Treating Squamous Cell Carcinoma of the Skin

Treatment options for squamous cell cancer (SCC) of the skin 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 SCCs are found and treated at an early stage, when they can be removed or destroyed with local treatments such as surgery or radiation therapy. Small SCCs can usually be cured with these treatments. Larger SCCs are harder to treat, and fast-growing cancers have a higher risk of coming back.

While it’s not common, SCC can sometimes 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.

(To learn about treating precancers and very early forms of squamous cell skin cancer, see Treating Actinic Keratosis and Bowen Disease.)

Surgery

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

Curettage and electrodesiccation: This approach might be useful in treating some small, thin SCCs that have a low risk of coming back, but it’s not usually used for larger tumors.

Shave excision: Shaving off the top layers of the skin (including the tumor) with a small surgical blade might be another option for some small SCCs that are at low risk for coming back after treatment.

Standard excision: This type of surgery, in which the tumor and a margin of normal skin around it are removed, is often used to treat SCCs.

Mohs surgery: Mohs surgery is especially useful for SCCs that are at higher risk for coming back, such as larger tumors, tumors 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 a standard excision if it didn’t remove all of the cancer (that is, if the surgical margins were positive). This approach is typically more complex and time-consuming than other types of surgery. Other surgical techniques similar to Mohs might also be an option in these situations.

Radiation therapy

Radiation therapy might be an option for people with large SCCs, especially for tumors in areas where surgery would be hard to do (such as the eyelids, ears, or nose), or for people who can’t have (or don’t want) surgery. Radiation isn’t often used as the first treatment for younger people with SCC because of the possible risk of long-term problems.

Radiation is sometimes used after surgery (standard 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. Sometimes chemotherapy might be given at the same time, which might help the radiation work better.

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) might be an option for some early squamous cell cancers that are at low risk for coming back, especially in people who can’t have surgery, but it’s typically not recommended for larger SCCs or those on certain parts of the nose, ears, eyelids, scalp, or legs.

Treating cancers that aren’t removed completely or that come back after treatment

Treatment options for SCC that remains after treatment or that comes back later depend on where the tumor is, what the first treatment was, and other factors.

If possible, surgery (such as Mohs surgery or a re-excision) is often recommended to try to remove any remaining cancer. Radiation therapy might be another option, especially if surgery can’t be done for some reason. Radiation usually can’t be repeated in the same area if it was the first treatment, because it’s more likely to cause serious side effects.

If the cancer comes back in nearby lymph nodes or in other parts of the body, systemic treatments such as immunotherapy or chemotherapy drugs might be an option (see below).

Treating advanced squamous cell cancers

Different types of treatments might be used for SCCs that have spread beyond the skin.

Lymph node dissection: Removing regional (nearby) lymph nodes might be recommended for some SCCs 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 then looked at under a microscope to see if they contain cancer cells. Sometimes, radiation therapy might be recommended after surgery.

Immunotherapy: For advanced SCCs 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 people with SCC that has spread to lymph nodes or distant organs. These types of treatment might be combined or used separately.