Squamous Cell Carcinoma

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Serving Hamilton, Stoney Creek, Grimsby and surrounding areas
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Squamous Cell Carcinoma (SCC):

Is often a rough, skin coloured, or pink bump
May sometimes ulcerate or bleed
Is a skin cancer of intermediate severity
May be as small as a 2 to 3 mm and as large as 20 cm or more across
Is usually present on sun exposed areas such as the ears, lips, nose, face and tops of the hands
Is caused by the sun exposure that occurred 10 to 70 years before the spots appear
May spread internally
Is rarely lethal
Is not melanoma

Prevention of Squamous Cell Carcinoma, and other skin cancers:

Wear a hat with a broad brim and protective clothing (e.g. long sleeves)
Avoid the outdoors when the sun is strongest between the hours of 10 am to 3 pm
Use a sunscreen year round with an SPF of at least 30
Wear a sunscreen which resists water and sweating and which protects against both UVA and UVB
Reapply sunscreen every hour if you are in water or sweating heavily
Wear sunscreen even if you are in the shade, it is still possible to burn
Avoid tanning beds
- The ultraviolet light tanning beds produce is known to cause skin cancer

Levulan Photodynamic Therapy (ALA PDT) for prevention of Squamous Cell Carcinoma:

- This treatment combines a medication called Levulan with either

- - Blue Light or
  - IPL (Intense Pulsed Light) treatments

- Levulan PDT may be used to treat pre-cancerous sun spots, disseminated superficial actinic porokeratosis (DSAP) or acne

What are the advantages of Levulan PDT compared with other treatments?:

- Unlike creams it has the advantage of being able to treat large areas in a single visit
- Unlike liquid nitrogen, the treatment is not painful
- It treats precancerous spots before they can be seen
  - Preventing skin cancer from developing

Levulan-IPL Photodynamic Therapy:

- Non-invasive and effective
- Used to treat acne, actinic keratoses (prec-cancerous sun spots), Disseminated Superficial Actinic Porokeratosis (DSAP), superficial basal cell carcinomas, as well as sun-damaged skin
- Acts by killing acne causing bacteria, overactive oil glands and premalignant skin cells and precancers

- Almost any area can be treated including:
  - Face and neck
  - Arms and hands
  - Feet and legs
  - Chest and back
  - Scalp

- The Levulan-IPL PDT treatment works with most skin types (I-IV) (from pale Caucasian to dark European and very light Asian)

- Levulan-IPL PDT cannot be used for darker skin types (V, VI) (South Asian, African) or if you have a tan

- - In this situation I recommend Blue Light PDT instead, which:
    - Can be used in all skin types
    - Can be used even if the skin is tanned
    - To learn more about Blue Light PDT, please click here

- As an added bonus, Levulan PDT also treats:
  - Brown freckling
  - Enlarged pores
  - Sun damage
  - Depleted skin collagen

- All of these lead to smoother, younger looking skin and reduced redness at the same time

- The cost of Levulan PDT is partially covered on most private drug insurance plans
- The cost of Levulan PDT is not covered on the Ontario ODSP (OHIP) drug plan for patients over 65 years of age

- If you would like to learn more about Levulan PDT for the treatment of superficial basal cell carcinoma, and skin cancer prevention, please click here

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Electrodessication and Curettage (Small Squamous Cell Carcinomas):

The skin around the squamous cell carcinoma is injected with a local anesthetic to numb the area
The injection stings for a few seconds
- After this, there is no pain or discomfort
The squamous cell carcinoma is removed from the skin in a scraping motion with an instrument called a curette
As the area is numb from the anesthetic, this process is not painful
The curetted area is then treated with electrocautery, a hot electric needle
- This is not painful as the area is still numb
Electrocautery stops and bleeding and kills any residual cancer cells
The lesion is scraped and cauterized a total of 3 times in one visit
No stitches are required
Antibiotic and a bandage are used to cover the wound
The day after surgery, the bandage should be removed and a small amount of antibiotic should be be applied
- This should occur twice daily site is healed
Redness, pain, swelling or a discharge from the wound may be a sign of infection
- The doctor should be informed immediately
You may bathe, shower and do your normal activities unless the squamous cell carcinoma that has been removed is very large and there is a risk of the wound being damaged
- The doctor will inform you about this
There is a small chance that the squamous cell carcinoma could grow back

Surgical Excision (All types of Squamous Cell Carcinoma):

The skin around the squamous cell carcinoma is injected with a local anesthetic to numb the area
The injection stings for a few seconds
- After this, there is no pain or discomfort
The squamous cell carcinoma and a small amount of surrounding normal skin is cut with a scalpel and removed
As the area is numb from the anesthetic, this process is not painful
Stitches are used to close the opening
Antibiotic and a bandage are used to cover the wound
The day after surgery, the bandage should be removed and a small amount of antibiotic should be be applied
- This should occur twice daily until the stitches are removed
Redness, pain, swelling or a discharge from the wound may be a sign of infection
- The doctor should be informed immediately
The stitches are removed in 5 to 10 days
The removal of stitches is painless
You may bathe, shower and do your normal activities unless the squamous cell carcinoma that has been removed is very large and there is a risk of the wound being damaged
- The doctor will inform you about this
There is a small chance that the squamous cell carcinoma could grow back

Radiation (All types of SCC):

To receive radiotherapy of a squamous cell carcinoma, the lesion must be biopsied (sampled) first
To do the biopsy:
- The skin around the squamous cell carcinoma is injected with a local anesthetic to numb the area
- The injection stings for a few seconds
  - After this, there is no pain or discomfort
- A small portion of the squamous cell carcinoma is removed
- As the area is numb from the anesthetic, this process is not painful
- Stitches are usually not necessary to close the opening
- The biopsied area is then treated with electrocautery, a hot electric needle
  - This is not painful as the area is still numb
- The electrocautery is used to stop any bleeding
- Antibiotic and a bandage are used to cover the wound
- The day after surgery, the bandage should be removed and a small amount of antibiotic should be be applied for 1 week
- Redness, pain, swelling or a discharge from the wound may be a sign of infection
  - The doctor should be informed immediately
- If stitches were used, they are removed in 5 to 10 days
- The removal of stitches is painless
- You may bathe, shower and do your normal activities after the biopsy
Once the biopsy result is available the doctor will make a referral to a radiation specialist
In Hamilton, the radiation treatments and specialists are located at the Juravinski Cancer Centre next to the Henderson General Hospital
The first visit with the radiation specialist is for an assessment only
If he or she agrees with your doctor that the lesion is suitable for radiation, treatments will be arranged
Most squamous cell carcinomas required 10 to 15 treatments
- These are done daily, Monday to Friday over a period of 2 to 3 weeks
After the radiation is complete, the spot will become red, scabby and crusted
This will heal over the next few weeks
There is a small chance that the basal cell carcinoma could grow back

Mohs Micrographic Surgery (Complicated SCC) :

Mohs micrographic surgery is a detailed surgical procedure to treat aggressive non-melanoma skin cancers, mainly on the face and neck
This treatment is usually reserved for the most complicated cases
For appropriate patients in the Hamilton area, referrals are made to the Mohs Centre at Women’s College Hospital in Toronto
Initially, the diagnosis must been confirmed with a biopsy (see above), prior to the referral being made

Would you like to see a Video Demonstration?

I am pleased to offer a new section on the website with video demonstrations of various procedures
To watch a video-clip in which Dr. V talks about:

Levulan PDT Treatments, please click here

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Cherry Hemangioma – Eye Brow
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