Squamous Cell Carcinoma in Florida: Symptoms, Causes, and Treatment

Squamous cell carcinoma is the second most common type of skin cancer, affecting more than one and a half million Americans each year. It arises from the squamous cells of the epidermis and most often develops on sun-exposed skin and lips, where cumulative damage from ultraviolet radiation is greatest. 

At Suncoast Skin Solutions, our board-certified dermatologists can diagnose and treat squamous cell skin cancer using a range of treatment options across our Florida locations. Early detection leads to excellent cure rates with straightforward treatment.

What is Squamous Cell Carcinoma?

Squamous cell carcinoma (SCC) is a cancer that begins in the squamous cells, which are the flat, thin cells that make up the outer layer of the skin (the epidermis). When these cells sustain enough DNA damage (from ultraviolet radiation, for example), they can grow uncontrollably and form a tumor. Left untreated, SCC can damage surrounding tissue and, in some cases, spread to lymph nodes or other organs.

What Does Squamous Cell Carcinoma Look Like?

SCC can appear in a few different ways, which is just one reason any persistent or changing lesion should be examined by a dermatologist. Here are some common visual signs of squamous cell carcinoma to look out for:

• A persistent, scaly red patch with irregular borders that may crust or bleed
• A firm, dome-shaped bump or nodule
• A wart-like growth that crusts and occasionally bleeds
• A non-healing sore or ulceration that heals and returns
• A raised growth with a rough surface and a central depression

Squamous cell carcinoma can arise on sun-exposed areas of the body, including the face, ears, neck, scalp, backs of the hands, forearms, and lower legs. However, it may also develop on the oral mucosa, genital mucosa, or perianal skin. 

How It Looks on Different Parts of the Body

Squamous cell carcinoma on the face and nose often appears as a firm pink or red bump with a scaly or crusted surface. Squamous cell carcinoma on the ear can be especially aggressive and may present as a thickened, tender nodule. On the scalp, squamous cell carcinoma frequently develops in areas of hair thinning and may appear as a rough, non-healing patch. On the lip, it often begins as a persistent rough spot that fails to resolve.

On darker skin tones, squamous cell carcinoma may appear as a darker brown or black patch rather than red, and it is more likely to arise in areas of chronic inflammation or old scars rather than sun-exposed skin. 

Any skin or mucosal lesion that grows, bleeds, changes in size, or fails to heal should be promptly examined by your provider.

Squamous Cell Carcinoma Stages

Squamous cell carcinoma is classified by stage, which reflects how far the cancer has progressed. 

Stage 0 

This early-stage squamous cell carcinoma is confined to the epidermis, the uppermost layer of the skin. Squamous cell carcinoma in situ (SCCIS), also called Bowen’s disease, has not yet invaded nerves or blood vessels, so it cannot metastasize. The prognosis is excellent, and cure rates are very high with appropriate treatment.

Stage I

The tumor is 2 centimeters or smaller, has not spread to lymph nodes or other areas of the body, and has no high-risk features. Stage I squamous cell carcinoma remains localized to the skin.

Stage II

The tumor is larger than 2 centimeters, or has one or more high-risk features such as significant depth, perineural invasion, or an aggressive location. The cancer is still confined to the skin at this stage.

Stage III

The cancer has spread to nearby lymph nodes or has invaded deeper structures such as bone, muscle, or cartilage.

Stage IV

Stage IV means the cancer has metastasized to distant organs or lymph nodes.

Types of Squamous Cell Carcinoma

Squamous cell skin cancer is further classified by how deeply it has invaded the skin and by how closely the cancer cells resemble normal squamous cells under the microscope. 

Squamous Cell Carcinoma in Situ (Bowen’s Disease)

This is early squamous cell carcinoma (stage 0),  and is confined to the epidermis. It may appear as a persistent, scaly red patch and is highly treatable with topical medications or minor surgical procedures.

Invasive Squamous Cell Carcinoma

Invasive squamous cell carcinoma has penetrated beyond the epidermis into the underlying dermis. It carries a risk of local tissue destruction and, in some cases, metastasis. Invasive SCC requires timely treatment to achieve the best possible outcome.

Well Differentiated vs. Poorly Differentiated SCC

Dermatopathologists grade squamous cell carcinoma by how closely the tumor cells resemble normal squamous cells:

• Well differentiated: the cells closely resemble normal squamous cells. These tumors are generally slower-growing and carry a better prognosis.
• Moderately differentiated: cells show intermediate features and behavior between well-differentiated and poorly differentiated subtypes.
• Poorly differentiated: the cells appear very abnormal. These tumors tend to be more aggressive and carry a higher risk of local recurrence and spread.

How Squamous Cell Carcinoma Compares to Other Skin Cancers

Patients often want to understand how squamous cell carcinoma differs from the other two most common forms of skin cancer. While all three arise from different cell types in the skin, they behave very differently and require different treatment approaches.

Squamous Cell Carcinoma vs. Basal Cell Carcinoma

Basal cell carcinoma grows slowly and very rarely spreads beyond the skin, while squamous cell carcinoma grows faster and carries a real, if modest, risk of metastasis. Squamous cell carcinoma also tends to feel rougher or scalier, while basal cell carcinoma often appears as a pearly or translucent bump.

Squamous Cell Carcinoma vs. Melanoma

Melanoma arises from pigment-producing cells (melanocytes) rather than squamous cells, and it’s far more likely to spread to other organs if not caught early. Visually, melanoma can present as a dark, irregular, or changing mole, whereas squamous cell carcinoma can appear as a scaly red patch, firm bump, or non-healing sore. 

Squamous Cell Carcinoma Risk Factors and Causes

Squamous cell carcinoma develops when squamous cells in the epidermis sustain enough DNA damage to grow uncontrollably. The majority of squamous cell carcinoma cases trace back to ultraviolet radiation, though other carcinogenic stimuli can contribute as well.

Causes

• Ultraviolet radiation from sunlight, including cumulative lifetime sun exposure
• Tanning bed use and other artificial UV exposure
• Chronic inflammation, non-healing wounds, or burn scars (Marjolin’s ulcer)
• Ionizing radiation exposure, including previous radiation therapy
• Certain chemical carcinogens, such as arsenic and some industrial chemicals
• Oncogenic viruses, particularly HPV, in cases of mucosal squamous cell skin cancer
• Immunosuppressant medications, including those taken after an organ transplant

Risk Factors

Individuals at highest risk for squamous cell carcinoma typically share several of the following risk factors:

• Chronic sun exposure or a history of severe sunburns
• Fair skin, light hair, and light eyes
• Age 50 or older, though squamous cell carcinoma is increasingly common in younger adults
• Male gender, though rates in women continue to rise
• Personal or family history of skin cancer
• A history of actinic keratoses or other precancerous lesions
• Immune-suppressing conditions or medications
• Previous radiation therapy to the skin
• Living in a sunny climate such as Florida

Reducing Your Risk

The most effective way to lower your risk is to protect your skin from ultraviolet damage. Wear a broad-spectrum sunscreen with SPF 30 or higher every day, reapply every two hours and after water exposure, and seek shade during peak UV hours (10 a.m. to 3 p.m.). You can also wear protective clothing and broad-brimmed hats, avoid indoor tanning facilities, and be conscious of ultraviolet reflections from water and snow. It’s also very important to perform monthly self-skin examinations and schedule annual professional skin exams if you can. 

How Is Squamous Cell Carcinoma Diagnosed?

A dermatologist must inspect your lesion and the skin surrounding it. They may use dermoscopy (a specialized handheld magnifier) to evaluate features that are not visible to the naked eye. If your dermatologist feels the lesion is suspicious, they’ll perform a skin biopsy.

Once the biopsy is complete, the sample is sent to a laboratory, where it is processed before very thin slices are cut and placed on a slide. A dermatopathologist then examines the slide under a microscope and makes a diagnosis. The final dermatopathology report identifies the tumor type, the grade of differentiation, the depth of invasion, and whether the margins appear clear. 

Types of Skin Biopsies for SCC

• Shave biopsy: a thin surface layer of the lesion is removed with a small blade. Tends to be best used for raised or superficial lesions.
• Punch biopsy: a small cylindrical core of skin is removed using a circular tool. Useful when a full-thickness sample is needed.
• Excisional biopsy: the entire lesion is removed along with a small margin of surrounding skin.
• Incisional biopsy: a portion of a larger lesion is removed to establish a diagnosis before planning definitive treatment.

Squamous Cell Carcinoma Treatment Methods

Multiple treatment modalities are available for squamous cell carcinoma, and your physician will consider your overall health, along with the tumor’s size, location, and subtype, before recommending the best approach. Many squamous cell carcinomas are surgically removed, while others may be treated with topical medications, cryotherapy, radiation, or advanced systemic therapies.

Topical Treatments

Prescription creams such as 5-fluorouracil or imiquimod may be used for squamous cell carcinoma in situ and very superficial tumors. These topical therapies are applied at home over several weeks and may be an appropriate option for select patients with early-stage disease.

Electrodessication and Curettage (ED&C)

In this procedure, the tumor is scraped away with a curette, and the base is cauterized. ED&C is commonly used for small, low-risk squamous cell carcinomas on the trunk or limbs.

Surgical Excision

Squamous cell carcinoma surgery by standard excision involves cutting out the tumor along with a margin of healthy tissue. This is a reliable approach for many cases of squamous cell carcinoma removal and is often performed in the office under local anesthesia.

Mohs Micrographic Surgery

Mohs surgery for squamous cell carcinoma is a highly specialized procedure in which the tumor is removed one thin layer at a time and examined under the microscope in real time until no cancer cells remain. Mohs surgery offers the highest cure rates while sparing the most healthy tissue, and it is the preferred approach for squamous cell carcinoma of the face, ears, nose, lips, and scalp, as well as for recurrent tumors and aggressive subtypes. 

Cryotherapy and Photodynamic Therapy

In select cases, liquid nitrogen cryotherapy or photodynamic therapy may be used to treat very superficial squamous cell carcinoma or squamous cell carcinoma in situ. 

Superficial Radiation Therapy

Superficial radiation therapy (SRT) may be recommended when surgery is not a suitable option, or as adjuvant treatment after surgery for high-risk squamous cell carcinoma.

Immunotherapy and Systemic Treatment

For advanced or metastatic disease, systemic therapies including immunotherapy agents such as cemiplimab (Libtayo) may be considered. Suncoast Skin Solutions coordinates comprehensive care with oncology partners to ensure patients with advanced squamous cell carcinoma receive the most appropriate treatment plan.

What to Expect After an SCC Diagnosis

A squamous cell carcinoma diagnosis is understandably stressful, but for the vast majority of patients, it is highly treatable. After your biopsy confirms SCC, your dermatologist will walk you through the specifics of your case (the stage, location, and subtype) and recommend a treatment plan. 

Your squamous cell carcinoma prognosis depends largely on when the cancer is found. When SCC is confined to the epidermis, cure rates are excellent. Once the tumor has invaded the dermis, the rate of metastasis generally ranges from 2 to 10 percent and depends on variables including size, location, depth, and differentiation. 

It’s also worth knowing that SCC can recur even after a clean excision, and patients with a history of squamous cell carcinoma are at higher risk for developing additional skin cancers down the road. That’s why ongoing follow-up with your Suncoast Skin Solutions dermatologist makes such a difference, and why we recommend regular skin checks for every patient with a history of skin cancer, along with continued daily sun protection and monthly self-examinations.