Squamous cell carcinoma

Squamous cell carcinoma (SCC) is a skin cancer, which usually starts as a scaly or crusty raised lesion. It can ulcerate, it can bleed, it can become red and inflamed. SCC is most commonly found on sun-exposed areas such as the back of the hands, the ears, the head and the neck. These lesions most commonly occur in the seventh decade of life. SCC is usually caused by sun-exposure, particularly in those individuals who have prolonged or repeated exposure (such as agricultural workers, builders, or out-door sportsmen or sportswomen). Individuals taking immunosuppressive medication after an organ transplant are also vulnerable.

Diagnosis

The diagnosis can be confirmed using a small biopsy: treatment is usually surgical removal of the lesion.

A thick large squamous cell carcinoma of the upper lip: treated successfully by surgical excision

Actinic or solar keratosis
Thick, scaly or rough patches of skin, are relatively common in sun exposed areas, particularly in older fair skinned patients. These lesions have been called pre-cancerous, as approximately 20% will form an SCC is left untreated.

Actinic keratosis can be treated with cryotherapy (freezing with liquid nitrogen in the out-patient clinic) or with creams such as Efudix (topical 5% 5-Fluorouracil) or Solaraze.

Actinic keratosis: the diagnosis was confirmed using a biopsy

Bowen’s disease

Squamous cell carcinoma in-situ (also known as Bowen’s disease) is a superficial, intra-epidermal form of skin cancer. Approximately 3-5% of lesions progress to form a thicker invasive cancer.

Lesions usually preset as flat salmon-pink coloured plaques with an irregular border. A biopsy will usually confirm the diagnosis.

Treatment options include: cryotherapy (freezing in clinic with liquid nitrogen spray), topical agents including 5-flourouracil, surgery, or for areas with poor healing potential such as the lower legs it may be appropriate to merely keep the lesion under observation.

Follow up after surgery

Squamous Cell Carcinoma of less than 2 mm thickness are considered to be of low risk and are usually discharged from further planned follow-up

Squamous Cell Carcinoma of between 2 and 6 mm thickness are considered to be of moderate risk and are usually followed up at 6 monthly intervals for for 3 years.

Squamous Cell Carcinoma of more than 6 mm thickness are considered to be of higher risk and are followed up at 4 monthly intervals for 2 years and 6 monthly intervals for 3 further years

Skin Cancer and War Pensions

Men or women with skin cancer who have served in the British Armed Forces may qualify for a lump sum or regular pension.

Patients who have developed a Basal Cell Carcinoma, Squamous Cell Carcinoma or Melanoma, particularly those who served areas of high sun intensity should contact

Service Personnel and Veterans Agency
UK Helpline
Free Phone 0800 169 22 77

Veterans UK have a helpful team who will provide support and help patients complete any paperwork.

More information about squamous cell carcinoma
Information can be found on the BAPRAS website: http://www.bapras.org.uk/public/patient-information/surgery-guides/skin-cancer/squamous-cell-carcinoma, or on the BAD website: www.bad.org.uk/library-media/documents/Squamous Cell Carcinoma