Generality
Squamous cell carcinoma is a malignant skin tumor affecting the squamous cells of the epidermis.
Figure: skin lesion associated with squamous cell carcinoma. From the site: www.surgicalnotes.co.uk
In most cases, it is caused by excessive exposure to the sun's UV rays or by overuse of tanning lamps.
Its onset determines the appearance of a skin wound, with different connotations depending on the patient in question.
If diagnosed early, squamous cell carcinoma is usually treated successfully; if complications arise, it is because the tumor has arisen in a delicate part of the body or because the patient is a "fragile" individual and more predisposed than others to skin cancer.
If proper caution is taken, it can be prevented.
What is squamous cell carcinoma?
Squamous cell carcinoma is a malignant skin tumor, other than melanoma, which originates in the squamous cells of the epidermis.
Generally, it is not a very aggressive tumor, but it can become one and cause various complications when it occurs in certain areas of the body or when it is not treated properly.
Squamous cell carcinoma has several synonyms: in fact, it is also called squamous carcinoma, squamous cell carcinoma, squamous cell epithelioma or spinalioma.
What are squamous cells?
Squamous cells are more or less thin cellular elements, which are found in the outermost layers of the skin, precisely in the epidermis.
Squamous cells belong to the family of so-called keratinocytes, which are the cells that produce keratin.
SKIN CANCER OTHER THAN MELANOMA
Skin cancers other than melanoma (or non-melanoma skin cancers) are the most common skin cancers, and among the most widespread in general. The common element is the involvement of the most superficial layers of the skin; what differentiates them is the type of cell affected by the neoplasm.
The most common non-melanoma skin cancers are two carcinomas: squamous cell carcinomas, which we are talking about, and basal cell carcinomas, also known as basal cell epithelioma.
EPIDEMIOLOGY
Skin cancers other than melanoma. Squamous cell carcinoma and basal cell carcinoma represent, respectively, 20% and 75% of all skin cancers other than melanoma (the remaining 5% is shown in the table). This means that, out of 10 patients with skin cancer other than melanoma, 2 suffer from squamous carcinoma and 7/8 from basal cell carcinoma (what advances is represented by the remaining 5%).
The remaining 5% of non-melanoma skin cancers consist of:
- Merkel cell carcinoma
- Cutaneous T-cell lymphoma
- Cutaneous B-cell lymphoma
- Sebaceous gland carcinoma
- Kaposi's sarcoma
- Dermatofibrosarcoma protuberans
Figure: a basal cell carcinoma compared to a squamous cell. From the site: www.veteranstoday.com
In Italy, the annual incidence calculated is 100-105 cases per 100,000 inhabitants.
Squamous cell carcinoma. Squamous carcinoma usually occurs at an advanced age (around 60 years of age) and is more common among men than among women. Its annual incidence varies according to the geographical area considered, as it increases the closer you get to the equator and / or you are at a high altitude. As regards Italy, the calculated annual incidence is approximately 22-23 cases per 100,000 individuals.
Causes
What is a tumor?
A tumor is the result of out-of-control cell multiplication triggered by one or more genetic DNA mutations. In other words, when DNA undergoes certain changes and these changes are irreparable, then the cells that contain it undergo excessive and unstoppable growth and breakdown.
In the case of squamous cell carcinoma, the cells that multiply in an uncontrolled way (due to one or more genetic errors of the DNA), are the squamous cells of the epidermis. These cells, in a healthy individual, are born, grow and die in a way ordered; in an individual with spinaloma, on the other hand, they reproduce without any control, altering the normal process of cell turnover that occurs on the surface of the skin.
WHAT IS THE ORIGIN OF DNA CHANGES?
Mutations in DNA, which lead to the formation of most squamous cell carcinomas, occur due to exposure to ultraviolet (UV) radiation from the sun and tanning lamps.
Genetic changes, which do not have this origin, on the other hand, are explained by an unusual contact between the patient and certain toxic substances, or by a too weak immune system.
RISK FACTORS
Several circumstances have been identified that favor the appearance of squamous carcinoma. These risk factors consist of:
- Clear skin. Anyone can get squamous cell carcinoma, regardless of skin color. However, those with less melanin (i.e. the skin pigment that protects us from UV rays) are more predisposed than those with more. Therefore, people with very fair skin, who burn easily in the sun (due to the lack of this pigment) are at high risk.
- Too much sun. Too much exposure to the UV rays of the sun, even if you do not have fair skin, has a decisive effect on the appearance of squamous carcinoma and any other skin cancer, favoring it.
- Excessive exposure to tanning lamps. Tanning lamps emit the same ultraviolet radiation as the sun, so excessive use of them has the same effects as the sun.
- History of severe sunburn. Those who, in the past, suffered from severe sunburn are more at risk than those who, on the other hand, have always protected themselves adequately.
- Personal history of precancerous skin lesions. People with actinic keratosis or Bowen's disease, which are two pre-cancerous skin lesions, are more at risk of getting sick than healthy people.
- Personal history of a previous skin cancer. Individuals who have had the same or another skin cancer in the past are more at risk of relapse.
- Weak immune system. The immune system of an individual is his defense barrier against infections and other threats, brought from the external or internal environment. When this defense is ineffective, it predisposes to various ailments, including skin cancers. An emblematic case, of what has just been said, is represented by leukemia or lymphoma patients and organ transplant recipients, who - being forced to suppress their immune system with special drugs - expose themselves to infectious diseases and, in fact, to tumors of the skin.
- Genetic predisposition. People with xeroderma pigmentosum are extremely sensitive to sunlight, so they are predisposed to all known skin cancers, including squamous cell carcinoma. The incidence in these subjects is very high, so much so that they have to protect the skin even when they are in their homes.
Symptoms and Complications
For further information: Squamous cell carcinoma symptoms)
Squamous cell carcinoma presents with a distinctive skin mark.
This sign can occur anywhere (therefore also in the mouth, genitals and anus); however, in most cases, it appears in the body areas most exposed to the sun, such as scalp, back of hands, face and ears. characteristics vary from person to person, so much so that it could look like:
- A red, stiff lump
- A scaly, crusty sore
- An ulcerative lesion that never heals
- In the lips, a rough, scaly-looking area that tends to become an open sore
- Inside the mouth, a sore with a rough and red surface
- In the genitals and anus, a wart
WHEN TO SEEK YOUR DOCTOR
It is advisable to contact your dermatologist, if a skin wound, which appeared in an inexplicable part of the body, tends to never heal and to constantly reform.
COMPLICATIONS
If it is not treated in time and properly, squamous cell carcinoma could, in sequence, contaminate the surrounding healthy tissues, reach the lymph nodes and / or other internal organs (such as, for example, the liver) and, finally, lead to death.
All of these complications are more likely to occur if squamous cell carcinoma:
- It involves the formation of a very large and deep lesion or sore
- Occurs in the mucous membranes (for example, in the mouth or on the lips)
- It occurs in an individual with an ineffective immune system
Diagnosis
To diagnose squamous cell carcinoma, a physical examination and a tissue biopsy (i.e. of the suspect tissue) are required.
OBJECTIVE EXAMINATION
During the physical examination, the dermatologist examines the wound and questions the patient about his state of health and medical history.
From the aspect of the wound, he can assess, at least in part, the severity of the tumor; from the clinical history and the state of health, however, he can understand whether the individual under examination is potentially a subject at high risk of squamous cell carcinoma or not.
BIOPSY
The biopsy is the only diagnostic check able to establish the true nature of the wound, present on the skin, and, in the case of a tumor, the type of neoplasm.
This examination involves taking a small piece of tissue directly from the suspected skin area and observing it under a microscope. On the instrument, any tumor cells present have an unmistakable appearance.
Treatment
The only way to recover from squamous cell carcinoma is to completely remove the skin wound. Removal can take place with different methods, depending on the location, size and aggressiveness of the tumor.Here are the various therapeutic techniques that can be used for the removal of squamous carcinoma:
-
Figure: instrument for electrodissication. Curettage and electrodissication. The first operation is curettage, or the scraping, using a special tool, of the superficial part of the tumor lesion. The second is electrodissection, ie the burning of the base of the neoplastic lesion by means of an electric needle. Curettage and electrodissection are an ideal solution for very small squamous cell carcinomas.
- Laser therapy. An intense beam of luminous light is "fired" directly on the skin area affected by the tumor. This has the power to vaporize the tumor sore, without damaging the surrounding tissue areas too much and without causing excessive blood loss. It is the solution ideal for superficial squamous cell carcinomas.
- Cryotherapy. It is cold therapy ("crio" comes from the Greek and means "cold"). It consists in applying liquid nitrogen to the affected area. Liquid nitrogen freezes cancer cells and kills them. It is a good solution for superficial squamous carcinomas.
- Photodynamic therapy. It involves the use of a photosensitizing drug, for topical use, and a source of light radiation. The photosensitizing drug is a kind of cream, which, when applied to the tumor area, makes it more sensitive to light; the light source, instead, it emits light, which is used to destroy tumor cells, which have become hyper-photosensitive after applying the drug.
- Topical drugs. There are several creams and lotions containing anticancer drugs. these, once spread on the affected area, destroy the cancer cells.
- Surgical excision (or excision). It is the surgical removal, by incision, of the tumor lesion present on the skin. The biggest risk with this procedure is to leave a skin scar, especially in delicate areas such as the face.
- Mohs surgery. It is the elimination of the neoplastic sore by small layers. By examining, from time to time, each layer removed under the microscope, the surgeon knows when the squamous cell carcinoma has been completely eliminated. This procedure, since it ends with the removal of the first layer without of tumor cells, guarantees the exclusive removal of the tumor, without excessively compromising healthy tissues.
- Radiotherapy. It involves the use of a source of high-energy X-rays, which, projected on the tumor area, kill the neoplastic cells. It is not always effective, as relapses can occur. It is applied above all in the case of very deep squamous carcinomas.
Prognosis and prevention
If the tumor is diagnosed and treated in time, and if you do not suffer from particular disorders (for example, xeroderma pigmentosum), squamous cell carcinoma is a malignant neoplasm from which it can be cured.
However, complications can still occur, for example if the tumor is severe and deep or if it has appeared in an uncomfortable anatomical point (face, mouth, genitals, etc.).
The prognosis, therefore, depends not only on the timeliness of treatment, but also on the characteristics (location, size, severity, etc.) of the squamous carcinoma.
PREVENTION
Squamous cell carcinoma is a cancer that can be prevented by following certain recommendations. Here are the main ones:
- Avoid exposing yourself to too much sun in the central hours of the hottest days. In these moments, in fact, the UV radiation is considerable and highly harmful to the skin.
- Use protective sun creams. Their use is particularly encouraged to light-skinned individuals who are at the seaside, to those who carry out an "outdoor work" activity and to people at high risk of skin cancer (people with a weakened immune system, patients with xeroderma pigmentosum). etc).
- Cover the parts of the body that are usually most exposed to sunlight and wear sunglasses. For both of these tips, the same goes for sun protection creams: they must be followed by everyone, but especially by certain people who are most at risk.
- Do not abuse tanning lamps or, better still, avoid using them. Its use is strongly discouraged, especially for those who have fair skin or who are predisposed to skin cancer.
- Check your skin periodically. It is good to examine, from time to time, the whole body, even the most unthinkable points (genitals, between the toes, etc.). It may be useful to have more mirrors, in order to inspect even the most hidden or invisible parts of the body.
- Do not overlook any skin abnormalities that appear suddenly, as it could be squamous cell carcinoma or any other skin cancer.
.jpg)
