LIVING WITH SQUAMOUS CELL SKIN CANCER:
SECONDARY PREVENTION

After the initial surgical procedure or other treatment for your squamous cell skin cancer, you can take proactive measures to prevent additional tumors from forming (secondary prevention). These preventive steps include keeping an appropriate follow-up medical appointment schedule, conducting skin self-examinations, and practicing sun safety.*

Follow-Up

Appointments

After you have completed your treatment for squamous cell skin cancer, it is important to keep all follow-up medical appointments, because you are at risk of your squamous cell skin cancer returning (recurring) as well as for developing a new squamous cell skin cancer. Seventy to eighty percent of squamous cell skin cancer cases that recur come back within the first two years of the initial treatment. Of all patients with squamous cell skin cancer, thirty to fifty percent will develop another squamous cell skin cancer within five years. You are also at risk of developing other skin cancers, such as melanoma, so it is important to be followed closely by your dermatologist.

30%-50%

Proportion of patients with squamous cell skin cancer who
will develop another squamous cell skin cancer within five years

The table below shows the recommended follow-up schedule and exams/tests for different stages of squamous cell skin cancer.

Skin Self-Examination

It’s important that you conduct skin self-examinations on a regular basis. These exams are an important aspect of early detection for squamous cell skin cancer and other skin cancers. If you’re unsure how to perform a skin self-exam, click here for a pictorial tutorial. If you find anything suspicious during your exam, call your dermatologist’s office and tell them that you’ve been treated for squamous cell skin cancer.

How to Check Your Lymph Nodes

If you had a high risk squamous cell skin cancer or if you had cancer in your lymph nodes, your healthcare provider will examine your lymph nodes at your follow-up appointments. You should also be examining your own lymph nodes on a monthly basis. Below are the steps you can take:

Head-and-Neck Lymph Nodes

Feel the lymph nodes shown, using a gentle circular motion with your fingertip
Begin with the nodes in front of the ear (1), then follow in numerical order, finishing just above the collar bone (10)
Compare both sides. Feel for any enlargement, generally anything the size of a pea or bigger
When feeling the nodes in your neck (marked 8), tilt your head towards the side you are examining; this helps to relax the muscle. Then press your fingers under the muscle
When checking the lymph nodes above the collarbone, hunch your shoulders and bring your elbows forward to relax the skin. Then feel above the collarbone (marked 10)

Lymph Nodes in the Armpit

Remove all clothing above the waist to get easy access to the armpits
Sit comfortably
Check each armpit. For the left side, lift your left arm slightly; put your right hand high into the armpit and place your fingers on the armpit. Then lower your arm
Feel around in the central part the armpit
Now move your fingers firmly against the chest wall and feel the front borders. Then feel the back border of the armpit and the inner border of your arm
Repeat on the other armpit

Lymph Nodes in the Groin

Examine two areas in the groin:

Feel the horizontal chain of nodes in the right groin just below the ligament, as shown in the diagram
Feel the vertical chain along the upper thigh, as shown in the diagram
Repeat on the other side

Protect Your Skin

Patients with a history of squamous cell skin cancer need to practice meticulous sun protection. You can review guidelines for protecting yourself from UV radiation in the SUN SAFETY section. The main points are:

Protect your skin from the sun’s UV radiation. Allow your body to repair existing damage and to prevent further damage.
- Avoid the sun whenever possible. If you are outside during the day, seek shade
- Wear sunscreen every day. Regardless of the weather, wear a sunscreen that offers broad-spectrum protection of SPF 30 or higher and water resistance
- Wear protective clothing every day. Put on a wide-brimmed hat and sunglasses before going outside. Also, whenever possible, wear a long sleeve shirt, long pants, shoes, and socks
Never use a tanning bed or other type of indoor tanning device. Indoor tanning is never safe. In fact, the UV radiation from tanning beds and other indoor tanning equipment is generally stronger than the UV radiation from the sun. Treat indoor tanning equipment like a carcinogen—and stay away.

Chemoprophylaxis—A Limited Use

Chemoprophylaxis, which is use of a chemical agent or drug to prevent the development of a disease, has a limited role in patients with squamous cell skin cancer. The oral retinoid acetritin (Soriatane^®) is recommended for solid organ transplant recipients with a history of squamous cell skin cancer to prevent additional squamous cell skin cancers from developing. However, oral retinoids can have significant side effects, including harmful effects on developing embryos and fetuses. This drug must be used with extreme caution in women of child-bearing potential. Experts disagree about the use of other agents such as nicotinamide, a vitamin B3 supplement, or other retinoids such as tretinoin, retinol, and isotretinoin, for chemoprophylaxis. If you are in a high-risk group, it’s important to have a conversation with your doctor about chemoprophylaxis and which options might make sense for you.

Fact vs Fiction:

I should take antioxidant supplements to reduce my risk of skin cancer.

FICTION. Some laboratory studies suggest that antioxidants might be protective against skin cancer because they decrease the damage to DNA caused by UV radiation. However, in clinical studies, vitamin A, selenium, and other antioxidant supplements did not reduce the number of skin cancers that people developed. In addition, these supplements might cause side effects—for example, large doses of vitamin A can turn your skin yellow. Selenium can upset your stomach. Finally, recent studies have suggested that antioxidant supplements may actually accelerate the growth of tumor cells and make cancer more invasive. Therefore, don’t take antioxidant supplements. Simply eat a well-balanced diet containing plenty of antioxidant-rich fruits and vegetables.

*In this section, we refer to follow-up and other secondary prevention strategies. We consulted the American Academy of Dermatology (AAD) and the National Comprehensive Cancer Network (NCCN) guidelines on these topics. These professional groups are the foremost authorities on skin cancer management. To consult these guidelines, please see RESOURCES.

Images on lymph-node examination from the British Association of Dermatologists (BAD) Skin Support website.[Permission pending]

LIVING WITH SQUAMOUS CELL SKIN CANCER: SECONDARY PREVENTION