ASDS releases squamous cell carcinoma recommendations

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Importance of initial treatment emphasized by authors of comprehensive analysis.

ASDS experts emphasize that the initial treatment represents the best chance to cure squamous cell carcinoma.

Early detection and treatment are critical for curing squamous cell carcinoma, according to an expert group of dermatologic surgeons appointed by the American Society for Dermatologic Surgery Board of Directors to review all aspects of the second-most common form of skin cancer.

The first-ever consensus recommendations for the treatment of squamous cell carcinoma (SCC), which also analyzes the effectiveness and costs of various treatment methods, is featured in the November issue of the Dermatologic Surgery journal.

With an estimated 700,000 cases of SCC diagnosed in the United States each year, the document provides physicians a set of clinical principles and courses of action for treatment based on evidence from a comprehensive literature review and the evaluation of treatment methods. The analysis takes into consideration cure rates, recurrence rates, aesthetic and functional outcomes, and cost-effectiveness.

The consensus recommendations highlight the importance of early detection and swift enactment of a treatment plan.

“It cannot be overemphasized that the best chance for [curing SCC] is in the first treatment of the initial lesion, as all tumor treatment options are less successful for persistent or recurrent tumors than for primary tumors,” the authors write.

The authors identify complete tumor eradication as the primary goal of SCC treatment. Their analysis reveals that Mohs Micrographic Surgery offers the highest cure rate, maximum tissue preservation and the best cosmetic outcome. It is the preferred procedure for high-risk tumors, like squamous cell carcinoma.

SCC begins in the squamous cells, which are found in the outer layer of the skin. SCC might appear as a crusted or scaly area of skin with a red, inflamed base that resembles a growing bump, a non-healing ulcer or a crusted patch of skin. While usually appearing on parts of the body that receive frequent sun exposure, SCC can develop anywhere.

The authors write that SCC necessitates early treatment to prevent it from causing damage to surrounding body features and from spreading to other areas of the body. Although many SCCs are small, low-risk cancers that are easily treated in physicians’ offices with minor surgical procedures, some can become problematic.

SCCs that continue to grow can cause significant tissue destruction and invade blood vessels, nerves, muscles, bones and vital organs such as the eye. Significant cosmetic deformity can occur, and the cancer has the potential to become fatal if the progression is not halted, according to the authors.

The consensus recommendations note several factors influencing the level of risk posed by SCCs:

  • Location – SCCs located on the head and neck are more likely to recur and spread than those on the body’s trunk and extremities.
  • Size – The chances of SCC recurrence and spreading increase as tumor size increases.
  • Depth – The risk of the SCC spreading increases “dramatically,” according to the authors, for lesions with a depth of 4 millimeters or greater. Penetration into connective tissue, muscle, bone or cartilage also heighten the risk.
  • Poorly defined borders – Lesions without clear borders have higher rates of treatment failure.

In addition to Mohs Micrographic Surgery, the authors assessed advantages and disadvantages of other surgical and non-surgical treatment options.

Surgical excision is another prevalent treatment option for SCC, but its margin assessment limitations hamper cure rates, according to the analysis. Topical treatments can be effective but offer no proof the tumor is gone.

In addition to its effectiveness, Mohs Micrographic Surgery also is considered to be an efficient treatment. Mohs typically only necessitates two visits – one for the surgery and the other for suture removal. Combined with its superior cure rates, Mohs tends to be a sound investment, say the authors, who write: “When performed in the office setting with immediate reconstruction, it is an efficient and cost-effective procedure.”

Radiation therapy, by contrast, can be the most expensive treatment because it can require numerous patient visits to minimize scarring, inflammation and skin breakdown, according to the analysis.

The authors of the consensus recommendations are Arielle N.B. Kauvar, M.D.; Christopher J. Arpey, M.D.; George J. Hruza, M.D.; Suzanne M. Olbricht, M.D.; and Richard G. Bennett, M.D.

In May, ASDS similarly released new consensus recommendations for the treatment of basal cell carcinoma. Those recommendations emphasized that surgical options provide the best outcomes for BCC treatment and that patients with a suspicious lesion should undergo a complete skin examination by a qualified physician.

About ASDS
The American Society for Dermatologic Surgery is the largest specialty organization exclusively representing dermatologic surgeons who have unique training and experience to treat the health, function and beauty of your skin. ASDS members are pioneers in the field. Many are involved in the clinical studies that bring popular treatments to revitalize skin and fill and diminish wrinkles to the forefront. Their work has helped create and enhance many of the devices that remove blemishes, hair and fat, and tighten skin. Dermatologic surgeons also are experts in skin cancer prevention, detection and treatment. As the incidence of skin cancer rises, dermatologic surgeons are committed to taking steps to minimize the life-threatening effects of this disease. For more information, visit

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Jay Schwab
Communications Manager
American Society for Dermatologic Surgery

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