Squamous cell carcinoma • Identify and treat spinalioma

Squamous cell carcinoma is the second most common type of malignant skin cancer after basal cell carcinoma. Both forms are assigned to white skin cancer. How can squamous cell carcinoma of the skin be recognized and what are the treatment options?

In Germany, an estimated 93,000 people are newly diagnosed with squamous cell carcinoma of the skin (SCC) – also known as spinalioma, squamous cell carcinoma or spinocellular carcinoma. The trend is rising. The disease occurs particularly frequently with increasing age: The average age for squamous cell cancer is around 70 years. White skin cancer is more common in men than women.

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Identify skin diseases with these images

What is squamous cell carcinoma?

A squamous cell carcinoma is a malignant skin tumor that grows locally and is destructive. However, it rarely forms metastases (secondary tumors) and is almost always curable.

In principle, a spinalioma can develop in all body regions that have a squamous epithelium (covering tissue made up of flat cells) or tissue structures that can transform into squamous epithelium (squamous epithelium metaplasia). In addition to the skin, these parts of the body also include the mucous membranes (e.g. in the esophagus, throat, cervix) or the lungs.

However, a spinalioma usually develops on skin areas that are most frequently and intensively exposed to UV radiation from the sun over the course of a lifetime, such as the décolleté, neck, face, ears and, especially in bald men, also on the scalp.

Causes: Solar radiation as the main risk factor for squamous cell carcinoma

The most important risk factor for the development of squamous cell carcinoma is excessive UV radiation. People who are particularly affected are:

  • who spend a lot of time in the sun
  • with a light skin type
  • with a weakened immune system (e.g. as a result of an illness or medicinal, immunosuppressive therapy)

As a result of years of exposure to the sun, the epidermis is chronically damaged. So-called actinic or solar keratoses can develop, which are considered to be precancerous stages. An estimated five percent of these rough spots transform into squamous carcinoma. In rarer cases, however, the carcinoma can also arise from wounds, burn scars or specific skin diseases.

Appearance: How can a spinalioma be recognized?

The preliminary stage of squamous cell carcinoma, actinic keratosis, initially appears as scaly redness on the skin that is not or only slightly raised. The surface can feel like fine sandpaper.

As the disease progresses, the changes in the skin harden and finally knots with a rough, heavily calloused surface develop. However, the knots can also develop without prior visible signs. This horny layer is very tight and is difficult to remove with scratches. The broken area then begins to bleed. Basically, all non-healing lesions in sun-exposed areas are suspicious and should be evaluated medically.

There is always a risk of metastasis (secondary growths in other regions of the body) in squamous cell cancer if the tumor penetrates from its place of origin, the uppermost skin layer (epidermis), into deeper skin layers. Unlike malignant melanoma (black skin cancer), however, squamous cell carcinoma does not have a pronounced tendency to metastasize. Its tendency to metastasize is estimated at three to five percent.

Diagnosis: This is how a squamous cell carcinoma is diagnosed

The following applies to all forms of skin cancer: the earlier it is detected, the better the treatment options and the more favorable the prognosis for healing. Squamous cell carcinomas with a diameter of less than one centimeter and which have not yet formed metastases have very good chances of recovery.

Therefore, people who are often outside and very light-skinned people who naturally have many pigment spots (nevi or naevi) should regularly check themselves for skin changes at home in front of the mirror. For people over the age of 35 who have statutory health insurance, the health insurance fund covers the costs of skin cancer screening every two years.

Skin screening in dermatological practice

After a detailed questioning (anamnesis) about previous dermatological diseases, the skin of the entire body is examined with the naked eye and, if necessary, also with a reflected-light microscope (dermatoscope). If skin cancer is suspected, a tissue sample (biopsy) is taken for histological examination (histology) in the laboratory. There, the type of tumour, its diameter and the extent to which it has spread into the deeper layers of the skin are determined.

Classification of squamous cell carcinoma

A histological classification by the World Health Organization (WHO) divides squamous cell carcinomas into different subtypes:

  • Spindle cell squamous cell carcinoma (aggressive)
  • Acantholytic squamous cell carcinoma (with lysis of keratinized cells)
  • Verrucous (wart-like) squamous cell carcinoma (favorable prognosis)
  • Lymphoepitheliomartiges Plattenepithelkarzinom
  • Squamous cell carcinoma with horn formation

Further diagnostics: Imaging methods such as ultrasound

If a spinalioma is detected, further diagnostic steps are necessary. If the tumor has already grown more than two millimeters into deeper skin layers, an ultrasound examination (sonography) of the lymph nodes should also be carried out to clarify any secondary tumors. If indications of metastases are found, further imaging examinations must be carried out in order to determine the degree of spread of the secondary tumors. Particular attention is paid to the chest and lungs.

Black skin cancer or mole?  These pictures will help you identify!

Standard therapy: Surgical removal of the squamous cell tumor

In the case of squamous cell carcinoma, the tumor is usually surgically removed (excision) with histological control of the incision edges to ensure complete removal. If the risk of metastasis of the squamous cell carcinoma is estimated to be high, the treating physicians can also remove the adjacent lymph nodes. Depending on the extent and assessment of the skin cancer, further surgical interventions on metastatic organs and systemic chemotherapy, which affects the entire organism, may also be necessary.

Other therapy methods

Especially in older patients, an operation is not always possible – for example, if there are additional diseases that weaken them too much (multimorbidity). In these cases, further therapy methods are available for the treatment of squamous cell carcinoma, such as:

  • Radiation (radiation therapy)
  • Photodynamic Therapy (PDT)
  • immunotherapy
  • chemotherapy

However, these therapeutic procedures can also be carried out in addition to surgical removal of the tumor if it makes sense from a medical point of view. For example, in the case of metastasizing squamous cell carcinoma, chemotherapy may be indicated after the tumor operation, provided the general condition of the patient allows it.

In the case of relatively superficial squamous cell carcinomas, the tumor can also be excised (curettage). Cryotherapy is also possible for more superficial tumors: Cold therapy in which the tumor cells are frozen with liquid nitrogen and thus destroyed with a “cold shock”.

After the therapy: Regular checks

Regular check-ups after treatment (follow-up care) are just as important as removing or destroying the tumor. Because despite the immediate histological control of the operated or treated tissue, it can never be completely ruled out that there are still tumor cells there. Over time, these can grow into a new squamous cell carcinoma (recurrence).

Regular follow-up appointments are therefore recommended for patients with squamous cell carcinoma after tumor therapy. How often follow-up examinations should be performed depends on the individual case. Quarterly check-ups are advisable in the first year.

UV protection is an important measure to prevent squamous cell cancer

Sunburn is dangerous, even if acute symptoms usually go away quickly: Many people underestimate the extent of the permanent cell damage that UV radiation from the sun can cause. If you expose yourself to the sun frequently and with insufficient protection, you not only risk repeated red, peeling skin areas, but also permanent skin damage, which many years later can develop into actinic keratosis and finally skin cancer.

Accordingly, comprehensive sun protection is indispensable for adults and especially for children. Most people use sunscreen when they go to the lake or swimming pool. But it is just as important to protect the uncovered parts of the body such as the face, décolleté, neck, scalp and ears when taking a walk in the sun or during the afternoon in the beer garden. The sunscreen should be applied generously, have a high sun protection factor (SPF) and protect against both UV-A and UV-B radiation.

The stinging midday sun should generally be avoided. Prolonged exposure to direct sun is not recommended at any time of the day. Children and people with thinning hair in particular should protect themselves in summer with a wide-brimmed sun hat.

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Source: Lifeline | Das Gesundheitsportal by www.lifeline.de.

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