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NCCN Guidelines for Patients ® : Squamous Cell Skin Cancer our Pleaseonline surveycomplete at NCCN.org/patients/survey NCCN GUIDELINES FOR PATIENTS® 2020 Squamous Cell Skin Cancer Presented with support from: Available online at NCCN.org/patients Ü Squamous Cell Skin Cancer It's easy to get lost in the cancer world Let Ü NCCN Guidelines for Patients® be your guide 9 Step-by-step guides to the cancer care options likely to have the best results 9 Based on treatment guidelines used by health care providers worldwide 9 Designed to help you discuss cancer treatment with your doctors NCCN Guidelines for Patients®: Squamous Cell Skin Cancer, 2020 1 About NCCN Guidelines for Patients® are developed by the National Comprehensive Cancer Network® (NCCN®) NCCN Clinical Practice NCCN Guidelines NCCN Ü Ü Guidelines in Oncology for Patients (NCCN Guidelines®) 9 An alliance of leading 9 Developed by doctors from 9 Present information from the cancer centers across the NCCN cancer centers using NCCN Guidelines in an easy- United States devoted to the latest research and years to-learn format patient care, research, and of experience 9 For people with cancer and education 9 For providers of cancer care those who support them all over the world Cancer centers 9 Explain the cancer care that are part of NCCN: 9 Expert recommendations for options likely to have the NCCN.org/cancercenters cancer screening, diagnosis, best results and treatment Free online at Free online at NCCN.org/patientguidelines NCCN.org/guidelines and supported by funding from NCCN Foundation® These NCCN Guidelines for Patients are based on the NCCN Guidelines® for Squamous Cell Skin Cancer (Version 2.2020, July 14, 2020). © 2020 National Comprehensive Cancer Network, Inc. All rights reserved. NCCN Foundation seeks to support the millions of patients and their families NCCN Guidelines for Patients and illustrations herein may not be reproduced in affected by a cancer diagnosis by funding and distributing NCCN Guidelines for any form for any purpose without the express written permission of NCCN. No Patients. NCCN Foundation is also committed to advancing cancer treatment one, including doctors or patients, may use the NCCN Guidelines for Patients for by funding the nation’s promising doctors at the center of innovation in cancer any commercial purpose and may not claim, represent, or imply that the NCCN research. For more details and the full library of patient and caregiver resources, Guidelines for Patients that have been modified in any manner are derived visit NCCN.org/patients. from, based on, related to, or arise out of the NCCN Guidelines for Patients. The NCCN Guidelines are a work in progress that may be redefined as often National Comprehensive Cancer Network (NCCN) / NCCN Foundation as new significant data become available. NCCN makes no warranties of any 3025 Chemical Road, Suite 100 kind whatsoever regarding its content, use, or application and disclaims any Plymouth Meeting, PA 19462 responsibility for its application or use in any way. 215.690.0300 NCCN Guidelines for Patients®: Squamous Cell Skin Cancer, 2020 2 Supporters Endorsed by Save Your Skin Foundation Save Your Skin Foundation (SYSF) is a Canadian patient-led not-for-profit group dedicated to the fight against non-melanoma skin cancers, melanoma and ocular melanoma. By using and sharing the valuable and thorough NCCN Guidelines, SYSF is confident in their provision of solid patient support with accurate and current information on these cancers and related topics such as skin cancer treatment with immunotherapy. saveyourskin.ca To make a gift or learn more, please visit NCCNFoundation.org/donate or e-mail [email protected]. NCCN Guidelines for Patients®: Squamous Cell Skin Cancer, 2020 3 NCCN Guidelines for Patients®: Squamous Cell Skin Cancer, 2020 4 Squamous Cell Skin Cancer Contents 6 Squamous cell skin cancer basics 12 Overview of treatments 20 Treatment guide: Local cSCC 25 Treatment guide: cSCC in lymph nodes 29 When treatment is over 35 Making treatment decisions 43 Words to know 45 NCCN Contributors 46 NCCN Cancer Centers 48 Index NCCN Guidelines for Patients®: Squamous Cell Skin Cancer, 2020 5 1 Squamous cell skin cancer basics 7 About 8 Who is at risk? 10 Diagnosis 11 Review NCCN Guidelines for Patients®: Squamous Cell Skin Cancer, 2020 6 1 Squamous cell skin cancer basics About Cutaneous squamous cell carcinoma cell skin cancer” and “cSCC” are used (cSCC) is the second most common interchangeably throughout this guide. type of skin cancer. It is highly treatable and can often be cured. There are three main layers of skin. Squamous cells and basal cells are found in the top-most layer (the epidermis). Squamous cells are also found in other areas of the body, such as the lungs, thyroid, and esophagus. Cancer that About starts in a squamous cell is called a squamous cell carcinoma. Squamous cell skin cancer is a very common The dermis layer is below the epidermis. It skin cancer, especially in fair-skinned people. contains hair follicles, nerves, sweat glands, oil It is the second most common type of skin glands, and blood vessels. Beneath the dermis cancer, after basal cell carcinoma. The third is the “fatty” layer of skin (the subcutaneous type—melanoma—is rare but often more tissue). This layer is best known for its many fat aggressive. Because they are so different from cells. melanoma, basal cell and squamous cell skin cancers are referred to as non-melanoma skin cancers. This patient guide is about squamous cell skin cancer only. The terms “squamous Squamous cells Basal cells Layers and cell structure of skin Epidermis Squamous cells are found in the top layer of skin, called the epidermis. Dermis Subcutaneous tissue NCCN Guidelines for Patients®: Squamous Cell Skin Cancer, 2020 7 1 Squamous cell skin cancer basics Who is at risk? Who is at risk? Older people also may have weaker immune systems, which makes it easier for cancer to A risk factor is something that increases the develop. chances of getting a particular disease. For example, smoking cigarettes is a risk factor for Indoor tanning developing lung cancer. The major risk factors The use of tanning beds is a major risk factor for squamous cell skin cancer are described for squamous cell skin cancer. All types of next. tanning (especially indoor tanning) increases the risk of getting any type of skin cancer. Sunlight Most squamous cell skin cancers are caused Scars and chronic wounds by spending too much time in the sun over the cSCC can form in scars or chronic (non- course of many years, especially in people healing) wounds, such as ulcers (sores) and who sunburn easily. People with light skin, hair, burns. This is known as Marjolin’s ulcer. cSCC and eyes who have been exposed to too much that starts in damaged, inflamed, or scarred sun throughout their lives are at the highest skin is difficult to treat and more likely to come risk for squamous cell skin cancer. People who back after treatment. work outdoors are also at higher risk. Because long-term sun exposure can lead to squamous cell skin cancer, it is more common in older people who have spent more years in the sun. Sun exposure Most squamous cell skin cancers are caused by spending too much time in the sun over a long period of time. NCCN Guidelines for Patients®: Squamous Cell Skin Cancer, 2020 8 1 Squamous cell skin cancer basics Who is at risk? Actinic keratoses Genetic syndromes An actinic keratosis is an area of rough skin Having certain genetic syndromes means you caused by exposure to the sun over time. are at higher risk of getting squamous cell skin Actinic keratoses vary in appearance, and may cancer. One such syndrome is albinism (lack be red, white, tan, or pink in color. They may of color in the hair, skin, and eyes). Another is appear as small scaly spots or stick out from xeroderma pigmentosum, in which the body is the skin like bumps. Some may even look like not able to repair damage to deoxyribonucleic warts. Having actinic keratoses means you are acid (DNA) caused by sunlight. Skin cells with a at higher risk of developing squamous cell skin lot of DNA damage can eventually become skin cancer. cancers. Bowen’s disease Weakened immune system The earliest form of squamous cell skin cancer Having a weakened immune system can put is called Bowen’s disease. The cancer cells you at risk of squamous cell skin cancer. An are only in the epidermis and have not invaded example of this is organ transplantation. If deeper layers of the skin. Bowen’s disease is you received an organ from another person, also known as cSCC in situ and stage 0 cSCC. you likely take drugs to stop your body from attacking the donated organ. These drugs, called immunosuppressants, also reduce the Actinic keratosis on hand Actinic keratosis on top of head An actinic keratosis is an area of rough skin Actinic keratoses can vary in appearance caused by being in the sun over time. and may be red, white, tan, or pink in color. NCCN Guidelines for Patients®: Squamous Cell Skin Cancer, 2020 9 1 Squamous cell skin cancer basics Diagnosis body’s ability to fight infection and disease. Your immune system also may not work well because of other medical conditions, such as lymphoma, chronic lymphocytic leukemia, and human immunodeficiency virus (HIV). Any of these increases the risk of getting squamous cell skin cancer. SNAPSHOT Cutaneous squamous cell carcinoma (cSCC) Diagnosis An area of abnormal skin is called a lesion. If • A very common type of skin cancer, a lesion suspicious for skin cancer is found, especially in light-skinned people
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