Squamous Cell Carcinoma: Treatment for Advanced Cases

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Squamous cell carcinoma is a type of cancer that arises in the skin, but that doesn’t mean you should take it any less seriously than a tumor arising inside the body. When left untreated, squamous cell carcinoma, also called SCC, can progress like any other type of cancer, invading the lymph nodes and spreading to other tissues (metastasis). When this happens, people with advanced squamous cell carcinoma (also called stage 4 squamous cell carcinoma) usually require treatment that goes beyond removing the skin lesion.

What Is Stage 4 Squamous Cell Carcinoma?

Fortunately, advanced SCC is rare. Squamous cell carcinomas usually grow slowly and can be removed from the skin before they penetrate deeper tissue layers.

In 2018, the American Joint Commission on Cancer (AJCC) revised its staging guidelines for “nonmelanoma skin carcinomas,” which include squamous cell carcinoma. This staging system applies only to SCC lesions that arise on the head and neck, because that’s where most squamous cell carcinomas tend to develop.

The current staging system uses three values to determine SCC staging:

  • T value: refers to the tumor’s size
  • N value: refers to whether or not the cancer has spread to a nearby lymph node
  • M value: refers to whether or not the cancer has metastasized

Staging a squamous cell carcinoma is complicated, and both the clinician and the pathologist are needed to accurately determine the stage of any skin cancer. In general, a stage 4 squamous cell carcinoma usually is fairly large in size, has invaded at least one regional lymph node to cause significant enlargement, and may have spread (metastasized) to distant organs or bones.

Treatment Options for Advanced Squamous Cell Carcinoma

Your doctor will work with a clinical team to develop a treatment plan for advanced SCC that may involve several approaches. Your team will recommend the options best suited to treat the cancer based on your age, overall health status, location of the tumor, specific stage of carcinoma, and prognosis.

Usually a first line of treatment for any skin cancer is surgical removal of the tumor. In addition to surgery, your doctor may recommend additional treatment options for advanced SCC.

Chemotherapy

Several cancer drugs and drug combinations can be effective for treating advanced squamous cell carcinoma. These medications are delivered via an intravenous (IV) line over the course of several appointments.

Immunotherapy

This type of therapy engages your body’s own immune system to destroy cancer cells. The one approved immunotherapy treatment for SCC is cemiplimab-rwlc. This medication is given through an IV approximately once every three weeks. Researchers are investigating other immunotherapy medications to treat SCC.

Radiation Therapy

Three types of radiation therapy might be used to treat stage 4 squamous cell carcinoma:

  • Brachytherapy: implanting tiny radioactive “seeds” into the tumor or surrounding tissues to directly disrupt the ability of the cancerous cells to survive
  • External beam radiation therapy: directing powerful radiation beams into the tumor to destroy the cancerous cells
  • Superficial radiation therapy: directing beams of radiation toward the skin layers just below the tumor, which destroys only the surface tumor itself

Two other approaches a doctor might take toward an advanced SCC include:

  • Observation: In this approach, your doctor will adopt a “watchful waiting” method to see if the SCC grows. A doctor might recommend observation in older patients with slow-growing tumors that exhibit no features of aggressiveness. Observation also may be a useful approach with patients who have additional medical conditions that make aggressive treatment risky.
  • Palliative care: Patients who opt not to treat an advanced squamous cell carcinoma may consider palliative care. This type of care treats the symptoms of advanced cancer—such as pain or anxiety— without treating the cancer itself.

Fortunately, squamous cell carcinoma metastasis is relatively rare because SCCs often get detected early enough to treat the local cancer before it spreads, and the overall prognosis for squamous cell carcinoma generally is good. Surgically removing a tumor often represents a cure, though SCC has tends to recur.

Even advanced squamous cell carcinoma can be treated in most people. Your doctor will develop a treatment plan for you that gives you the best chance to survive and thrive after experiencing this very common type of skin cancer.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 May 19
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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