Skin cancer, Calgary South
The second most common skin cancer, and the one that can spread. It grows faster than basal cell carcinoma, it often starts as a rough sun damaged patch that was ignored, and it is treated more definitively for that reason. Dr. Paul Kuzel biopsies it, removes it surgically, and treats the precancerous changes around it before they become the next one.
What it is
Squamous cell carcinoma arises from the flat cells that make up most of the epidermis. Cumulative ultraviolet damage is the main driver, so it appears on the parts of the body that have taken decades of sun: the scalp, ears, face, lips, neck, backs of the hands and forearms, and the lower legs.
It usually looks like a firm scaly lump or nodule, often tender, sometimes with a crust or a central plug of hard keratin. Some form an open sore with a raised rim that will not heal. Some grow visibly over weeks rather than years. On the lip it can show as a persistent rough or ulcerated area. Anything that is growing quickly, bleeding, tender, or refusing to heal needs assessment now rather than at some later date.
Squamous cell carcinoma can spread to lymph nodes and beyond. That is uncommon, but it is the reason this cancer is not watched and not treated with a surface treatment. If you have a growing, tender or non healing lump, book an appointment rather than waiting to see whether it settles.
Actinic keratosis, the step before
Most squamous cell carcinomas do not appear out of nowhere. They come from actinic keratoses: rough, dry, scaly patches on sun exposed skin that are often easier to feel than to see, like fine sandpaper on the scalp, forehead, ears or hands. An actinic keratosis is not a cancer. It is a change in the skin where the cells have already been damaged, and a small proportion of them progress to invasive squamous cell carcinoma over time.
Nobody can tell you which individual patch will progress. That is precisely why they are treated as a field rather than picked off one at a time, and why a patch that becomes thick, tender, or starts to grow is biopsied instead of frozen.
Rough scaly patch on sun damaged skin. Precancerous. Treated with cryotherapy or photodynamic therapy, often across a whole area at once.
Also called Bowen disease. Abnormal cells still confined to the epidermis, usually a persistent scaly red patch. Treated surgically, and in selected cases with photodynamic therapy or cryotherapy.
The tumour has grown into the dermis. This is removed surgically with a margin and confirmed by pathology. Light and freezing treatments are not appropriate here.
Large or deep tumours, poorly differentiated ones, those on the lip or ear, recurrent tumours, those showing perineural invasion, and those in immunosuppressed patients. Managed more aggressively and often with specialist referral.
Who is more likely to get it
Who it suits
Invasive squamous cell carcinoma is a surgical problem. The lighter treatments have a real role, but that role is upstream, on the precancerous changes and on disease still confined to the surface.
When another team is the right answer
What happens
Dr. Kuzel examines the lesion with dermoscopy, feels its thickness and whether it is fixed to deeper tissue, checks the lymph nodes when the situation calls for it, and looks at the rest of your sun exposed skin.
A sample is taken under local anesthetic so a pathologist can confirm the diagnosis, say whether it is in situ or invasive, and describe how the tumour is behaving. Nothing that could be a squamous cell carcinoma is frozen or lasered before this, because destroying tissue destroys the diagnosis.
Size, depth, site, differentiation, perineural invasion and your immune status decide whether this is a straightforward excision or a tumour that needs wider margins and specialist involvement.
The excision is done in the clinic under local anesthetic. The tumour is removed with the planned margin and the wound closed with sutures. Larger defects may need a flap or a graft, which is discussed beforehand.
The report states whether the tumour was removed completely and repeats the risk features. If a margin is involved, further surgery is arranged. You are told the result either way.
The actinic keratoses around the site are treated with cryotherapy or photodynamic therapy, because the skin that produced one tumour is capable of producing another.
Regular skin checks, more frequent after a high risk tumour and for immunosuppressed patients, with attention to the surgical site and to the lymph nodes that drain it.
Healing and risks
Surgery for squamous cell carcinoma is usually straightforward, and it leaves a permanent scar. The treatments for actinic keratoses are shorter but not painless, and they leave the skin red and crusted for a while.
After excision
After cryotherapy or photodynamic therapy for actinic keratoses
After one squamous cell carcinoma your chance of another is meaningfully higher, and higher again if you are immunosuppressed. Daily sun protection, avoiding tanning, and keeping to a follow up schedule are the parts of this that work over years rather than weeks.
Questions
Most often a firm scaly lump or a crusted nodule on sun exposed skin, frequently tender, sometimes with an open sore in the middle that keeps scabbing over. Some grow noticeably over a few weeks. On the lip it can look like a rough or ulcerated patch that will not settle. If something is growing, sore, bleeding or not healing, have it assessed rather than watching it.
No. They are precancerous changes in sun damaged skin, rough patches that are often easier to feel than to see. A small proportion progress to invasive squamous cell carcinoma, and there is no way to tell in advance which ones will. That is why they are treated as a field with cryotherapy or photodynamic therapy, and why a patch that thickens, becomes tender or starts growing gets biopsied instead.
Yes. It is uncommon, in the range of a few percent of cases, but it is a real possibility, and the risk is higher for tumours that are large or deep, poorly differentiated, on the lip or ear, recurrent, showing invasion around nerves, or occurring in someone whose immune system is suppressed. That possibility is why this cancer is removed surgically and confirmed by pathology rather than treated at the surface.
Not an invasive one. Photodynamic therapy and cryotherapy treat actinic keratoses, and in selected cases squamous cell carcinoma in situ, where the abnormal cells are still confined to the surface. Invasive tumours extend deeper than light or freezing reach, so treating them that way risks leaving cancer behind under skin that looks healed. The biopsy determines which situation you are in.
Your risk of squamous cell carcinoma is many times higher than average, lesions appear earlier and in greater numbers, and they can behave more aggressively. In practice that means more frequent skin checks, a lower threshold to biopsy, earlier treatment of actinic keratoses, wider margins on some tumours, and coordination with the team managing your immunosuppression. Do not wait between appointments if something new appears.
The excision is done under local anesthetic, so you feel the freezing going in and then pressure rather than pain. Afterwards most people manage with acetaminophen for a day or two. Sutures come out at about 5 to 7 days on the face and 10 to 14 days elsewhere, and normal activity resumes at about two weeks. Lower leg wounds take longer.
Assessment and treatment of skin cancer and of actinic keratoses are medically necessary care and are generally covered by the Alberta Health Care Insurance Plan for eligible residents. Purely cosmetic work is not covered. There is no price list here because the plan depends on the diagnosis, the site and the pathology, and anything you would pay for is explained before it is booked.
Follow up is usually more frequent in the first two years, because that is when recurrence and new tumours are most likely, then spaced out if things stay quiet. Patients with high risk tumours or ongoing immunosuppression are seen more often. Between visits, examine your own skin and book earlier if something new is growing.
Book
A lump that is growing, tender, bleeding or refusing to heal is worth an appointment this month. Squamous cell carcinoma treated early is a small operation with a high cure rate, and it does not stay small indefinitely.
Book a consultation Call (403) 286-6888
Related reading: skin cancer treatments, skin checks, basal cell carcinoma.
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