Facial Squamous Cell Carcinoma Surgery Sydney

Squamous Cell Carcinoma (SCC)

Squamous cell carcinoma (SCC) is a skin cancer that develops from the squamous cells making up the outer layers of the skin. On the face and head it is common on the lip, ear, temple, nose, eyelid and scalp, areas that receive steady ultraviolet exposure over many years. SCC is the second most common skin cancer in Australia after BCC.

A facial SCC often appears as a firm, raised lump that feels tender, or as a rough, scaly, crusted patch that keeps breaking down. Many grow over weeks or months rather than years. SCC can also develop within sun damaged skin such as a solar keratosis, or on the lower lip, where sun damage causes persistent scaling and cracking.

Unlike BCC, SCC has some capacity to spread to lymph nodes, and lesions on the ear and lip carry a higher risk of doing so. For that reason a suspected SCC on the face should be assessed without delay. If you have a sore, lump or scaly patch on your face that has not healed within a few weeks, see your GP or dermatologist.

Signs to look out for

• A firm, raised lump that is tender to touch, sometimes with a crusted or horn like surface.
• A rough, scaly patch that bleeds, crusts and reappears in the same spot.
• A sore on the lip or ear that has not healed in four to six weeks.
• A lesion that has grown noticeably over weeks rather than years.
• Persistent scaling, splitting or a white patch on the lower lip.
• Numbness or tingling in the area, or a lump in front of or below the ear, which should be reported promptly.

How a facial SCC is diagnosed

Assessment includes examination of the lesion with dermoscopy, a check of the surrounding sun damaged skin, and feeling the lymph nodes in the neck and around the ears, since facial SCC drains to those areas.

Diagnosis is confirmed by biopsy and histopathology. The pathologist reports the thickness, how well differentiated the tumour is, how deeply it invades and whether it is tracking along nerves. These features determine the margin taken at surgery and whether imaging, lymph node assessment or discussion at a multidisciplinary meeting is recommended.

How it is treated

Surgical excision with a margin is the standard treatment for a facial SCC. Radiotherapy is an alternative in selected cases and is directed by a radiation oncologist. Because facial SCCs often sit on the lip, ear or eyelid, the repair is planned alongside the excision.

1. Planning. The lesion is measured and the margin marked according to its size, thickness and site. Most excisions are day procedures under local anaesthetic, with general anaesthetic used for larger or deeper tumours.
2. Excision. Dr Maryam removes the SCC with a margin of surrounding skin and an appropriate depth, and orientates the specimen for the pathologist. In Mohs cases the Mohs surgeon performs the excision and Dr Maryam performs the reconstruction.
3. Margin checking. Histopathology reports whether tumour reaches any margin and confirms the risk features seen on biopsy. Further excision or additional treatment is sometimes recommended.
4. Reconstruction. Direct closure, a local flap, a full thickness skin graft or cartilage support is chosen for the site. Lip, eyelid and ear repairs are planned to maintain movement and the position of the border.
5. Further assessment. Where pathology indicates higher risk features, imaging or referral for lymph node assessment may be arranged.

Recovery and follow up

Timeframes vary with the size of the excision, the site and the type of reconstruction, and with any additional treatment that is advised.

• Oedema, bruising and tightness around the lip, eyelid or ear are usual in the first week or two.
• Facial sutures are generally removed at about five to ten days, and staged repairs involve a further procedure some weeks later.
• Scars are firm and pink for a period and typically soften over roughly six to twelve months.
• Follow up appointments are more frequent after an SCC, and include checking the scar and the lymph node areas.
• Regular skin checks with your GP or dermatologist, along with daily sun protection, hats and shade, remain part of your long term care.

Your care with Dr Maryam

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

Your plan is set once your examination findings and pathology have been reviewed, and it can change if the report indicates that more tissue needs to be taken. What is achievable depends on the type, size, site and stage of the lesion. Call 1300 067 668 to arrange an appointment.