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Early Detection, Diagnosis, and Staging of Squamous Cell Carcinoma of the Skin
Learn about the signs and symptoms of squamous cell carcinoma (SCC) of the skin, also known as squamous cell skin cancer. Find out how these cancers are tested for, diagnosed, and staged.
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Can squamous cell carcinoma of the skin be found early?
With self-exams and skin checks by a healthcare professional, squamous cell skin cancers can often be found early, when treatment is more likely to be successful.
Skin awareness and self-exams
Although the American Cancer Society does not have guidelines for the early detection of skin cancer, many doctors recommend checking your own skin regularly, preferably once a month.
Knowing your own skin is important to finding skin cancer early. Learn the patterns of moles, blemishes, freckles, and other marks on your skin so that you’ll notice any changes.
Skin self-exams are best done in a well-lit room in front of a full-length mirror. Use a handheld mirror for areas that are hard to see, such as the backs of your thighs.
Examine all parts of your body, including the palms of your hands and soles of your feet, as well as your nails, scalp, ears, and back. A spouse, partner, close friend, or family member can also help you with these exams, especially for those hard-to-see areas, such as your scalp and back.
When to see a doctor
Any spots on the skin that are new or changing in size, shape, or color should be checked by a doctor.
Any unusual sore, lump, blemish, marking, or change in skin appearance or texture might be a sign of skin cancer or a warning that it might occur. The area might become red, swollen, scaly, crusty, or begin oozing or bleeding. It might feel itchy, tender, or painful.
Be sure to show your doctor any areas that concern you and ask your doctor to look at areas that might be hard for you to see.
Skin exam by a healthcare professional
Some doctors and other healthcare professionals do skin exams as part of routine health checkups.
Having regular skin exams is especially important for people who are at high risk of skin cancer, such as:
- People with a weakened immune system, such as those who have had an organ transplant
- People with conditions such as xeroderma pigmentosum (XP)
Talk to your doctor about how often you should have your skin examined.
Smartphone apps to look for skin cancer
In recent years, smartphone apps powered by artificial intelligence (AI) have been developed to help identify areas that might be skin cancer and should be looked at by a doctor.
Although these tools continue to improve over time, there are still concerns about their accuracy, and more research is needed before expert groups would recommend them. For now, it’s best to have any area you’re concerned about looked at by a trained healthcare professional.
What are the signs and symptoms of squamous cell carcinoma?
Most squamous cell skin cancers are found early because of signs or symptoms. These cancers usually develop on areas of skin exposed to the sun, especially the face, ears, neck, lips, arms, and hands, but they can occur anywhere on the body.
Squamous cell skin cancers can appear as:
- Rough or scaly red or dark patches, which might crust or bleed
- Raised growths or lumps, sometimes with a lower area in the center
- Open sores that might have oozing or crusted areas, which might not heal, or that heal and then come back
- Wart-like growths
Some SCCs might look different from these descriptions, so it’s important to see a healthcare provider if you have any new or changing skin growths, sores that don’t heal, or other areas that concern you.
Exams and tests for squamous cell carcinoma of the skin
If you have an abnormal area that might be skin cancer, your doctor will examine it and might do tests to find out whether it is cancer or some other skin condition.
If you’re being seen by your primary doctor and skin cancer is suspected, you might be referred to a dermatologist, a doctor who treats skin diseases.
If skin cancer is found and there’s a chance it might have spread to other areas of the body, other tests might be done as well.
Medical history and physical exam
First, your doctor usually will ask about your symptoms, such as when the mark first appeared on the skin, whether it has changed in size or appearance, and whether it has been painful, itchy, or bleeding.
You might also be asked about possible risk factors for skin cancer, including your history of sun exposure and tanning practices, whether you or anyone in your family has had skin cancer, and whether you have any other skin conditions.
During the physical exam, the doctor will note the size, shape, color, and texture of the area in question, and whether it is bleeding, oozing, or crusting. The rest of your body might be checked for moles and other spots that could be related to skin cancer or other skin conditions.
The doctor might also feel the nearby lymph nodes, which are bean-sized collections of immune system cells under the skin in certain areas. Some squamous cell skin cancers can spread to lymph nodes. When this happens, the nodes might be felt as lumps under the skin.
Special techniques to look at the skin
Dermatologists sometimes use special techniques to look more closely at abnormal areas. This helps them decide whether an abnormal area should be biopsied to determine whether it’s cancer.
Along with a standard physical exam, dermatologists often use a technique called dermoscopy, also known as dermatoscopy, epiluminescence microscopy (ELM) or surface microscopy, to look at spots on the skin more closely. It even gives them the ability to see some structures below the surface of the skin that can’t be seen with the naked eye.
In this technique, the doctor uses a dermatoscope, which is a special magnifying lens and light source held near the skin. Sometimes a thin layer of alcohol or oil is put on the skin beforehand.
Digital images of the area can also be taken, which can be used to see if an area changes over time. In some systems, the images can be analyzed by a computer, which can help the doctor determine whether the area might be skin cancer.
RCM is another technique dermatologists can use to look at an abnormal area of skin to a certain depth. In this technique, a low-powered laser is aimed at the suspicious area. The light from the laser enters the upper layers of the skin and reflects off the structures there. A special microscope detects the light as it bounces back, which is used to create a detailed, 3D image of the area. This can help the doctor determine if the area needs to be biopsied.
RCM might be especially useful for people with many unusual areas of skin, as it can cut down on the number of skin biopsies these people might need.
Some newer handheld devices can be placed over the skin to help healthcare providers get a better idea of whether an abnormal area is likely to be skin cancer, without needing to remove it.
These devices might be especially helpful for primary care providers and other health professionals who don’t usually see as many skin cancers as dermatologists do.
These types of devices are placed on the skin. The tip of the device sends out beams of light or electrical signals, which bounce back off the skin cells.
The device analyzes the pattern of signals coming from the area and lets the provider know if a biopsy should be done to test for cancer.
Skin biopsy
If the doctor thinks that a suspicious area might be skin cancer, part or all of the area will be removed and sent to a lab to be looked at under a microscope. This is called a skin biopsy.
Sometimes a biopsy can remove the entire cancer. Whether more treatment is needed depends on what the biopsy shows and other features of the cancer.
There are different types of skin biopsies. The doctor will choose which one is best for you based on the suspected type of skin cancer, where it is on your body, its size, and other factors.
Skin biopsies are done using a local anesthetic (numbing medicine), which is injected into the area with a very small needle. You will probably feel a small prick and a little stinging as the medicine is injected, but you should not feel any pain during the biopsy.
Any biopsy is likely to leave at least a small scar. Different methods can result in different scars, so ask your doctor about possible scarring before the biopsy.
For a shave biopsy, the doctor shaves off the top layers of the skin with a small surgical blade. Bleeding from the biopsy site is stopped by applying an ointment or a chemical that stops bleeding, or by using a small electrical current to cauterize the wound.
For a punch biopsy, the doctor uses a tool that looks like a tiny round cookie cutter to remove a deeper sample of skin. The doctor rotates the punch biopsy tool on the skin until it cuts through all the layers of the skin. The sample is removed, and the edges of the biopsy site are often stitched together.
To examine an abnormal area that is larger or that might have grown into deeper layers of the skin, the doctor might use an excisional or, less often, an incisional biopsy.
- An excisional biopsy removes the entire abnormal area, along with a small margin of normal skin around it.
- An incisional biopsy removes only a portion of the abnormal area.
For these types of biopsies, a surgical knife is used to cut through the full thickness of skin. A wedge or sliver of skin is removed for examination, and the edges of the wound are usually stitched together.
Skin biopsies are done using a local anesthetic (numbing medicine), which is injected into the area with a very small needle. You will likely feel a small prick and a little stinging as the medicine is injected, but you should not feel any pain during the biopsy.
All skin biopsy samples are sent to a lab, where a doctor called a pathologist looks at them under a microscope and might do other tests on them. Often, the samples are sent to a dermatopathologist, a doctor who has special training in looking at skin biopsy samples.
Lymph node biopsy
It isn’t common for squamous cell cancer to spread beyond the skin. If it does, it usually first goes to nearby lymph nodes, which are bean-sized collections of immune cells.
If your doctor can feel lymph nodes under the skin near the tumor that are too large or too firm, a lymph node biopsy might be done to find out whether cancer has spread to them. This might be done in different ways.
For an FNA, the doctor uses a syringe with a thin, hollow needle to remove very small fragments of the lymph node. A local anesthetic is sometimes used to numb the area first. This test rarely causes much discomfort and does not leave a scar.
FNAs are not as invasive as some other types of biopsies, but they might not always provide a large enough sample to find cancer cells. In these cases, a more invasive type of biopsy might be needed.
If an FNA doesn’t find cancer in a lymph node but the doctor still suspects the cancer has spread there, the lymph node might be removed by surgery and examined. If the lymph node is just under the skin, this can often be done in a doctor’s office or outpatient surgical center using local anesthesia (numbing medicine). This will leave a small scar.
For squamous cell skin cancers that have a high risk of spreading, a sentinel lymph node biopsy (SLNB) might be done to find the lymph nodes that are likely to be the first place the cancer would go if it has spread. These lymph nodes are called sentinel nodes. This test can help determine the stage (extent) of the cancer and help guide treatment options.
How it’s done
To find the sentinel nodes, the doctor injects a small amount of radioactive material into the area around the cancer. The sentinel lymph nodes take up the radioactivity first and are located using a special camera or handheld detector.
Once the radioactive area has been marked, the person is taken for surgery, and usually a blue dye is injected in the same place the radioactive substance was injected. A small cut is made in the marked area to find which lymph nodes became radioactive or turned blue. These sentinel nodes are removed and looked at under a microscope.
If no cancer cells are found, no more lymph nodes need to be taken out because it’s very unlikely the cancer would have spread beyond this point. If cancer cells are found in the sentinel node, additional treatment or follow up is usually recommended. This might include removing more nearby lymph nodes. This is called a lymph node dissection.
Imaging tests
It’s not common for squamous cell skin cancer to spread to the lymph nodes or to other parts of the body, so most people with these cancers don’t need imaging tests.
If your doctor thinks you might be at risk for the cancer spreading beyond the skin, imaging tests such as an MRI, CT scan, or PET scan might be done.
Stages and risk groups for squamous cell carcinoma of the skin
Staging is the process of figuring out whether cancer has spread, and if so, how far. Staging isn’t often needed for SCC, because these cancers can usually be cured before they spread to other parts of the body. But when staging is needed, it is based on the results of physical exams, biopsies, and imaging tests if they are done.
SCCs can be divided into risk groups, based on how likely they are to spread or to come back after treatment. This can be used to help determine the best treatment options.
Questions to ask if you have squamous cell carcinoma
- Can you explain what squamous cell skin cancer is?
- Has the cancer grown deeply into the skin? Is there a chance it has spread to nearby areas or to other parts of the body?
- What is the stage or risk group of the cancer? What does this mean?
- Are there any other factors that might affect my treatment options?
- Will I need any other tests before we decide on treatment?
- Do I need to see any other doctors?
- If I’m concerned about the costs and insurance coverage for my diagnosis and treatment, who can help me?
- Written by
- References
Developed by the American Cancer Society medical and editorial content team with medical review and contribution by the American Society of Clinical Oncology (ASCO).
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Xu YG, Aylward JL, Swanson AM, et al. Chapter 67: Nonmelanoma Skin Cancers. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, Pa: Elsevier; 2020.
Last Revised: August 27, 2026
American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy.
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