Squamous Cell Carcinoma - When should you worry?

Dr. David Roy • May 1, 2017
Squamous Cell | What is it | Pine Belt Dermatology
   Today we are discussing squamous cell carcinoma (SCC) because it is a topic that I am very passionate about and one that I feel causes a fair bit of confusion. SCC is the second most common form of skin cancer and, in the South, the number of people who die from SCC of the skin is about equal to the number of people who die from melanoma. I have heard many patients and, unfortunately, several physicians say that SCC should not be of great concern and that I make too big of a deal out of this particular cancer. The truth is, not all SCCs are extremely aggressive. While a significant number of these cancers are treated with simple surgery or a burn and scrape technique known as electrodessication and curettage, there is a subset of these tumors that behave in a very aggressive manner. Some of these tumors can be as aggressive and deadly as an invasive malignant melanoma. There are particular clinical and histopathological (microscopic) findings of SCC which suggest a nastier course and we will discuss those later in the blog. 

   The question then becomes, why are some skin cancers so bad while others seem to be so easily treated? That is a very good question and a very important question. The answer, however, is quite complicated as there is a lot about cancer in general that we do not understand. Medicine itself is imperfect. We would like to think that we have all the answers, but the reality is that we make assumptions and judgments based on the information that we have. Unfortunately that information is incomplete. The picture is still being painted. We learn everyday that diseases themselves are difficult to put into neat little boxes, with the truth being that most diseases run a spectrum from relatively benign to very destructive, and everything in between. What makes us better equipped to anticipate and handle difficult situations is our experience with diseases over time. What we have observed and recorded (statistical and historical data) help us to make sound and educated judgment calls in specific situations. As time goes on, our understanding will grow and hopefully one day we will be able to answer the question posed earlier.

   So what types of data guide us when it comes to SCC? There are several factors to consider when deciding if a SCC may behave in an aggressive manner and it is important to ask your doctor specifically about the nature of your cancer. These factors include the site of the lesion, the size of the lesion, the depth of the lesion, the histopathological subtype (meaning what specific pattern of growth, and associated microscopic findings, that are noted on the pathology report), recurrent/previously treated lesions, tumors previously treated with radiation, rapidly growing tumors, tumors at sites of chronic inflammation (like swollen and red lower legs or areas of slowly healing or chronic wounds), and if there is tumor seen invading the nerves and/or blood vessels. 

   So what might you want to know about your biopsy? There are several different types of SCC. Some are referred to as squamous cell carcinoma in situ. This means the cancer is confined to the upper part of the skin known as the epidermis and is not considered an invasive tumor. The first thing you want to know is whether or not your cancer is invasive, meaning it has spread to the lower part of the skin, known as the dermis. Next, I would recommend asking your physician if your tumor is considered a high risk tumor. High risk tumors are defined as having one or more of the following features:
  • Depth of invasion of the tumor is greater than or equal to 2 millimeters
  • Deepest part of the tumor involves the bottom layer of the dermis, which is referred to as the reticular dermis (lowest part of the skin itself before you get to the fat)
  • Presence of perineural invasion, meaning the cells have spread directly around the nerves
  • Lesion is located on the ears, or lips
  • Tumor is what we call poorly or undifferentiated (this means the tumor cells do not resemble the cells that they are derived from and are behaving in an unpredictable manner)
   When it comes to differentiation, there are four classifications that are used - well differentiated, moderately differentiated, poorly differentiated and undifferentiated. Well differentiated tumors are the most common and least aggressive. Moderately differentiated tumors are more aggressive than well differentiated tumors, and poorly and undifferentiated tumors are the most aggressive and most likely to spread. Certain types of SCC (subtypes) are considered to be more aggressive than others as well. These include the following:
  • Acantholytic
  • Adenoidal
  • Adenosquamous
  • Desmoplastic
  • Spindle
  • Verrucous spindle cell
   Why should you be worried about SCC? When it comes to SCC, 2% of patients with a typical well differentiated SCC could die from their disease. That is two out of every 100 patients. When it comes to more aggressive tumors, 14% of patients with moderately differentiated SCCs could die, and for poorly differentiated tumors, that number jumps to 53%. So, 53 out of every 100 patients with poorly differentiated tumors could succumb to their disease. In patients whose tumors demonstrate perineural invasion, the size of the involved nerve is very important. If the nerve is greater than 0.1 millimeter in diameter, the risk of death was 32%. Thus, SCC can, in some cases, behave in a very aggressive and deadly manner.

   Treatment is tailored to the specific tumor and specific patient situation. Most non-aggressive tumors should be treated with surgery or electrodessication and curettage. More aggressive tumors should be treated with surgery. Mohs surgery is a highly effective treatment option for SCC and is considered the best option in certain circumstances. Following surgery, we will sometimes recommend radiation therapy and possible lymph node biopsy, but these are only used in extreme cases. Your doctor will recommend a treatment plan and remember, it never hurts to get a second opinion if you are unsure.

I hope this answers some of your questions about SCC. Let us know if you have any other questions about this or any other topic.
July 31, 2026
At Pine Belt Dermatology & Skin Cancer Center , we understand that selecting the right skincare products can be challenging. While many over-the-counter (OTC) options promise results, not all skin concerns can be addressed with these products. Knowing the difference between OTC and prescription treatments helps you make educated decisions and recognize when to seek professional care. If you are treating acne, eczema, rosacea, or signs of aging, upgrading your treatment plan at the right time can improve your skin health and confidence. Understanding Over-the-Counter Skin Treatments Over-the-counter skincare products are available without a prescription and are intended for mild to moderate skin concerns. When used consistently, many contain ingredients that help maintain healthy skin. Common OTC ingredients include: Salicylic acid for acne Benzoyl peroxide to reduce acne-causing bacteria Retinol for fine lines and uneven texture Hydrocortisone cream for minor itching and irritation Moisturizers with ceramides or hyaluronic acid to heal the skin barrier These products are a good starting point for mild conditions. However, because OTC treatments use lower-strength active ingredients, they may not be effective for chronic or serious skin issues. When Prescription Skin Treatments May Be Necessary Prescription treatments use stronger active ingredients and are customized to your specific skin condition. A dermatologist can diagnose the underlying cause and recommend medications that address the problem more effectively than OTC products. Prescription treatments may include: Oral medications for moderate to severe acne Prescription-strength retinoids Medications to manage eczema or psoriasis Treatments for rosacea and chronic redne Prescription creams for hyperpigmentation or melasma Antifungal or antibacterial medications for skin infections These therapies are chosen based on your medical history, skin type, and treatment goals to maximize results and minimize side effects. Time to Upgrade Your Treatment While many start with OTC products, some situations require a dermatology appointment. Consider seeing a dermatologist if: Your skin condition has not improved after several weeks of steady OTC treatment. Acne is causing painful cysts, nodules, or permanent scarring. Rashes, redness, or irritation continue to worsen. You experience frequent flare-ups of eczema, psoriasis, or rosacea. You notice new or changing skin growths or unusual spots. Your skin concern is affecting your confidence or quality of life. Early treatment has the potential to prevent conditions from getting worse and minimize the chances of long-term skin damage. Why Professional Assessment Matters Many skin conditions look similar, making self-diagnosis challenging. For example, stubborn acne may be rosacea, and chronic dry patches could indicate eczema, psoriasis, or another condition. A board-certified dermatologist can accurately diagnose your skin concern and develop a customized treatment plan. Professional guidance also helps you avoid spending time and money on ineffective products. Healthy Skin Starts with the Right Treatment Over-the-counter products are important for daily skincare, but they may not treat complex or persistent concerns. Transitioning to prescription treatment at the right time can greatly improve your skin’s appearance and long-term health. At Pine Belt Dermatology & Skin Cancer Center , our team offers complete evaluations and customized treatment plans for acne, eczema, rosacea, hyperpigmentation, skin cancer screenings, and other skin conditions. If your current skincare routine is not resulting in success, we are here to help you achieve healthier, more confident skin. 
June 29, 2026
At Pine Belt Dermatology & Skin Cancer Center, we believe education is key to protecting and maintaining healthy skin. July is significant for skin health, featuring both UV Safety Awareness Month and World Skin Health Day on July 8 . These occasions highlight the importance of sun protection and raise awareness of common concerns, such as hyperpigmentation and melasma . Understanding how ultraviolet (UV) exposure affects your skin helps prevent long-term damage and supports a healthier, more even complexion. Why UV Protection Matters The sun emits ultraviolet rays that can damage skin even on cloudy days. While many associate UV exposure with sunburn, its effects are broader. Repeated UV exposure accelerates skin aging, increases skin cancer risk, and contributes to pigmentation disorders. Common effects of excessive UV exposure include: • Sunburn and skin irritation • Premature aging, including fine lines and wrinkles • Dark spots and uneven skin tone • Increased risk of skin cancer • Worsening of hyperpigmentation and melasma Daily sun protection is one of the most effective ways to maintain healthy skin and reduce preventable damage. What Is Hyperpigmentation? Hyperpigmentation is a common condition where areas of skin become darker than the surrounding tissue due to excess melanin production. Multiple factors can contribute to hyperpigmentation, including: • Sun exposure • Acne scars and inflammation • Hormonal changes • Skin injuries or irritation • Certain medications While hyperpigmentation is mostly harmless, many seek treatment to improve skin tone as well as restore confidence. Understanding Melasma Melasma is a type of hyperpigmentation that shows up as brown or gray-brown patches, typically on the cheeks, forehead, nose, and upper lip. Melasma is frequently associated with: • Hormone changes during pregnancy • Birth control medications • Hormone replacement therapy • Genetic predisposition • Sun exposure Although melasma is not dangerous, it can be difficult to treat because UV exposure frequently triggers or worsens it. Even minimal sun exposure can increase pigment production and make discoloration more noticeable. Protecting Your Skin from UV Damage Whether you are concerned about skin cancer, hyperpigmentation, or melasma, daily sun protection is essential. Dermatologists suggest: • Using sun lotion with SPF 30 or higher every day • Reapplying sunscreen every two hours when outdoors • Wearing wide-brimmed hats and protective clothing • Seeking shade during peak sunlight hours • Wearing UV-protective sunglasses • Avoiding tanning beds Consistent sun protection helps prevent new pigmentation issues. World Skin Health Day: A Reminder to Prioritize Skin Care Observed annually on July 8, World Skin Health Day encourages preventive steps to maintain healthy skin. This is a reminder to perform regular self-exams, schedule dermatology visits, and address concerns early. If you notice persistent dark spots, changes in pigmentation, or new skin lesions, seek an expert assessment to determine the cause and identify treatment options. Supporting Healthy Skin Year-Round UV Safety Awareness Month and World Skin Health Day remind us that protecting your skin is an investment in long-term health. Practicing sun safety and understanding conditions like hyperpigmentation and melasma help preserve your skin’s health, appearance, and function. At Pine Belt Dermatology & Skin Cancer Center, our team provides personalized evaluations and treatments for pigmentation concerns, sun-damaged skin, and overall skin health. Plan a visit and learn how we can help you achieve healthier, more confident skin.
Winter Skin Care vs. Summer Skin Care: What Changes?
June 1, 2026
At Pine Belt Dermatology & Skin Cancer Center, we understand that your skin’s needs change with the seasons. What works during the cold, dry winter months may not...
Nail Health: What Your Nails Say About Your Skin and Body
May 1, 2026
At Pine Belt Dermatology & Skin Cancer Center, we believe your nails are more than a cosmetic feature—they give valuable insight into...
April 13, 2026
When a ‘Rash’ Might Be Something More Serious At Pine Belt Dermatology & Skin Cancer Center, we recognize that rashes are common and frequently resolve quickly with minimal treatment. However, some rashes may signify underlying conditions that require prompt medical attention. Identifying when a rash is more than a minor irritation is key to protecting your health. Comprehending Common vs. Concerning Rashes Most everyday rashes result from irritants, allergies, heat, or minor infections and typically improve within a few days with over-the-counter treatments. However, if a rash lasts longer, worsens, or appears with other symptoms, it may signal a more serious issue. Identifying the difference between a routine rash and one that requires medical evaluation helps avoid complications and ensure appropriate care. Warning Signs to Watch For Certain features may indicate a rash requires clinical assessment, including: Rapidly spreading or worsening rash Severe pain, swelling, or blistering Signs of infection such as pus, warmth, or red streaks Fever or flu-like symptoms accompanying the rash A rash that does not improve after several days of treatment Dark, purple, or bruised-looking areas on the skin For example, a rash with fever may indicate a viral or bacterial infection, whereas painful blistering can suggest conditions such as shingles. In rare cases, rashes may signal autoimmune disorders or severe allergic reactions. Rashes That May Point to Underlying Conditions Some rashes may be linked to broader health concerns, including conditions that cause inflammation in the skin and other organs: Allergic reactions that may escalate into further severe responses Infections that spread beyond the skin if untreated Medication reactions that require immediate adjustment Persistent or unusual skin changes may be early signs of skin cancer or precancerous conditions, especially if they do not heal or continue to change over time. Why Early Evaluation Matters Delaying care for a worrisome rash may allow the underlying condition to progress. Early diagnosis improves treatment outcomes and helps prevent discomfort and complications. A dermatology specialist can assess the rash’s appearance, location, and progression, and may recommend diagnostic tests if needed. This approach assures treatment addresses the underlying cause, not just the visible symptoms. When to See a Dermatology Specialist If you are unsure about your rash, it is best to err on the side of caution. Consider seeking care if: The rash is persistent, painful, or unusual in appearance Over-the-counter treatments are not effective You experience additional symptoms such as fever or fatigue The rash interferes with your daily comfort or quality of life At Pine Belt Dermatology & Skin Cancer Center, our experienced providers supply comprehensive skin evaluations and customized treatment plans. We take time to understand your symptoms and deliver clear, effective solutions tailored to your needs. Protecting Your Skin and Your Health While many rashes are minor, some may be early warning signs of more serious health concerns. Monitoring skin changes and pursuing prompt medical advice can produce a notable effect. If you notice a rash that does not seem right, do not ignore it. Schedule a consultation with Pine Belt Dermatology & Skin Cancer Center for expert evaluation and peace of mind. Your skin is an important indicator of your overall health, and taking it seriously supports ongoing well-being.
The Link Between Stress & Skin Conditions | Pine Belt Dermatolog
By Bob Berendsen March 1, 2026
At Pine Belt Dermatology & Skin Cancer Center, we know that healthy skin is affected by more than just external care—it’s related to your overall health...
UV Light Therapy for Scalp Psoriasis | Pine Belt Dermatology
By Bob Berendsen February 5, 2026
Here’s how UV light therapy works, why it is useful for scalp psoriasis during winter, what to expect from treatment, and how to use it safely.
Dermatologist-Approved Tips for Safe and Effective Skincare | Pine Belt Dermatology
By Bob Berendsen January 1, 2026
A truly effective skincare routine should be tailored to your needs, protect your natural barrier, and target concerns with proven ingredients.
Psoriasis During the Winter Season | Pine Belt
By Bob Berendsen December 2, 2025
The cold, dry air outside combined with indoor heating can strip away your skin’s natural moisture, leaving it tight, flaky, and more vulnerable to irritation.
Winter Skin Survival Guide: How to Combat Dryness | Pine Belt Dermatology
By Bob Berendsen November 4, 2025
At Pine Belt Dermatology, we understand how winter weather affects your skin and how frustrating it can be to deal with the discomfort that comes with it.