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.
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.
- 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.
- 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.