Treatments for squamous cell carcinoma

The following are treatment options for squamous cell carcinoma (SCC) of the skin. Your healthcare team will suggest treatments based on the risk group. They will work with you to develop a treatment plan.

SCC is most often treated with local therapy. This means that only the cancer on the skin and the area around it are treated. Surgery is the main local therapy used for SCC.

If SCC has spread to other parts of the body, systemic therapy may be used. Systemic therapy travels through the bloodstream to reach and destroy cancer cells all over the body. Immunotherapy and targeted therapy are some systemic therapies that may be used for SCC.

Surgery is usually offered for SCC. The type of surgery done depends on the risk group, where the cancer is located and the size of the cancer.

Surgical excision removes the cancer along with some normal tissue around it (called the surgical margin). It is a common treatment for most types of SCC.

Mohs surgery removes the cancer in layers, little by little, until no cancer remains. It is mainly done for high-risk SCC or SCC that comes back after treatment (called recurrent SCC). It can also be used when SCC could not be completely removed by surgical excision. Mohs surgery is often used for cancers with a border that is uneven, especially on the face, hands or feet.

Curettage and electrodesiccation (C&E) uses a sharp tool (called a curette) to scrape the cancer and remove it from the body. Then the area is treated with an electrical current to destroy any remaining cancer cells. It is commonly used for low-risk SCC, including SCC in situ.

Cryosurgery uses extreme cold to freeze and destroy tissue. It is often used to treat small tumours on the surface of the skin with clear and smooth borders, such as SCC in situ. It is usually offered when other types of surgery can’t be done.

A skin graft or a skin flap may be done to repair the skin and nearby area after SCC is removed. Skin from another area of the body is removed and placed over the surgical area to cover the open wound and repair the skin. It may be done if a large area of skin is removed to make sure the cancer is completely gone.

A lymph node dissection removes lymph nodes from the body. It is not done very often, but may be offered for SCC that has spread to lymph nodes. Imaging tests or a physical exam will be done to see which lymph nodes need to be removed.

Find out more about surgery for non-melanoma skin cancer.

Radiation therapy uses high-energy rays or particles to destroy cancer cells. You may be offered radiation therapy to:

• treat SCC that can’t be removed with surgery or if surgery will change your appearance or how the area functions
• treat SCC that could not be completely removed by surgery
• after surgery to destroy cancer cells that have spread to the lymph nodes
• treat high-risk cancers along with other treatments, such as surgery
• treat SCC that comes back after treatment
• help relieve or control symptoms (called palliative therapy)

Radiation therapy is usually given daily for several weeks.

Find out more about radiation therapy for non-melanoma skin cancer.

Drug therapy uses drugs to treat SCC. The type of drug therapy used depends on where the cancer is located.

Topical therapy is given as a cream or ointment that contains drugs and is applied on the skin. It may be offered to treat SCC in situ. In some cases, topical therapy is used for low-risk SCC. The topical therapy drugs that may be used are:

• the chemotherapy drug fluorouracil (also called 5-fluorouracil or 5-FU)
• the immunotherapy drug imiquimod (Aldara, Zyclara)

Topical therapy drugs are usually put on the growth or abnormal area once a day for several weeks.

Immunotherapy helps to strengthen or restore the immune system's ability to fight cancer. The immunotherapy drugs that may be used for SCC are:

• cemiplimab (Libtayo)
• pembrolizumab (Keytruda)

These drugs are used for SCC that has grown into nearby areas (called locally advanced SCC) or has spread to other parts of the body (called metastatic SCC) when surgery or radiation can’t be offered. Pembrolizumab may also sometimes be given after surgery (called adjuvant therapy).

Immunotherapy drugs are given by a needle into a vein (intravenously) every 2 or 3 weeks.

Targeted therapy uses drugs to target specific molecules (such as proteins) on or inside cancer cells to stop the growth and spread of cancer cells. The targeted therapy drug used for SCC is cetuximab (Erbitux). Cetuximab may be used for locally advanced or metastatic SCC when surgery can't be offered. It may also be used as adjuvant therapy. Cetuximab is given intravenously.

Systemic chemotherapy is not usually offered for SCC. But it may be used for metastatic SCC. The most common chemotherapy drug used is cisplatin. It is given intravenously. It can be used alone or combined with other drugs in some cases, including the immunotherapy drug called interferon and retinoid drugs.

Find out more about drug therapy for non-melanoma skin cancer.

You may be offered photodynamic therapy (PDT) for SCC in situ. It uses a light-sensitive drug (photosensitizer) and a special type of light to destroy cancer cells.

Find out more about photodynamic therapy for non-melanoma skin cancer.

Talk to your doctor about clinical trials open to people with non-melanoma skin cancer in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.