Squamous Cell Carcinoma Treatment Options
Understanding the various squamous cell carcinoma treatment options is crucial for patients and their families. This article focuses on treatment for squamous cell carcinoma of the skin, from local procedures used for early disease to the immunotherapy drugs used when the cancer has spread beyond the skin or come back.
Key Takeaways
- Treatment for squamous cell carcinoma (SCC) of the skin is chosen based on whether the cancer is confined to the skin (localized), has spread beyond the skin or is out of reach for local treatment, or has come back after earlier treatment, together with the tumor’s size, location, and the patient’s overall health.
- Localized SCC is generally treated with a surgical procedure — simple excision, Mohs micrographic surgery, or curettage and electrodesiccation — or with radiation therapy; photodynamic therapy is an option specifically for squamous cell carcinoma in situ, the earliest stage.
- SCC that has spread beyond the skin or cannot be treated locally is generally treated with immunotherapy — the PD-1 inhibitor drugs cemiplimab or pembrolizumab — or by enrolling in a checkpoint-inhibitor immunotherapy trial.
- If squamous cell carcinoma comes back but has not spread, the same local tools used for early disease — excision, Mohs surgery, or radiation — are generally used again.
- A multidisciplinary care team weighs the cancer’s stage, size, and location, and the patient’s general health, to choose the approach most likely to clear the cancer while sparing healthy tissue.
Overview of Squamous Cell Carcinoma Treatment
Squamous cell carcinoma treatment is generally built around three situations: cancer that is still confined to the skin, cancer that has spread beyond the skin or cannot be reached with local treatment, and cancer that has recurred after earlier therapy. Squamous cell carcinoma and basal cell carcinoma are the two most common types of skin cancer, and treatment for either is guided by the cancer’s stage, how large it is, its location on the body, and the patient’s general health. The aim throughout is to clear the cancerous cells, lower the chance the cancer returns, and preserve as much normal skin function and appearance as the situation allows.
Initial Assessment and Staging
Treatment planning begins with a skin biopsy, in which part or all of the suspicious growth is taken and checked microscopically to confirm the diagnosis. From there, prognosis and the treatment options that follow depend mainly on the stage of the cancer, whether the patient’s immune system is suppressed, whether the patient uses tobacco, and general health. Because staging carries this much weight, it is worked out before a specific treatment plan is recommended; the details of how squamous cell carcinoma is staged are covered separately.
Personalized Treatment Planning
Once staging is complete, a care team — typically a dermatologist working with a surgeon, radiation oncologist, or medical oncologist as needed — reviews the cancer’s stage, how big the tumor is and which part of the body it affects, and the patient’s general health to settle on a plan. This individualized review is what determines which of the specific procedures and drugs described below actually apply to a given case.
Localized Treatment Approaches for SCC
When squamous cell carcinoma is still confined to the skin, doctors generally reach for one of several local procedures, or for radiation therapy, rather than a treatment that works through the whole body.
Surgical Removal and Excision
Simple excision cuts out the tumor together with a margin of normal-appearing skin around it, and is one of several standard local options for squamous cell carcinoma. In Mohs micrographic surgery, the surgeon removes the tumor one thin layer at a time, checking each layer under a microscope for remaining cancer cells before taking the next one, continuing until none are seen; this precision is why it is often chosen for skin cancer located on the face, on the fingers, or in the genital area, or where a tumor’s border is hard to define. Curettage and electrodesiccation — sometimes called electrosurgery — scrapes the tumor away with a spoon-shaped tool called a curette, then applies a needle-shaped electrode carrying an electric current to stop bleeding and destroy any cancer cells left at the wound’s edge; this cycle may be repeated up to three times in one session. Cryosurgery destroys the abnormal tissue by freezing it with a specialized instrument, and is an option for carcinoma in situ. Which of these a doctor recommends depends on the tumor’s size, depth, and location, and how much healthy skin needs to be preserved.
Radiation Therapy
External radiation therapy, delivered from a machine outside the body toward the area with cancer, is also used to treat this disease, particularly when surgery would be difficult in a given location or is not a good fit for the patient. If squamous cell carcinoma comes back after treatment but has not spread beyond the skin, the same local approaches generally apply again: simple excision, Mohs micrographic surgery, or radiation therapy.
Systemic Therapies for Advanced SCC
When squamous cell carcinoma has spread beyond the skin, or sits somewhere local treatment cannot reach it, care shifts toward options that work throughout the body.
Chemotherapy and Targeted Drugs
When chemotherapy is used for this cancer, it is generally applied topically, directly on the skin, rather than given as a systemic infusion. Retinoids, a group of vitamin-A-derived compounds, occasionally serve as an additional drug option for this cancer. Unlike basal cell carcinoma, which has its own signal-transduction-inhibitor targeted drugs, current patient guidance does not list a comparable molecularly targeted drug specifically for squamous cell carcinoma; the systemic option with the strongest evidence for advanced disease is immunotherapy, covered next.
Immunotherapy
Once squamous cell carcinoma has spread beyond the skin or sits somewhere surgery and radiation cannot fully reach, immunotherapy becomes a standard option. Cemiplimab and pembrolizumab are PD-1 inhibitor drugs that block a checkpoint signal cancer cells rely on to hide from the immune system, which frees immune cells to recognize and attack the tumor; doctors turn to either drug once the disease has grown well past its original site or reached distant areas of the body. Interferon, given by injection, is another immunotherapy option listed for this cancer. Enrolling in a checkpoint-inhibitor immunotherapy trial is also listed alongside these drugs as a standard path for disease that local treatment cannot reach.
Emerging and Advanced SCC Treatments
Research into squamous cell carcinoma continues, and much of the newest progress for advanced disease has centered on the immunotherapy drugs described above rather than on an entirely new category of treatment.
Clinical Trials and Novel Therapies
Taking part in a clinical trial is itself one of the standard-listed paths for squamous cell carcinoma that has spread or cannot be treated locally, alongside using cemiplimab or pembrolizumab outside of a trial setting. Clinical trials compare a new approach against current standard care, and many of today’s standard cancer treatments — including the checkpoint immunotherapy drugs now used for advanced disease of this type — were established this way. Patients can enter a trial before, during, or after other treatment begins, and current studies can be searched through national clinical trial registries.
Any complementary or alternative approach should support, not replace, the treatment plan set with a doctor, and is worth discussing with the care team before it is started.
Frequently Asked Questions
What is the best treatment for squamous cell carcinoma?
There is no single best treatment; the right approach depends on whether the cancer is localized, has spread beyond the skin, or has recurred, along with the tumor’s size, location, and the patient’s general health. Localized disease is generally treated with excision, Mohs surgery, curettage and electrodesiccation, cryosurgery, or radiation, while disease that has spread or cannot be treated locally is generally treated with immunotherapy or a clinical trial. A care team weighs these factors together to choose the option most likely to clear the cancer.
What are the different types of squamous cell carcinoma treatments?
For localized disease, options include radiation therapy, cryosurgery, curettage and electrodesiccation, simple excision, and Mohs micrographic surgery, with photodynamic therapy reserved for the earliest, in-situ stage. For cancer that has advanced past the skin or cannot be reached with local treatment, immunotherapy with cemiplimab or pembrolizumab, interferon by injection, or participation in a checkpoint-inhibitor immunotherapy study are the standard options. Recurrent disease that has not spread is generally treated again with the same local approaches used for localized disease.
Are there new advancements in squamous cell carcinoma treatment?
The most notable recent progress for squamous cell carcinoma has been in immunotherapy: the PD-1 inhibitor drugs cemiplimab and pembrolizumab are now standard options once the cancer has grown past the skin or cannot be treated locally, an option that did not exist for this cancer until relatively recently. Clinical trials of immune checkpoint inhibitor therapy continue to test further refinements for patients whose disease has spread or come back.
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