Melanoma FAQ

What causes a squamous cell carcinoma?

The most important cause is too much exposure to ultraviolet light from the sun or other sources. This can cause the DNA of skin cells (keratinocytes) in the outer layer of the skin (the epidermis) to change. Sometimes this alteration in DNA allows the skin cells to grow out of control and develop into an SCC. Ultraviolet light damage can cause SCC directly, or sometimes it can induce a scaly area called an actinic keratosis or Bowen’s disease. These can change into SCC if they are not treated.

Squamous cell carcinomas can also develop in skin damaged by other forms of radiation, in burns and persistent chronic ulcers and wounds and in old scars. Certain human viral wart viruses can also be a factor. However, SCC itself is not contagious.

Who is most likely to have a squamous cell carcinoma?

The following groups of people are at greater risk of developing SCC:

• Immunosuppressed individuals (people with reduced immune systems) either due to medical treatment, such as methotrexate, ciclosporin and azathioprine, or due to diseases which affect immune function, including inherited diseases of the immune system or acquired conditions such as leukaemia or HIV;
• Patients who have had an organ transplant because of the treatment required to suppress their immune systems to prevent organ rejection
• People who are more susceptible to sunburn;
• People who have had significant cumulative ultraviolet light exposure, for example:
  • people who have lived in countries near to the equator, or who have been posted to work in these countries, e.g. military personnel, construction workers;
  • outdoor workers, such as builders, farmers;
  • people of advanced years, who have had a lifetime of frequent sun exposure;
• People with skin conditions such as albinism and xeroderma pigmentosum that make them more susceptible to SCC.

Are squamous cell carcinomas hereditary?

What does a squamous cell carcinoma look like?

SCC can vary in their appearance, but most usually appear as a scaly or crusty raised area of skin with a red, inflamed base. SCCs can be sore or tender and they can bleed but this is not always the case. They can appear as an ulcer.

SCC can occur on any part of the body, but they are more common on sun exposed sites such as the head, ears, neck and back of the hands.

How will my squamous cell carcinoma be diagnosed?

Can a squamous cell carcinoma be cured?

How can a squamous cell carcinoma be treated?

Surgery is usually the recommended treatment. This involves removing the SCC with a margin of normal skin around it, using a local anaesthetic. The skin is then closed with stitches or sometimes a skin graft is needed. Sometimes other surgical methods are used such as curettage and cautery. This involves scraping the SCC away using local anaesthetic.

Radiotherapy can also be used to treat SCC. This involves shining a beam of X-rays onto the skin. Usually several sessions are required.

For advanced SCC, a combination of treatments may be used. For SCC that has spread to other parts of the body a combination of surgery, radiotherapy and/or chemotherapy may be used.

What causes basal cell carcinoma?

The commonest cause is exposure to ultraviolet (UV) light from the sun or from sunbeds. BCCs can occur anywhere on the body, but are most common on areas that are exposed to the sun such as your face, head, neck and ears. It is also possible for a BCC to develop in a longstanding scar. BCCs are not infectious.

BCCs mainly affect fair skinned adults, but other skin types are also at risk. Those with the highest risk of developing a basal cell carcinoma are:

• People with pale skin who burn easily and rarely tan (generally with light coloured or red hair, although some may have dark hair but still have fair skin).
• Those who have had a lot of exposure to the sun, such as people with outdoor hobbies or outdoor workers, and people who have lived in sunny climates.
• People who have used sun beds or have regularly sunbathed.
• People who have previously had a basal cell carcinoma.

Are basal cell carcinomas hereditary?

What does a basal cell carcinoma look like?

How will my basal cell carcinoma be diagnosed?

Can basal cell carcinomas be cured?

Yes, BCCs can be cured in almost every case, although treatment can be more complicated if the BCC has been neglected for a long time, or if it occurs in an awkward place, such as close to the eye or on the nose or ear.

BCCs rarely spread to other parts of the body. Therefore, although it is a type of skin cancer it is almost never a danger to life.

How can a basal cell carcinoma be treated?

The commonest treatment for BCC is surgery. Usually, this means cutting away the BCC, along with some clear skin around it, using local anaesthetic injection to numb the skin. The skin can usually be closed with a few stitches, but sometimes a skin graft is needed.

Other types of treatment include:

• Mohs micrographic surgery. This surgical procedure is used to treat more complex BCCs such as those present at difficult anatomical sites or recurrent BCCs. The procedure involves excision of the affected skin and examination of the skin removed under the microscope straight away to see if all of the BCC has been removed. If any residual BCC is left at the edge of the excision further skin is excised from that area and examined under the microscope and this process is continued until all of the BCC is removed. The site is then often closed with a skin graft. This is a time consuming process and is only undertaken when simple surgery may not be suitable.
• Radiotherapy – shining X-rays onto the area containing the BCC.
• Vismodegib – this is a type of chemotherapy that has recently become available for the treatment of very complex BCCs, e.g. locally advanced BCCs or the very rare BCC that has spread to other parts of the body.
• Superficial BCCs:

–       Curettage and cautery – the skin is numbed with local anaesthetic and the BCC is scraped away (curettage) and then the skin surface is sealed by heat (cautery).

–       Cryotherapy – freezing the BCC with liquid nitrogen.

–       Creams – these can be applied to the skin. The two most commonly used are 5-fluorouracil (5-FU) and imiquimod.

–       Photodynamic therapy – a special cream is applied to the BCC which is taken up by the cells that are then destroyed by exposure to a specific wavelength of light. This treatment is only available in certain dermatology departments (see Patient Information Leaflet on Photodynamic Therapy).

Surgical excision is the preferred treatment, but the choice of other treatments depends on the site and size of the BCC, the condition of the surrounding skin and number of BCC to be treated (some people have multiple ) as well as the overall state of health of each person to be treated.