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Squamous Cell Skin Cancer our Pleaseonline surveycomplete at NCCN.org/patients/survey NCCN GUIDELINES FOR PATIENTS® 2019 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 99Step-by-step guides to the cancer care options likely to have the best results 99Based on treatment guidelines used by health care providers worldwide 99Designed to help you discuss cancer treatment with your doctors NCCN Guidelines for Patients®: Squamous Cell Skin Cancer, 2019 1 About NCCN Guidelines for Patients® are developed by NCCN® NCCN® NCCN Guidelines® NCCN Guidelines for Patients® Ü Ü 99An alliance of 28 leading 99Developed by doctors from 99Presents information from the cancer centers across the NCCN Cancer Centers using NCCN Guidelines in an easy-to- United States devoted to the latest research and years learn format patient care, research, and of experience education. 99For people with cancer and 99For providers of cancer care those who support them all over the world 99Cancer centers that are part 99Explains the cancer care of NCCN: 99Expert recommendations for options likely to have the best NCCN.org/cancercenters cancer screening, diagnosis, results and treatment NCCN Quick GuideTM Sheets 99Key points from the NCCN Guidelines for Patients and supported by funding from NCCN Foundation® These guidelines are based on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Squamous Cell Skin Cancer (Version 2.2019, October 23, 2018). © 2019 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 affected by a cancer diagnosis by funding and distributing NCCN Guidelines for in 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 has been modified in any manner is derived from, visit NCCN.org/patients. We rely solely on donations to fund the NCCN Guidelines based on, related to or arises out of the NCCN Guidelines for Patients. The NCCN for Patients. To donate, visit NCCNFoundation.org/Donate. Guidelines are a work in progress that may be redefined as often as new significant data become available. NCCN makes no warranties of any kind whatsoever National Comprehensive Cancer Network® (NCCN®) and NCCN Foundation® regarding its content, use, or application and disclaims any responsibility for its 3025 Chemical Road, Suite 100 | Plymouth Meeting, PA 19462 | 215.690.0300 application or use in any way. NCCN Guidelines for Patients®: Squamous Cell Skin Cancer, 2019 2 Supporters Endorsed by Save Your Skin Foundation (SYSF) is a Canadian patient-led not-for-profit group dedicated to fighting against non-melanoma skin cancers, melanoma and ocular melanoma. By using and sharing the valuable and comprehensive NCCN Guidelines for Patients®, SYSF is confident in their provision of solid patient support with accurate and current information on these cancers and related topics such as melanoma treatment with immunotherapy. www.saveyourskin.ca NCCN Guidelines for Patients®: Squamous Cell Skin Cancer, 2019 3 NCCN Guidelines for Patients®: Squamous Cell Skin Cancer, 2019 4 Squamous Cell Skin Cancer Contents 6 Squamous cell skin cancer basics 12 Overview of treatments 20 Treatment guide: Local SCC 27 Treatment guide: Regional SCC 31 When treatment is over 36 Making treatment decisions 43 Words to know 44 NCCN Contributors 45 NCCN Cancer Centers 46 Index NCCN Guidelines for Patients®: Squamous Cell Skin Cancer, 2019 5 1 Squamous cell skin cancer basics 7 Types of skin cancer 8 Squamous cell skin cancer 10 Diagnosing SCC 11 Review NCCN Guidelines for Patients®: Squamous Cell Skin Cancer, 2019 6 1 Squamous cell skin cancer basics Types of skin cancer You’ve learned you have skin cancer. Basal cell carcinoma is the most common, followed This chapter goes over the basics of closely by squamous cell carcinoma. Melanoma is cancer and how it affects the skin. This the rarest of the three, but also the most dangerous. first look at your cancer will help prepare Because they are so different from melanoma, basal you for next steps. cell and squamous cell skin cancer are often called non-melanoma skin cancers. This book is about squamous cell skin cancer only. There are three main layers of skin. The epidermis is Types of skin cancer the outermost layer. Squamous cells and basal cells are both found in the epidermis. See Figure 1. The dermis layer is below the epidermis. It contains hair There are three main types of skin cancer: follicles, nerves, sweat glands, oil glands, and blood vessels. Beneath the dermis is the hypodermis. This Basal cell carcinoma layer is sometimes called subcutaneous tissue. Like Squamous (pronounced skway-miss) cell the dermis, the hypodermis also contains connective carcinoma tissue, blood vessels, and nerves. This layer is best known, however, for its many fat cells. Fat storage is Melanoma the main purpose of the hypodermis. Figure 1 Layers and cell structure Squamous Cells Basal Cells of skin Squamous cells are found in the outer layer of skin, called the Epidermis epidermis. Melanocyte Dermis Hypodermis (Subcutaneous tissue) NCCN Guidelines for Patients®: Squamous Cell Skin Cancer, 2019 7 1 Squamous cell skin cancer basics Squamous cell skin cancer Squamous cell skin cancer Sunlight Most squamous cell skin cancers are caused by spending too much time in the sun over the course of Squamous cells are thin, flat, and look like fish scales many years, especially in people who sunburn easily. under a microscope. They are found on the surface People with light skin, hair, and eyes who have been of the skin and in other areas of the body, like the exposed to too much sun are at the highest risk lungs, thyroid, and esophagus. When cancer starts for squamous cell skin cancer. People who work in a squamous cell, it is called a squamous cell outdoors are also at higher risk. Also, because long- carcinoma. Squamous cell carcinoma of the skin is term sun exposure can lead to squamous cell skin often shortened to CSCC (cutaneous squamous cell cancer, it is more common in older people who have carcinoma), or just SCC. The word cutaneous means spent more years in the sun. Older people also have that it’s an SCC of the skin. The terms “squamous weaker immune systems, which makes it easier for cell carcinoma,” “squamous cell skin cancer,” cancer to start growing. See Figure 2. and “SCC” are used interchangeably throughout this book. Indoor tanning The use of tanning beds is a major risk factor for What causes squamous cell skin cancer? squamous cell skin cancer. Any type of tanning A risk factor is something that increases the chances (especially indoor tanning) can increase your chance of getting a particular disease. For example, smoking of getting skin cancer. cigarettes is a risk factor for lung cancer. The major risk factors for squamous cell skin cancer are described next. Figure 2 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, 2019 8 1 Squamous cell skin cancer basics Squamous cell skin cancer Scars and chronic wounds SCC can form in scars or chronic (non-healing) wounds, such as ulcers (sores) and burns. When this happens, it is called Marjolin’s ulcer. SCC that starts in damaged, inflamed, or scarred skin is difficult to Snapshot: treat and more likely to come back after treatment. Squamous cell carcinoma (SCC) Actinic keratoses An actinic keratosis is an area of thick, rough skin caused by being in the sun. Actinic keratoses can 9 A very common type of cancer in vary a lot in appearance, and may be red, white, light-skinned people tan, or pink in color. Many stick out from the skin like bumps, and may even look like warts. See Figures 9 Usually starts in areas of the body 3 and 4. Having actinic keratoses means you are at exposed to sun, especially the head high risk of developing squamous cell skin cancer. and neck Bowen’s disease Very early squamous cell carcinoma that is only in 9 Once an SCC is completely the epidermis and has not invaded deeper layers removed, over 95% of people are of the skin yet is called Bowen’s disease. It is also cured called SCC in situ and stage 0 SCC. Having Bowen’s disease means you are at high risk of developing 9 Rarely spreads to distant areas of squamous cell skin cancer. the body 9 Can spread in the area where it forms, causing severe damage and, in rare cases, death I had no idea skin cancer could be so serious. I had never even heard of squamous cell before. Now I have scars and side effects, and a “medical team. – Gary, age 54 3-year SCC survivor NCCN Guidelines for Patients®: Squamous Cell Skin Cancer, 2019 9 1 Squamous cell skin cancer basics Diagnosing SCC Genetic syndromes Diagnosing SCC If you have certain genetic syndromes, it means you are at higher risk of getting SCC. One such Squamous cell carcinoma is typically discovered syndrome is albinism (lack of color in the hair, skin, when a suspicious area of skin is spotted—either by and eyes).
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