun exposed areas, and because photodamage is likely an important factor in the pathogenesis of SCC, photoprotection should be emphasized.