Squamous cell carcinoma (SCC) is a type of skin cancer that develops in squamous cells, which make up the outer layer of the skin. SCCs often appear as scaly red patches or elevated growths and are caused by cumulative lifetime sun exposure. Risk factors include light skin, age, male gender, and sun or chemical exposure. SCCs are most common on sun-exposed areas like the face and neck and are usually treated by removing the lesion, though advanced cases may require surgery, radiation, or chemotherapy. Maintaining good oral hygiene is important for preventing complications from oral SCCs and their treatment.

1. SQUAMOUS CELL CARCINOMA
Oral Pathology

2.  Malignant tumors that begin in the squamous cells that
form the outer layer, or epidermis, of the skin are called
Squamous cell carcinomas (SCCs). It is one of the
main types of skin cancer.
 SCCs often look like scaly red patches, open sores,
elevated growths with a central depression, or warts; they
may crust or bleed.
 SCCs may occur on all areas of the body including the
mucous membranes and genitals, but are most common
in areas frequently exposed to the sun, such as the rim of
the ear, lower lip, face, balding scalp, neck, hands, arms
and legs.
 Most lip and oral cavity cancers start in squamous cells,
the thin, flat cells that line the lips and oral cavity. (The Skin
Cancer Foundation, n.d.)

3. CUMULATIVE LIFETIME SUN EXPOSURE IS THE MAIN CAUSE OF SQUAMOUS
CELL CARCINOMA.
OTHER FACTORS THAT ARE RELATED TO THE DEVELOPMENT OF SQUAMOUS CELL
CARCINOMA:
(Shulstad Raymond M., Proper Steven, 2010)
Extrinsic factors Intrinsic factors
• industrial carcinogens,
such as pitch, tar, crude
paraffin oil, fuel oil,
creosote, lubricating oils,
arsenic, and nitrosoureas.
• age,
• lighter skin pigmentation,
• scars,
• dermatoses associated with
photosensitivity (chronic
cutaneous lupus),
• ulcerations,
• and lichen planus.

4.  Photograph 1. This man's skin has been badly damaged by years of sun exposure. He has a
squamous cell carcinoma on his face. (American Academy of Dermatology, n.d.)
 Squamous cell carcinoma may manifest as a variety of primary
morphologies.
 The main symptom is a growing bump that may have a rough, scaly surface
and flat, reddish patches. A sore that does not heal can be a sign of
squamous cell carcinoma.
 Squamous cell carcinomas typically occur on portions of the skin that have
been exposed to sunlight over a period of years; most lesions occur on the
head and neck, especially the face, with the arms and hands the next most
common locations. Histologically, a squamous cell carcinoma lesion involves
the full thickness of the epidermis, but without involvement of the dermis, the
deep vascular inner layer of the skin. (Ferguson, 2015)

5. Photograph 2. Squamous cell carcinoma. (American Academy of Dermatology, n.d.)
Oral manifestations:
 A sore on the lip or in the mouth that does not heal.
 A lump or thickening on the lips or gums or in the mouth.
 A white or red patch on the gums, tongue, or lining of the mouth.
 Bleeding, pain, or numbness in the lip or mouth.
 Change in voice.
 Loose teeth or dentures that no longer fit well.
 Trouble chewing or swallowing or moving the tongue or jaw.
 Swelling of jaw.
 Sore throat or feeling that something is caught in the throat.
 Lip and oral cavity cancer may not have any symptoms and is sometimes
found during a regular dental exam. (National Cancer Institute, 2016)

6. Risk factors for squamous cell carcinomas include:
 Exposure to sunlight and ultraviolet radiation.
 Age above fifty years.
 Male gender.
 Light-colored skin that burns easily.
 Blue or green eyes.
 Blond or red hair.
 Residence in a geographical area that receives high sun exposure.
 Repeated use of tanning beds.
 Exposure to chemical carcinogens such as arsenic and tar.
 History of a large number of x-rays.
 History of prior nonmelanoma skin cancer, and chronic immunosuppression.
(Ferguson, 2015)
 Diagnosed with actinic keratoses (AKs).
 Badly burned skin.
 Ulcer or sore on your skin that has been there for many months or years.
 Infected with human papillomavirus (HPV).
 Received many PUVA treatments.
 Have one of these medical conditions: xeroderma pigmentosum, epidermolysis
bullous, or albinism. (American Academy of Dermatology, n.d.)

7.  The prevention of the Squamous cell carcinoma is the
reduction of the risk factors causing the disease, mentioned
above, such as, for example: decrease the usage of tanning
beds and natural sunlight, tobacco products, heavy alcohol.
(National Cancer Institute, 2016)
Most squamous cell carcinomas are treated
in the doctor’s office by:
 Cryotherapy (cryosurgery): safe and low-cost procedure.
 Electrodesiccation and curettage: simple procedure involving
scraping and burning the tissue in the lesion.
 Excision with conventional margins: highly effective for many
squamous cell carcinomas. This technique commonly involves
removal of a greater amount of normal tissue than is
necessary for complete tumor removal.
 Mohs micrographic surgery: allows for examination of the
entire surgical margin during the procedure and the removal of
the tumor in a step-wise procedure until clear margins are
obtained.

8.  Photograph 3. The growth on this man’s lower lip grew for years before he sought
treatment. (American Academy of Dermatology, n.d.)
 It is important to remove the lesion completely in the first treatment because
it can recur, metastasize, and cause death. More advanced or more invasive
squamous cell carcinomas may require more aggressive treatment,
including surgical management, radiation therapy, or both.
 Nonsurgical treatment options for squamous cell carcinoma include
topical chemotherapy and immune response modifiers (generally used
for premalignant lesions), photodynamic therapy, radiation therapy
(generally used in patients for whom surgery is not feasible and as an
adjuvant therapy for patients with metastatic or high-risk squamous cell
carcinoma), and systemic chemotherapy (for patients with metastatic
disease). (Ferguson, 2015)

9. Some cancer treatments have toxic effects on the oral tissues
(stomatotoxic).
Chemotherapy and radiation therapy cause a lot of
complications:
 Risk for pain, oral and systemic infection due to
inflammation and ulceration of the mucous membranes.
 Xerostomia or salivary gland dysfunction.
 Impaired ability to eat, taste, swallow, and speak because
of mucositis, dry mouth, trismus, and infection.
 Abnormal dental development.
 Bleeding.
 Caries.
 Trismus or tissue fibrosis: restricted ability to open the
mouth.
 Osteonecrosis: decreased ability to heal if traumatized.
Medically necessary oral care before, during, and after cancer
treatment can prevent or reduce the incidence and severity of oral
complications. A comprehensive oral evaluation should take place one
month before cancer treatment starts to allow adequate time for
recovery from any required invasive dental procedures.

10. Oral hygiene considerations:
 Brush teeth, gums, and tongue gently with an
extra-soft toothbrush and fluoride toothpaste after
every meal and before bed.
 Floss teeth gently every day.
 Avoid mouthwashes containing alcohol.
 Exercise the jaw muscles three times a day to
prevent and treat jaw stiffness from radiation.
 Avoid candy, gum, and soda unless they are
sugar-free.
 Avoid spicy or acidic foods, toothpicks, tobacco
products, and alcohol. (National Institute of Dental and
Craniofacial Research, 2015)

11. References:
 The Skin Cancer Foundation (n.d.). Squamous Cell Carcinoma (SCC). Retrieved
November 20, 2016 from:
http://www.skincancer.org/skin-cancer-information/squamous-cell-carcinoma
 Shulstad Raymond M., Proper Steven (2010). Journal of the Dermatology Nurses'
Association. Lippincott Williams & Wilkins, Inc. Squamous Cell Carcinoma: A
Review of Etiology, Pathogenesis, Treatment, and Variants, p. 12 – 16.
 American Academy of Dermatology (n.d.). Squamous cell carcinoma. Citations and
photographs 1, 2, 3. Retrieved November 20, 2016 from:
https://www.aad.org/public/diseases/skin-cancer/squamous-cell-carcinoma
 Ferguson, J. P. (2015). Squamous cell carcinomas. Salem Press Encyclopedia Of
Health, p. 3.
 National Cancer Institute (2016). Head and Neck Cancer. Retrieved November 20, 2016
from: https://www.cancer.gov/types/head-and-neck/patient/lip-mouth-treatment-pdq
 National Institute of Dental and Craniofacial Research (2015). Oral complications of
cancer treatment: what the dental team can do. Retrieved November 20, 2016
from:
https://nidcr.nih.gov/oralhealth/topics/cancertreatment/oralcomplicationscanceroral.htm