When selecting a therapy for your squamous cell skin cancer, you and your doctor will discuss the stage of your disease, any other medical conditions you may have, and your personal preferences for different types of therapy. This section reviews recommendations for therapy by stage and provides some guidance on how to weigh the efficacy, safety, convenience, and other treatment factors that are important to you.
Since actinic keratoses are considered precancers, your doctor (GP/dermatologist) may recommend aggressively treating them. The decision for a therapeutic approach depends on your health, how many actinic keratoses you have, where they are, and what they look like. They can be treated in the oﬃce by cryotherapy, curettage and cautery, photodynamic therapy, or laser resurfacing (for cancers on the lip). Separately or in addition, your dermatologist may recommend topical therapies you can apply at home, such as 5-ﬂuorouracil (5-FU) cream, diclofenac sodium gel, imiquimod, or itirbanibulin. Be sure to have a conversation about these options with your dermatologist to determine the best approach for you. The topical treatments work by inducing an aggressive inflammatory reaction, so the skin can look sore and blistered whilst you are applying them. Please talk to your doctor about the best option for you.
For Bowen’s disease, the treatments are:
For low-risk, local squamous cell skin cancer, standard approaches include:
If your tumour is high risk, then you may be a candidate for the following treatments:
What happens if the surgery does not get it all or your doctor finds additional concerning features in the tumour? If the surgery does not remove all the cancer, another surgery may be an option. If that’s not possible, radiation therapy, systemic therapy, or a clinical trial may be considered. Also, if additional high-risk features are found, your doctor may alter the treatment plan. See Clinical Considerations, below.
If you have locally advanced squamous cell skin cancer, recommended treatment options include:
If your doctor takes a sample of the lymph node through fine needle aspiration, or core biopsy and finds positive nodes, a number of steps will be taken:
For that small subgroup of patients with squamous cell skin cancer who have distant disease, the recommendation is systemic therapy or a clinical trial. Surgery or radiotherapy can be considered for symptomatic sites as palliation.
See Clinical Considerations, below.
Squamous cell skin cancer on the head and neck requires a specialised multidisciplinary approach given the surgical challenges in this region. Typically, a head-and-neck surgeon will be consulted. Currently, for patients with only one small lymph node involved (less than 3 cm in diameter), that lymph node should be removed as well as any others on that side of the neck that look suspicious for squamous cell skin cancer. Additionally:
For a discussion of lymph node dissection for head and neck cancer and how to prepare for that surgery, see https://www.mskcc.org/cancer-care/patient-education/neck-dissection
*Throughout these treatment sections, we make references to recommended treatment 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.