How Is Cutaneous Squamous Cell Carcinoma Treated?

Surgery is the go-to treatment for cutaneous squamous cell carcinoma (CSCC) — a type of cancer that develops in the squamous cells of the skin.

But there are other ways to treat the cancer if a CSCC is very superficial (meaning it hasn’t penetrated below the top layer of the skin), is more advanced, or if a patient can’t have surgery, according to the Skin Cancer Foundation.

Your doctor can help you decide which option is right for you.

Surgical Options to Treat CSCC

Different types of surgery are available to treat CSCC. The method your doctor recommends will depend on where the lesion is located and how deep it is.

Excision Surgery

Excision surgery involves cutting out the tumor, along with surrounding normal tissue in case stray cancer cells are lurking in the periphery. Typically, this procedure is performed in a doctor’s office rather than a hospital.

Your skin will first be numbed with a local anesthetic. Then your dermatologist will use a surgical knife or other tool to cut out the growth. Most of the time, the skin is stitched back together and you’re left with a scar. The size of the scar will depend on how big the lesion was.

Mohs Micrographic Surgery

Mohs surgery is a specialized procedure that involves removing skin cancer layer by layer. It allows your doctor to remove the least amount of tissue to treat your cancer.

During the surgery, you’ll be awake while the surgeon removes a very thin layer of skin tissue and examines it under a microscope. This method continues until your doctor no longer finds cancer cells.

Mohs surgery is often used to treat CSCCs that are more complex or are found on the face, neck, or hands.

Curettage and Electrodesiccation

In this procedure, your doctor will first use a special instrument to scrape the lesion from your skin, which is a process called curetting. Then, with a technique called electrodessication, your dermatologist will apply an electric needle to destroy the remaining cancer cells.

This procedure is usually reserved for CSCCs that are small or very low risk. It can’t be performed on areas of the body where there’s a lot of hair, such as the scalp.

Laser Surgery

Laser surgery works by using heat to destroy tumors.

Typically, the surrounding tissue isn’t damaged, and the risk of bleeding, swelling, and scarring is low.

These treatments are usually an option for skin lesions that are very superficial.

Lymph Node Removal Surgery

While it’s not common for CSCC to metastasize (spread), it usually moves to the lymph nodes first. If your lymph nodes are enlarged or your doctor suspects the cancer has metastasized, you may need surgery to remove one or more lymph nodes.

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Nonsurgical Options for Treating CSCC

Various nonsurgical treatments are available for CSCC, depending on the extent of your cancer and where it is in your body.

Photodynamic Therapy (PDT)

During PDT, your doctor will apply a light-sensitizing liquid drug to your skin. Then, a special type of light is used to destroy cancer cells.

After having this treatment, you must avoid sunlight for at least 48 hours.

PDT is used for some minor CSCCs and a precancerous condition called actinic keratosis (AK).

Radiation Therapy

Radiation therapy involves using beams of energy to kill cancer cells. Your doctor might recommend radiation if you can’t have surgery or if you’ve had surgery for CSCC but have a high risk of recurrence.

There are different types of radiation used to treat CSCC, including:

• Superficial Radiation With this type, beams of radiation are directed right under the skin, so it treats only the tumor.
• External Beam Radiation External beam radiation sends high-energy beams into the tumor to kill cancer cells.
• Brachytherapy Radioactive implants are placed in or near the cancerous lesion.

Cryosurgery

Cryosurgery is a technique where doctors use liquid nitrogen to freeze and destroy skin cancer lesions. Eventually, the growth falls off and healthy skin emerges.

This method is typically used for superficial CSCCs or in patients who have bleeding disorders, implantable heart devices, or problems tolerating anesthesia.

Topical treatments

Some creams and gels that can treat low-risk or precancerous CSCCs include:

• Fluorouracil TopicalThis topical chemotherapy comes as a cream or lotion that you apply at home for three to six weeks.
• Imiquimod (Aldara) Imiquimod is a topical therapy that triggers immune cells to attack abnormal tissue. It comes as a lotion to use at home.
• Ingenol Mebutate (Picato) This medicine comes as a gel and is used to treat precancerous lesions in just a few days.
• Diclofenac (Solaraze) It’s a topical gel that contains diclofenac, which is a nonsteroidal anti-inflammatory drug (NSAID). It’s usually applied twice daily for two or three months.

Doctors may also use a technique called chemical peeling to treat actinic keratosis. With this method, a chemical, such as trichloroacetic acid (TCA), is applied to the lesion. Over the span of several days, the acid kills the tumor.

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Immunotherapy

Immunotherapy is a treatment that harnesses your body’s own immune system to attack cancer. This treatment is sometimes used for advanced CSCCs that have spread throughout the body.

The U.S. Food and Drug Administration (FDA) has approved cemiplimab-rwlc (Libtayo) as an immunotherapy to treat certain people with advanced CSCC.

In a clinical trial, about half the patients with CSCC who used cemiplimab-rwlc saw their tumors shrink.

Pembrolizumab (Keytruda) is another immunotherapy that’s been approved for treating advanced CSCC.

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Chemotherapy

Some people with metastatic CSCC may require chemotherapy — a treatment that uses drugs to kill cancer cells in the body.

The chemo drugs cisplatin (Platinol) and fluorouracil topical might be an option for CSCC that has spread. These medicines may be used alone or along with other treatments.

Chemo can cause side effects, such as hair loss, nausea, vomiting, mouth sores, diarrhea, fatigue, loss of appetite, and more.

Targeted Treatments

Targeted medicines zero in on certain flaws in cancer cells. They’re sometimes combined with chemotherapy to treat advanced CSCC.

The drug cetuximab (Erbitux) targets a protein called EGFR, which is often found on the surface of CSCC cells.

Targeted therapies typically pose fewer severe side effects than chemotherapy, but they can cause skin issues, diarrhea, mouth sores, loss of appetite, and other problems.

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Clinical Trials for CSCC

Some patients with CSCC enroll in research studies. A clinical trial helps doctors identify novel treatments for cancer and other conditions. If you participate in a clinical trial, you may receive a new treatment that’s not yet available to the general public.

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How to Decide on a Treatment Option

Your doctor can provide information on the best treatment options for your situation.

If your cancer is very slow-growing or if you’re elderly, your physician might recommend observing your lesion and exploring treatments only if the cancer worsens.

You might want to ask these questions when considering a treatment for CSCC:

• Has my skin cancer spread?
• Is my cancer likely to spread?
• What treatment approach do you recommend?
• Why do you believe this is the best choice?
• What side effects are possible?
• Are there other options I should consider?
• What are the chances that my cancer will come back?

Making an informed decision about your medical care is important. Be sure to research all your options and communicate any concerns you have with your healthcare provider.