Squamous Cell Carcinoma of the Skin

21.03.2024

SKIN SQUAMOUS CELL CANCER DIAGNOSIS AND TREATMENT

Cutaneous squamous cell cancer (cSCC) is a type of skin cancer that occurs as a result of abnormal growth of squamous cells in the upper layer of the skin. This type of cancer is most common on the skin in areas exposed to sunlight, such as the face, ears, neck, hands and arms. The most important cause of skin squamous cell cancer is long-term exposure to the sun. Early diagnosis and treatment of this type of cancer is extremely important because, as it progresses, it can cause larger lesions on the skin and spread to other parts of the body. If caught in the early stages, it can usually be treated with surgery and can be treated successfully. Therefore, it is important to take skin protective measures when exposed to sunlight and to have regular skin examinations, and to remember that cutaneous squamous cell cancer is a type of cancer that can be prevented or diagnosed early.

WHAT ARE THE RISK FACTORS?

Some risk factors that can lead to skin squamous cell carcinoma include:

Exposure to Sunlight: Prolonged exposure to sunlight or sunburns may increase the risk of skin squamous cell cancer. Especially light-skinned people and those who frequently go out in the sun are at greater risk.

Age: This type of cancer generally increases in risk with age. As we age, skin cells may become more susceptible to sun damage.

Skin Type: Individuals with light skin, blonde hair or blue eyes are among the groups at higher risk of skin cancer. These skin types are more sensitive to the sun.

Family History: Family history may increase the risk of skin cancer. If family members have a history of skin cancer, this may increase the risk.

Burns and Scars: Skin damage, especially burns and scars, can increase the risk of skin cancer.

Radiation Exposure: The risk of skin cancer may increase in people who have been exposed to radiation for radiotherapy or other reasons.

Smoking and Alcohol Use: Smoking and excessive alcohol consumption may increase the risk of skin cancer.

Immune System Weakness: People with weak immune systems may be at risk of skin cancer. People who receive organ transplants or use medications that suppress the immune system are especially at risk.

HPV Infections: Some types of HPV (Human Papillomavirus) may increase the risk of skin cancer.

These risk factors can affect the likelihood of developing skin squamous cell cancer, although not everyone can get skin cancer even if they do not have these factors. Therefore, sun protection, skin exams, and following doctor's recommendations are important in reducing the risk of skin cancer.

Image 1: The change in character of skin lesions should be monitored for the development of skin cancers.

HOW DOES IT OCCUR?

The cancer development mechanisms of skin squamous cell cancer are complex and usually occur due to exposure to sunlight. Prolonged sun exposure can cause damage to the DNA of skin cells. This DNA damage leads to uncontrolled proliferation of normal cells. Additionally, ultraviolet (UV) rays of sunlight can cause mutations in the DNA in skin cells, which can trigger the development of cancer. Skin cancer occurs when overexposure to the sun is combined with risk factors such as sunburns and skin damage, especially in fair-skinned individuals. These mechanisms are the main factors that contribute to the development of skin squamous cell carcinoma.

WHAT ARE THE SYMPTOMS?

Symptoms of skin squamous cell carcinoma may include:

Skin Lesions: The most obvious symptom of cancer is lesions on the skin. These can often appear as raised, reddish surfaces, sores, or lesions with scaly and crusty surfaces.

Wound Healing: It may also be a symptom that wounds on the skin do not heal for a long time or tend to bleed constantly.

Pain and Itching: Pain, itching or burning sensation may be experienced with the lesions.

Color Changes: Color changes on the skin surface may be associated with the growth and spread of lesions. Lesions can often have a dark or black appearance.

Bleeding: Bleeding or crusting may be observed from lesions on the skin surface.

Growth: Cancer cells can grow over time and the size of lesions on the skin may increase.

These symptoms may indicate the presence of squamous cell carcinoma of the skin, but any skin problem can also cause these symptoms. If you are experiencing such symptoms or are concerned, it is important to consult a dermatologist. The dermatologist can make a definitive diagnosis by performing the necessary examinations and recommend the appropriate treatment. Early diagnosis and treatment can help these types of skin cancers have better outcomes.

HOW IS IT DIAGNOSED?

Diagnosis of cutaneous squamous cell carcinoma is usually made by a dermatologist through a physical examination and certain diagnostic tests. First, the dermatologist evaluates potential signs of cancer by observing abnormal lesions or changes in the skin. If a suspicious lesion is found, the dermatologist will usually perform a biopsy of the skin and take a small tissue sample to examine. This biopsy is sent for laboratory tests to determine whether the lesion is cancerous and its type. Additionally, imaging techniques can sometimes be used to evaluate the size and extent of extent of skin lesions. Once diagnosed, the stage and spread of the cancer is determined through further testing. These diagnostic procedures help create a treatment plan for the disease and determine appropriate treatment options

WHAT ARE THE PATHOLOGICAL TYPES?

Pathological types of skin squamous cell cancer may be:

Conventional cSCC: This most common type typically begins in the upper layer of the skin surface and can grow rapidly. It can be divided into well-differentiated or poorly differentiated subtypes.

Bowenoid cSCC: This is a type that usually spreads on the skin surface and the cells appear abnormal. If left untreated, it can progress to more serious forms of cSCC.

Verrucous cSCC: This type forms raised lesions on the skin surface and typically grows more slowly. It may have a good prognosis, but it needs to be treated.

Adenoid cSCC : This type represents a subtype of cSCC in which some cells exhibit glandular (like gland cells) properties.

Metatypic cSCC: Metatypical cSCC may represent a transitional form between cSCC and basal cell cancer. It combines the features of two types.

Microinvasive ccSCC: This type represents an invasive form of cSCC and tends to penetrate further into surrounding tissues.

Each type of cSCC may differ in its cellular structure and behavior and may have an impact on the treatment plan and prognosis. Pathological evaluation is important in determining the correct diagnosis and treatment options. The receptors and markers that need to be examined in the treatment of cutaneous squamous cell cancer and in the evaluation of prognosis may vary depending on the specific condition of the patient. However, in general, EGFR (Epidermal Growth Factor Receptor), PD-1 (Programmed Death-1) and PD-L1 (Programmed Death Ligand-1), BRAF (B-Raf Proto-Oncogene, Serine/Threonine Kinase), c-KIT Factors such as , p16, S100 Proteins and Ki-67 can help evaluate the treatment plan and the patient's prognosis. These receptors and markers must be taken into account depending on the patient's medical history and disease status, so a personalized approach is required for each patient.

Image 2: Individuals with suspicious skin lesions should be examined by a dermatologist at regular intervals.

HOW IS TUMOR STAGING DONE?

Staging of cutaneous squamous cell carcinoma is used to determine the extent and spread of the cancer. Tumor staging helps determine the patient's treatment plan and prognosis. The system developed by the American Joint Committee on Cancer (AJCC), which is generally used by the American Cancer Society, is used and consists of the following stages:

Evre 0 (Tis): This stage, called carcinoma in situ, indicates that the cancer cells are limited to the surface epidermis layer and have not spread to the surrounding tissues.

Stage I: The cancer has spread below the surface but has not yet spread to nearby lymph nodes or other organs. The size and depth of the tumor are evaluated at this stage.

Stage II: The tumor has spread deeper but has not yet spread to the lymph nodes or other organs.

Stage III: The cancer has spread to lymph nodes or nearby tissues, but has still not reached more distant organs.

Stage IV: Cancer has spread to different parts of the body or distant organs. This stage is called metastatic cancer and usually indicates a more serious prognosis.

Tumor staging is based on the results of the patient's physical examination, biopsy results, imaging studies (for example, computed tomography or magnetic resonance imaging), and sentinel lymph node biopsies to determine the status of the lymph nodes. This information helps assess the spread of cancer and is important in determining appropriate treatment options.

HOW IS TREATMENT DONE ACCORDING TO STAGES?

Treatment of cutaneous squamous cell carcinoma may vary depending on the stage and type of cancer and the patient's overall health. Here are the treatment approaches according to stages:

Stage 0 (Tis) and Stage I: In these stages, cancer is found on the surface or in a very limited area. Treatment is usually done by surgical methods. Surgical excision is performed to remove the tumor and preserve healthy tissues. Because the risk of spread to the lymph nodes is low at this stage, it is usually not necessary to remove the lymph nodes.

Stage II: If the cancer has spread deep down and has not yet spread to the lymph nodes, surgery may still be the main treatment method. More extensive surgical procedures such as deep surgical excision or Mohs surgery may be required.

Stage III: If the cancer has spread to the lymph nodes or affected nearby tissues, treatment may often include surgical excision as well as removal of the lymph nodes. In advanced stages, additional treatment options such as radiotherapy or immunotherapy may also be considered.

Stage IV: If the cancer has metastasized to distant organs or different parts of the body, treatment is more complex and surgical treatment options are often limited. At this stage, systemic treatments, that is, drug treatments such as chemotherapy, targeted drugs or immunotherapy, are more commonly used. These treatments can help control the cancer and relieve symptoms.

The treatment plan should be determined according to the specific situation of each patient. Specialists such as dermatologists, oncologists and surgeons determine the most appropriate treatment options by evaluating the patient's cancer stage and general health condition. It is also important for patients to take skin protection measures during the treatment process and go to regular doctor's examinations, because early diagnosis and treatment can increase the success of treatment.

Image 3: Skin cancers have the potential to spread to different organs via blood or lymph vessels.

WHAT ARE THE SYSTEMIC DRUGS USED IN TREATMENT?

Some chemotherapy drugs, targeted smart drugs, and immunotherapy drugs used to treat skin squamous cell cancer include:

Chemotherapy Drugs:

Fluorouracil (5-FU): 5-FU is a chemotherapy drug that targets rapidly dividing cancer cells and can be used in the treatment of cSCC.

Cisplatin: Cisplatin is another chemotherapy drug that is effective in treating some types of cancer such as cSCC. It stops the growth of cancer cells by inhibiting DNA replication and cellular division.

Targeted Smart Drugs:

EGFR Inhibitors (Epidermal Growth Factor Receptor): In some cases of cSCC, EGFR inhibitors can be used. These drugs block the activity of the EGFR receptor and control the growth of cancer cells.

Immunotherapy Drugs:

PD-1 Inhibitors (Pembrolizumab and Cemiplimab): PD-1 inhibitors can be used in advanced stages of cSCC or in metastatic cases. These drugs treat cancer cells by encouraging the immune system to attack them.

The treatment plan is determined depending on the stage of cSCC, the patient's general health condition, and other factors. The most appropriate treatment options for each patient should be determined by an oncologist or dermatologist and personalized for the patient's specific situation.

HOW SHOULD FOLLOW-UP BE CARRIED OUT AFTER RECOVERY?

After skin squamous cell cancer is treated, it is important for patients to participate in a regular follow-up program. Post-recovery follow-up aims to detect early cancer recurrence or metastasis. The follow-up program is usually directed by dermatologists or oncologists and may include the following elements: regular skin exams, checking lymph nodes, imaging studies, blood tests, and monitoring for certain symptoms. The follow-up process is personalized by taking into account the patient's treatment history, stage, risk factors and medical history. Early diagnosis can increase treatment success and improve quality of life after treatment, so it is important to participate in a regular follow-up program.