Mohs Surgery & Skin Cancer
Squamous Cell Carcinoma
Diagnosis, Risk Factors & Surgical Treatment — Alcoa, TN
Squamous cell carcinoma is the second most common skin cancer, and unlike basal cell carcinoma, it carries a real risk of spreading to lymph nodes and distant organs if not treated promptly. With early detection and appropriate treatment, SCC is highly curable — but delayed or incomplete treatment can lead to serious consequences.
What Is Squamous Cell Carcinoma?
SCC arises from the squamous cells — the flat cells that make up most of the outermost layer of the skin. It can develop on any sun-exposed area of the body but is particularly common on the head, neck, ears, lips, hands, forearms, and lower legs. SCC can also arise in areas not typically exposed to the sun, including chronic wounds, scars, and mucous membranes.
Many SCCs develop from precancerous lesions called actinic keratoses (AKs) — rough, scaly patches caused by years of sun damage. Not all AKs become SCC, but monitoring and treating them is an important part of skin cancer prevention.
What Does SCC Look Like?
A firm, red nodule — often on the face, lip, ear, or hand
A flat lesion with a scaly, crusted surface
A new sore or raised area in an old scar
A rough, wart-like growth that may bleed easily
A red sore or rough patch inside the mouth
A wart-like sore on the genitals or anus
Risk Factors for SCC
Cumulative lifetime sun exposure — Tennessee's outdoor lifestyle is a significant contributor
History of sunburns, particularly blistering sunburns
Fair skin, light hair, light eyes
Prior skin cancer history — patients with one SCC are at significantly increased risk
Immunosuppression — organ transplant recipients have up to 200x higher SCC risk
Human papillomavirus (HPV) infection
Exposure to chemicals including arsenic, coal tar, or petroleum
Chronic wounds, scars, or inflammatory skin conditions
Use of immunosuppressive medications
When Is SCC Dangerous?
Most SCCs are curable when caught early. However, certain features indicate higher risk for metastasis and require aggressive treatment:
Tumor diameter > 2 cm
Depth > 2 mm or invasion beyond subcutaneous fat
Location on the lip, ear, or within a scar
Perineural invasion (cancer growing along nerves)
Poorly differentiated histology
Recurrent tumor
Immunosuppressed patient
SCC vs. Keratoacanthoma
Keratoacanthomas (KAs) are rapidly growing, dome-shaped tumors that can closely resemble SCC. Many dermatopathologists classify KAs as a variant of well-differentiated SCC. At Skinner Dermatology, these are treated with appropriate urgency — typically with Mohs surgery when located on the face or in high-risk areas.
Treatment of Squamous Cell Carcinoma
Mohs Micrographic Surgery — Preferred for High-Risk SCC
Mohs surgery offers the highest cure rates and tissue preservation for SCC, particularly on the face, scalp, ears, lips, and other cosmetically sensitive areas. Cure rates exceed 97% for primary SCC treated with Mohs.
Wide Local Excision
For low-risk SCC on the trunk or extremities with well-defined borders, standard excision with adequate margins is effective. Pathology review confirms margin status.
Sentinel Lymph Node Biopsy
For high-risk SCCs, evaluation of regional lymph nodes may be recommended in consultation with surgical oncology.
Adjuvant Radiation or Systemic Therapy
For advanced SCC with nerve involvement, bone invasion, or regional lymph node involvement, multidisciplinary management including radiation and/or systemic therapy may be recommended.
Don't Wait on a Suspicious Lesion
SCC on the face, ears, or lip can spread to lymph nodes. If you have a sore that won't heal, a rapidly growing bump, or a rough scaly patch that persists — call us. Same-week evaluation is available for suspicious lesions.
(865) 268-4444