Treating Squamous Cell Carcinoma of the Skin

Treatment options for squamous cell skin cancer depend on the risk of the cancer coming back, which is based on factors like the size and location of the tumor and how the cancer cells look under a microscope, as well as if a person has a weakened immune system.

Most squamous cell skin cancers are found and treated at an early stage, when they can be removed or destroyed with local treatment methods. Small squamous cell cancers can usually be cured with these treatments. Larger squamous cell cancers are harder to treat, and fast-growing cancers have a higher risk of coming back.

In rare cases, squamous cell cancers can spread to lymph nodes or distant parts of the body. If this happens, treatments such as radiation therapy, immunotherapy, and/or chemotherapy may be needed.

Surgery

Different types of surgery can be used to treat squamous cell skin cancers.

Excision: Cutting out the tumor, along with a small margin of normal skin, is often used to treat squamous cell cancers.

Curettage and electrodesiccation: This approach is sometimes useful in treating small (less than 1 cm across), thin squamous cell cancers, but it’s not recommended for larger tumors.

Mohs surgery: Mohs surgery is especially useful for squamous cell cancers that pose a higher risk for coming back, such as tumors larger than 2 cm (about 4/5 inch) across or with poorly defined edges, cancers that have come back after other treatments, cancers that are spreading along nerves under the skin, and cancers on certain areas of the face or genital area. Mohs surgery might also be done after an excision if it didn’t remove all of the cancer (if the surgical margins were positive). This approach is typically more complex and time-consuming than other types of surgery.

Radiation therapy

Radiation therapy is often a good option for patients with large cancers, especially in areas where surgery would be hard to do (such as the eyelids, ears, or nose), or for patients who can’t have surgery. It’s not often used as the first treatment for younger patients because of the possible risk of long-term problems.

Radiation is sometimes used after surgery (simple excision or lymph node dissection) if all of the cancer was not removed (if the surgical margins were positive), if nerves are involved, or if there is a chance that some cancer may still be left.

Radiation can also be used to treat cancers that have come back after surgery and have become too large or deep to be removed surgically.

Cryotherapy

Cryotherapy (cryosurgery) is used for some early squamous cell cancers, especially in people who can’t have surgery, but is not recommended for larger invasive tumors or those on certain parts of the nose, ears, eyelids, scalp, or legs.

Treating advanced squamous cell cancers

Lymph node dissection: Removing regional (nearby) lymph nodes might be recommended for some squamous cell cancers that are very large or have grown deeply into the skin, as well as if the lymph nodes feel enlarged and/or hard. The removed lymph nodes are looked at under a microscope to see if they contain cancer cells. Sometimes, radiation therapy might be recommended after surgery.

Immunotherapy: For advanced squamous cell cancers that can’t be cured with surgery or radiation therapy, one option might be using an immunotherapy drug such as cemiplimab (Libtayo) or pembrolizumab (Keytruda). However, these drugs haven’t been studied in people with weakened immune systems, such as people who take medicines for autoimmune diseases or who have had an organ transplant, so the balance between benefits and risks for these people isn’t clear.

Systemic chemotherapy and/or targeted therapy: Chemotherapy and targeted therapy drugs (EGFR inhibitors) might be other options for patients with squamous cell cancer that has spread to lymph nodes or distant organs. These types of treatment might be combined or used separately.