Squamous Cell Carcinoma (SCC)

Squamous cell carcinoma (SCC) is the second most common skin cancer, after basal cell carcinoma. It develops in the squamous cells of the outer layer of the skin, usually on areas that get the most sun. SCC is highly curable when found early, but it is more likely to spread than basal cell carcinoma, so prompt diagnosis and treatment matter.

What Is Squamous Cell Carcinoma?

Squamous cell carcinoma arises from the flat squamous cells that make up most of the epidermis, the outer layer of the skin. It is usually caused by long-term ultraviolet (UV) exposure from the sun or tanning beds, so it tends to appear on sun-exposed skin. SCC can also develop from a precancer called an actinic keratosis, which is why treating actinic keratoses early is important. Learn more about actinic keratosis and how it compares in our guide to basal cell vs. squamous cell carcinoma.

What Does SCC Look Like?

Squamous cell carcinoma can look different from person to person. Common signs include:

• A rough, scaly, or crusted red patch that may be tender
• A firm, raised bump or nodule
• A wart-like growth
• An open sore that will not heal, or heals and returns
• A spot that bleeds, itches, or crusts over

SCC appears most often on the face, ears, lips, scalp, neck, and the backs of the hands and forearms, but it can occur anywhere, including areas with less sun exposure. Any spot that grows, bleeds, or does not heal within a few weeks should be evaluated.

What Causes SCC and Who Is at Risk?

• Cumulative sun exposure and the use of tanning beds
• Fair skin, light eyes, and a tendency to burn
• Older age and a history of frequent sunburns
• A weakened immune system, including organ transplant recipients
• A history of actinic keratoses or previous skin cancer
• Certain exposures, such as prior radiation, chronic wounds or scars, and some HPV infections

How Is SCC Diagnosed?

A dermatology provider examines the spot, often with a handheld device called a dermatoscope, and confirms the diagnosis with a skin biopsy. During a biopsy, a small sample of the lesion is removed and examined under the microscope. Full-body skin exams help find SCC and other skin cancers early, before they grow or spread. See how to check your skin and the value of an annual skin exam.

How Is SCC Treated?

Treatment is chosen based on the tumor’s size, location, depth, and microscopic features, along with your overall health.

Mohs micrographic surgery

Mohs surgery removes the cancer one thin layer at a time and checks each layer under the microscope until the margins are clear. It offers the highest cure rate while preserving the most healthy tissue, so it is often preferred for SCC on the face, ears, lips, scalp, and hands, for large or recurrent tumors, for aggressive subtypes, and in immunosuppressed patients. For skin cancers near the eye, Belaray coordinates Mohs removal with same-visit oculofacial reconstruction.

Other treatments

• Standard surgical excision for many tumors on the trunk and limbs
• Curettage and electrodesiccation for small, low-risk tumors
• Radiation therapy for patients who are not candidates for surgery

High-Risk SCC and Spread

Most squamous cell carcinomas never spread. The overall risk of spread is roughly 2 to 5 percent, but it is higher for tumors that are large, deep, or recurrent, tumors on the lip or ear, tumors with aggressive features under the microscope, and tumors in people who are immunosuppressed. Finding and treating SCC early keeps this risk low, which is why a non-healing or changing spot should be checked promptly.

Prevention and Follow-Up

Daily broad-spectrum sunscreen, sun-protective clothing, and avoiding tanning beds lower your risk of SCC and other skin cancers. After a skin cancer diagnosis, regular full-body skin exams are important, because people who have had one skin cancer have a higher chance of developing another. Explore our Skin Cancer Center for how Belaray handles screening, surgery, and reconstruction under one roof.

Frequently Asked Questions

What does squamous cell carcinoma look like?

Squamous cell carcinoma often looks like a rough, scaly red patch, a firm raised bump, a wart-like growth, or a sore that will not heal and may bleed or crust. It shows up most often on sun-exposed skin such as the face, ears, lips, scalp, neck, and the backs of the hands. Any spot that keeps growing, bleeds, or does not heal within a few weeks should be checked.

Is squamous cell carcinoma dangerous or can it spread?

Most squamous cell carcinomas are cured when found and treated early. SCC is more likely to spread than basal cell carcinoma, with an overall risk of spread of roughly 2 to 5 percent, and a higher risk for large or high-risk tumors, tumors on the lip or ear, and in people who are immunosuppressed. Early treatment keeps the risk of spread low.

How is squamous cell carcinoma treated?

Treatment depends on the size, location, and features of the tumor. Options include Mohs micrographic surgery, standard surgical excision, curettage and electrodesiccation for small low-risk tumors, and radiation for patients who are not surgical candidates. Mohs surgery is often preferred on the face and other high-risk sites because it offers the highest cure rate while preserving healthy tissue.

Does squamous cell carcinoma require Mohs surgery?

Not always, but Mohs surgery is preferred for SCC on the face, ears, lips, scalp, hands, and other cosmetically or functionally sensitive areas, for large or recurrent tumors, for aggressive subtypes, and in immunosuppressed patients. For small, low-risk SCC on the trunk or limbs, simpler treatments such as excision or curettage may be appropriate.

Can squamous cell carcinoma be cured?

Yes. When detected and treated early, squamous cell carcinoma has very high cure rates, and Mohs surgery offers cure rates around 97 percent or higher for many tumors. After treatment, regular full-body skin exams are important because people who have had one skin cancer are at higher risk of developing another.

Where can I get squamous cell carcinoma treatment on Long Island?

Belaray Dermatology treats squamous cell carcinoma at its Hicksville (Nassau County) and Stony Brook (Suffolk County) offices, including Mohs surgery performed by three dual board-certified Mohs surgeons. Call or text (516) 822-7546 to schedule an evaluation.

Related reading: Basal cell vs. squamous cell carcinoma, actinic keratosis (precancer), what is Mohs surgery, and skin cancer screening on Long Island.