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Squamous Cell Carcinoma
Squamous cell carcinoma (SCC), the second most common form of skin cancer, is an uncontrolled growth of abnormal cells arising from the squamous cells in the epidermis, the skin’s outermost layer. SCCs often look like scaly red patches, open sores, warts or elevated growths with a central depression; they may crust or bleed. Cumulative, long-term exposure to ultraviolet (UV) radiation from the sun over your lifetime causes most SCCs. Daily year-round sun exposure, intense exposure in the summer months or on sunny vacations and the UV produced by indoor tanning devices all add to the damage that can lead to SCC.
A biopsy is a small sampling of the skin tissue. The area is numbed with local anesthetic and then a small piece of tissue is removed. Depending on the type of biopsy taken, sometimes sutures are required. Once proven by biopsy to be a Basal Cell Carcinoma, there are several treatment options, depending on the specific type of Basal Cell Carcinoma.
Using a scalpel, the physician removes the entire growth along with a surrounding border of apparently normal skin as a safety margin. The skin around the surgical site is closed with stitches, and the tissue specimen is sent to the laboratory to verify that all cancerous cells have been removed. Cure rates are generally above 95 percent in most body areas, similar to those of curettage and electrodesiccation. A repeat excision may be necessary on a subsequent occasion if evidence of skin cancer is found in the specimen.
A physician trained in Mohs micrographic surgery removes a thin layer of tissue containing the tumor. While the patient waits, frozen sections of this excised layer are mapped in detail and examined under a microscope, generally in an on-site laboratory. If cancer is present in any area of the excised tissue, the procedure is repeated only on the body area where those cancer cells were identified (the tissue mapping allows the Mohs surgeon to pinpoint this area of the body), until the last excised layer viewed microscopically is cancer-free. This technique can save the greatest amount of healthy tissue and has the highest cure rate, 99 percent or better. It is often used for large tumors in cosmetically important areas, and those that have recurred, are poorly demarcated (hard to pinpoint), or are in critical areas.
PDT is FDA-approved for the treatment of superficial or nodular BCC, with cure rates ranging from 70 to 90 percent. A light-sensitizing agent, topical 5-aminolevulinic acid (5-ALA), is applied to the lesion in the physician’s office. Subsequently, the medicated area is activated by a strong blue light; theoretically, this will selectively destroy BCCs while causing minimal damage to surrounding normal tissue. Some redness, pain, and swelling can result. Patients must strictly avoid sunlight for at least 48 hours, or UV exposure may further activate the medication, causing severe sunburn.