Squamous Cell Carcinoma Surgery, Body & Limbs

Squamous Cell Carcinoma (SCC)

Squamous cell carcinoma (SCC) is a skin cancer that arises from squamous cells in the outer layers of the skin. On the trunk and limbs it is most common on the forearms, backs of the hands, lower legs, shoulders and upper back, and it is usually the result of accumulated ultraviolet exposure. SCC is the second most common skin cancer in Australia after BCC.

An SCC on the body typically appears as a firm, raised, tender lump, or as a thickened scaly patch that crusts, bleeds and does not settle. On the lower leg it can look like a small ulcer or a wound that will not heal. Many arise in skin that already shows sun damage, and some develop from a solar keratosis over weeks to months.

SCC can grow faster than BCC and has some capacity to spread to lymph nodes, particularly when a lesion is large, thick, recurrent, or arising in a scar or a long standing wound. For that reason an SCC is generally removed promptly. If you have a lump or sore on your arm, leg, chest or back that has not healed within a few weeks, see your GP or dermatologist, and do not delay if it is changing quickly.

Signs to look out for

• A firm, tender lump that has grown over weeks rather than years.
• A thick, scaly or crusted patch on the forearm, hand or shin that keeps bleeding.
• An ulcer or wound on the leg that has not healed within a month.
• A lesion with a hard, horn like projection from its surface.
• A lump appearing within an old scar, burn or chronic wound.
• New swelling or a lump in the armpit or groin, which should be reported promptly.

How an SCC on the body is diagnosed

Assessment includes examining the lesion with dermoscopy, checking the rest of your skin for other sun damage, and feeling the draining lymph nodes in the armpit, groin or neck depending on where the lesion sits.

Diagnosis is confirmed by biopsy and histopathology. The report gives the thickness, the degree of differentiation, the depth of invasion and whether tumour is tracking along nerves. These features determine the margin taken at surgery and whether imaging, lymph node assessment or multidisciplinary discussion is recommended.

How it is treated

Surgical excision with a margin is the standard treatment for SCC on the trunk and limbs. Radiotherapy is an alternative in selected cases and is directed by a radiation oncologist. Larger lesions on the limbs often need reconstruction rather than direct closure.

1. Planning. The lesion is measured and the margin marked according to size, thickness and site. Small excisions are day procedures under local anaesthetic, while larger excisions, flaps and grafts may be done under general anaesthetic.
2. Excision. The SCC is removed with a margin of surrounding skin and a depth judged from the pathology and examination findings, and the specimen is orientated for the pathologist.
3. Margin checking. The pathologist reports whether tumour reaches any margin. If it does, further excision or another form of treatment is sometimes recommended.
4. Reconstruction. Where the defect cannot be closed directly, a split skin graft, a full thickness graft or a local flap is used. On the shin and over joints, the repair is chosen with movement and healing in mind.
5. Further assessment. If the pathology shows higher risk features, additional imaging or referral for lymph node assessment may be arranged.

Recovery and follow up

Timeframes vary with the size of the excision, the method of closure and the site. Lower limb wounds and skin grafts generally take longer than wounds on the trunk.

• Graft donor sites are dressed and usually heal over about two to three weeks.
• Sutures on the trunk and limbs are commonly removed at around ten to fourteen days.
• Movement, lifting and exercise are restricted for a period, and leg elevation is advised to limit oedema.
• Follow up appointments cover wound healing, your pathology result, the lymph node areas and any further treatment advised.
• Regular skin checks with your GP or dermatologist, checking your own skin between visits, and daily sun protection are part of long term care.

Your care with Dr Maryam

Dr Maryam Seyedabadi, Specialist Plastic Surgeon, MBBS FRACS, AHPRA MED0001341746, consults at 2c Heeley Street, Paddington and operates at St Luke’s Hospital in Potts Point, East Sydney Private Hospital, Sydney Day Hospital, Double Bay Day Hospital and The Skin Hospital in Darlinghurst. With a referral from your GP or dermatologist, a Medicare rebate can be claimed for these procedures.

Because outcomes depend on the type, size, site and stage of the lesion, your plan is confirmed once your examination and pathology have been reviewed, and it may change if the report indicates that more tissue needs to be removed. To arrange a consultation in Sydney, call 1300 067 668.