A new spot on your skin? A wound that won't heal? Let's be aware of Squamous Cell Carcinoma (SCC), a skin cancer!

We sometimes get little spots, bumps, or sores on our skin that don't heal, right? Most of us don't pay much attention to them. We think, "It's probably just something small," and we forget about them. But sometimes, even a very small change like this can be an early sign of a serious condition that we need to pay attention to. So, we definitely need to know, and today we are going to talk about a very common type of skin cancer. That is Squamous Cell Carcinoma, which we call SCC for short.

Simply put, what is Squamous Cell Carcinoma (SCC)?

Squamous Cell Carcinoma (SCC) is a type of skin cancer. It is the second most common type of skin cancer in Sri Lanka and around the world.

To understand this, let's first take a look at how our skin is made. The top layer of our skin is called the epidermis . The flat cells in this layer are called squamous cells . These cells are stacked on top of each other, like tiles on a wall. So, when these squamous cells start to grow abnormally and out of control, SCC occurs.

This type of cancer usually develops most often in areas of our body that are exposed to the sun. For example:

• Face
• Skull (especially in bald people)
• Earplugs
• Lips
• Hands and legs

However, this cancer can also develop in places where the sun does not shine. Not only that, but this type of cancer can also occur in places where there are mucous membranes, such as inside our mouths, lungs, and rectum.

What are the main types of this cancer?

SCC cancer can be divided into two main types depending on its location in the body and how it has spread.

1. Cutaneous SCC: This is the most common type. Here, the cancer is only in the skin. This also has two subtypes.

• In situ (Stage 0): Here, the cancer cells are only in the top layer of the skin (epidermis). They have not spread deeper. This is also called Bowen's disease . If detected early, it can be completely cured.
• Invasive: Here, cancer cells have spread beyond the top layer of the skin and into the underlying layers.

2. Metastatic SCC: This is a more serious condition. What happens here is that the cancer that was in the skin has spread to other organs, for example, lymph nodes, lungs, liver, etc. But the good news is that a very small percentage of SCC cancers spread this way. If detected and treated early, this risk can be greatly reduced.

What are the symptoms and signs of SCC cancer? How to recognize them?

This is the most important part. It is very important to always pay attention to your skin. Because the first signs of this cancer appear as small changes in the skin. These signs can vary from person to person.

The table below lists some common symptoms that can be seen in SCC cancer.

Who is at higher risk of developing this cancer?

Anyone can develop SCC cancer, but some people are at a slightly higher risk.

• People with excessive sun exposure: People who work in the sun, farm, or go to the beach, as well as those who spend a lot of time in the sun from a young age, are at higher risk.
• People with light skin: Melanin, the pigment that gives skin its color, protects us from the sun's rays. People with light skin have less melanin, so they are more susceptible to sun damage. People with blue/green eyes and red or blonde hair are at higher risk.
• People over 50 years of age: As you age, the risk of developing skin cancer increases due to accumulated damage to the skin over time.
• People with weakened immune systems: People who have had organ transplants, are HIV-infected, or are taking medications that suppress the immune system are at higher risk.
• Smokers: Smoking is a major cause of SCC cancers, especially those of the lips and mouth.
• People exposed to certain chemicals: Exposure to things like arsenic is also a risk.
• People who have previously had skin cancer.

Why does this cancer develop? What is the cause?

This is a bit of a complicated story. Simply put, it's like this. Inside our cells are things called genes. These genes are what tell cells how to function, when to divide, and when to die.

We have a special gene in our body called p53 . It's like a supervisor in a factory. Its job is to control cell division. Because it stops too many cells from forming, we call it a tumor suppressor gene .

However, when exposed to harmful UV radiation from the sun for a long time, this supervisor gene called p53 can be damaged. We call it a gene mutation. What happens is that that control is lost. Squamous cells don't get the message to "stop dividing now." So they keep dividing uncontrollably, clumping together, and forming a cancerous tumor. This is the main cause of SCC cancer.

How does a doctor accurately diagnose SCC?

When you tell a doctor about a suspicious spot on your skin, the first thing he or she does is examine it carefully. He or she will look at things like its size, shape, color, and texture. Then he or she will ask you a few questions.

• "Since when did you see this?"
• "Did it get bigger than it was before?"
• "Does it itch? Does it hurt? Does it bleed?"

Then, to 100% confirm the diagnosis, a skin biopsy is often recommended.

What is a Skin Biopsy?

This involves numbing the area, removing a very small piece of skin from the suspicious area, and sending it to a laboratory to be examined under a microscope. This allows us to see exactly whether or not there are cancer cells in it.

If the cancer is large or if there is a suspicion that it has spread deep, tests such as a CT scan or MRI scan may be done. This can help determine how far the cancer has spread.

What are the treatments for SCC cancer?

There are several treatments for SCC cancer. Your doctor will decide which treatment is best for you. This will depend on many factors, including the size, location, depth of the cancer, and your overall health.

The best news is that more than 95% of SCC cancers are completely curable, especially if detected early!

Here are some of the main treatment methods:

• Excision: This is the most common treatment. The cancerous lump, along with a small amount of healthy skin around it, is cut out and removed, and the skin is sewn back together.
• Mohs Surgery: This is a special surgical procedure. It is used especially for cancers in sensitive areas like the face, nose, and ears. Here, the cancer is cut out in very thin layers, one by one, and each layer is immediately examined under a microscope. This is done until it is confirmed that there are no more cancer cells. This saves as much healthy skin as possible.
• Curettage and Electrodesiccation: This involves scraping the cancer away with a spoon-like instrument and then cauterizing the area with an electric current. This is most often done for small, superficial cancers.
• Cryosurgery: A method of destroying cancer cells by freezing them using a very cold substance, such as liquid nitrogen.
• Radiation Therapy: This treatment is used in cases where surgery is not possible, or to destroy any cancer cells that may remain after surgery.
• Chemotherapy and Immunotherapy: In severe cases where the cancer has spread to other parts of the body (metastatic), treatment with drugs given in the form of injections or pills may be necessary.

Can we protect ourselves from SCC cancer?

Yes, absolutely. There are many things we can do to protect ourselves from this cancer. The most important thing is to make these a habit.

• Protect yourself from the sun: Avoid the harsh sun as much as possible, especially between 10 am and 4 pm.
• Use sunscreen: When going out in the sun, always use a broad-spectrum (protects against both UVA and UVB) sunscreen with an SPF of 30 or higher. Apply generously to your face, neck, and hands.
• Wear protective clothing: long-sleeved clothing, long pants, a wide-brimmed hat, and sunglasses with UV protection.
• Avoid tanning beds: These devices that artificially tan the skin are very harmful.
• Avoid smoking: Quitting smoking can greatly reduce the risk of mouth and lip cancer.
• Check your skin regularly: At least once a month, stand in front of a mirror and examine your entire body from head to toe. Look for new spots, changing birthmarks, and sores that won't heal.

If you notice any suspicious changes on your skin, please don't ignore it. Don't panic. See a qualified doctor as soon as possible for advice. Because the earlier you detect these things, the greater the chance of a full recovery with treatment.

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