Squamous Cell Carcinoma
Squamous cells make up the most part of the epithelial layer of skin, respiratory tracts, digestive tracts, and the inner linings of many organs within the body. Hence, on the cancers that involve face and eyelids, squamous cell carcinoma is a condition that afflicts the outermost layer of epidermis, containing squamous cells. The cancer cells grow and spread in the squamous cells of tissues that form the mouth, digestive tracts, lungs, cervix and vagina in women, prostate gland in men and, urinary bladder. The source of squamous cell carcinoma is associated with over exposure to the UV radiations from the Sun light. Actinic Keratosis that causes vascular lesions in the skin, can trigger squamous cell carcinoma.
Symptoms and Risks
The squamous cell carcinoma is classified in stages depending on the metastasis rate and recurrence of tumours. A high risk cutaneous squamous cell carcinoma could appear on lips, ears, face, genitalia, hands and feet. The tumourous growth could have a diameter of about 2 cm or more. The subtle symptoms begin with reddish blotches, lesions, spurting growth in an existing mole or wart and, sores that take a long time to heal. Persistent symptoms may indicate a possibility of squamous cell carcinoma.
Stages of Squamous cell carcinoma
Tx – Source of Primary tumour not known
T0 – Primary tumour not traceable
Tis – Traces of cancer cells found in the target site
T1 – Size of the tumour in squamous cells is less or equal to 2 cm
T2 – Size of the tumour in squamous cells is greater than 2 cm
T3 – The tumour is grown big enough to invade orbit, maxilla and the temporal bone
T4 – The tumour is big enough to invade the axial skeleton of the skull base
In case of cutaneous squamous cell carcinoma, the nodal stages are assessed on whether the tumour has spread into lymph nodes or not.
Nx – Assessment of regional lymph nodes not feasible at this stage
N0 – No metastasis detected in the lymph nodes
N1 – Metastasis detected in a lymph node, less or equal to 3 cm.
N2 – Metastasis detected in a lymph node, greater than 3 cm. The metastasis may spread to other lymph nodes.
N3 – Metastasis detected in lymph nodes, greater or equal to 6 cm
In case of doubt, the doctor conducts an array of tests to evaluate the size, colour, texture and the shape of a lesion or, a rough scaly patch that has spurted on the skin. A section of the afflicted area is excised for a skin biopsy, performed by a dermatologist. Based on the prognosis reports with details about the size, degree and stage of the tumour, treatment options on the cancer affecting face and eyelids, are listed by the doctor.
On the cancers involving face and eyelids, people with lighter complexion, coloured hair and eyes are more susceptible to being afflicted with squamous cell carcinoma. The other factors that can trigger squamous cell carcinoma are:
- A weakened immune system (Bowen’s disease),
- Previous exposures to radiations and x-rays and sunburns,
- Organ transplants,
- Viruses like HIV and HPV
- Genetic disorders like xeroderma pigmentosum.
Diagnosis and Treatment
On cancers that affect face and eyelids, squamous cell carcinoma is one of the most completely curable types of cancer, if diagnosed early. However, if the cancer cells in the squamous layer of the epidermis have spread to lymph nodes and other organs, radiation therapy or chemotherapy is advised. Some of the common techniques involved in treatment procedures of cancers affecting face and eyelids are as mentioned below:
Excision is a surgical procedure that involves excising the section of the skin that contains the tumourous growth in the squamous cells. This procedure is effective if squamous carcinoma has been detected at an early stage. Electrodesiccation is used for excising the tumourous growth that is less than 1 cm.
Mohs Surgery is a successful surgical procedure for treating cancers involving face and eyelids such as squamous cell carcinoma, wherein the tumour is greater than 2cm. The surgeon trained in Mohs surgery, uses a curette which is a ring shaped pointed instrument, in the surgery. He removes the section of the skin containing the tumourous growth carefully and performs a biopsy on it. If the cancer cells are found in the tissue layer of the fragmented section, the excision procedure is repeated. Post surgery, the wound is stitched back. Mohs Surgery has an advantage over other forms of treatment as it spares a considerable amount of healthy tissue, during the treatment and, has a higher success rate. However, if the cancer cells have spread to sensitive regions such as eyelids, ears and genitalia, radiation therapy is recommended.
Patients suffering from a severe degree of squamous cell carcinoma in the eyelids, ears and nose undergo radiation therapy. Radiation therapy is also found to be effective in cancers involving face and eyelids as surgical procedures may leave behind residual cancer cells in the nerves that cannot be excised. X-ray beams are focussed on the tumourous growth in the squamous cells of the skin. The procedure does not require surgical means or administering anaesthesia to the patient. For patients, whose cancer cells have spread into the lymph nodes and organs within, systemic chemotherapy is combined with surgery to remove the cancer cells completely. Photodynamic therapy is yet another alternative means to burn the cancer cells by emitting a light beam. The light beam contains the chemicals to destroy the tumour completely.
Cryosurgery is a procedure that involves usage of a spray device with a cotton tip dipped in liquid nitrogen on cancers involving face and eyelids. The area of treatment is frozen using the device, thereby freezing the affected tissue. Post a few rounds of treatment, the growth begins to wither away and, eventually falls off. This treatment does not require administering of anaesthesia to patient. Therefore, it is a preferred method of treatment for patients with a history of bleeding disorders. Cryosurgery is effective for treating squamous cells carcinoma at a nascent stage.
Post treatment on cancers involving face and eyelids, patients experience redness and swelling in the skin for a while. Hence, they are advised against going out and, are asked to avoid exposure to indoor light too. They are advised to wear a fully covered clothing and, wear a UV filtering sunglasses to avoid the radiations from affecting the skin and the eyes. A yearly check up helps in assessment of the condition of the skin.
Doctors like Dr. Debraj Shome have performed on countless oculoplastic surgeries that have treated squamous cell carcinoma.