Skin Squamous Cell Carcinoma Recurrent

Squamous cell carcinoma of the skin can return after treatment, presenting challenges for patients and healthcare providers alike. Understanding recurrence patterns, risk factors, and available treatment options is essential for managing this condition effectively.

Table of contents

• What is Recurrent Squamous Cell Carcinoma
• Who Is Most at Risk for Recurrence
• When and Where Cancer Returns
• Early Detection and Follow-Up Care
• Treatment Options for Recurrent Disease
• Reducing the Risk of Recurrence

What is Recurrent Squamous Cell Carcinoma

Recurrent squamous cell carcinoma of the skin is a rare but difficult to treat condition^[2]. After successful removal of an initial tumor, squamous cell carcinoma can sometimes return in the same area or nearby skin. This recurrence may happen months or even years later^[6].

Though recurrence doesn’t always indicate a more aggressive form, it often means that cancerous cells may not have been entirely removed or that the skin remains vulnerable to further damage from ultraviolet radiation^[6]. When patients present with locally recurrent disease not amenable for surgery due to location of the lesion or widespread disease, or with metastatic disease (cancer that has spread to other parts of the body), there are few treatment options available^[2].

Who Is Most at Risk for Recurrence

Certain factors increase the likelihood of squamous cell carcinoma returning. Individuals with weakened immune systems, those who’ve had previous skin cancers, or patients whose initial tumor was large or located on high-risk areas like the lips or ears face a higher chance of recurrence^[6]. Chronic sun exposure and not following recommended follow-up care can also contribute to the risk^[6].

Once you’ve had skin cancer, your likelihood of getting skin cancer again increases. There is a ten-fold chance that squamous cell carcinoma may recur in the tissue surrounding an initial lesion during the two-year period following initial treatment^[5]. Of all patients with squamous cell skin cancer, thirty to fifty percent will develop another squamous cell skin cancer within five years^[20].

The majority of patients who present to the clinic with advanced disease are elderly individuals who are in poor clinical condition and carry several comorbidities^[2]. Frequently, the disease presents itself in elderly patients with poor performance status and bearing many comorbidities, thus the decision to administer systemic chemotherapy becomes difficult to make^[2].

When and Where Cancer Returns

Seventy to eighty percent of squamous cell skin cancer cases that recur come back within the first two years of the initial treatment^[20]. The cancer tends to recur in the same general area where the original tumor was located^[6]. This is typically because the surrounding skin may have been exposed to the same harmful UV rays that caused the initial tumor, or microscopic cancer cells were left behind during treatment.

Research has indicated that the type of treatment performed affects a person’s risk for future cancer development within a five-year period after treatment. For example, the recurrence risk is approximately 10% after surgical excision, just under 8% after electrodesiccation and curettage, approximately 7.5% after cryotherapy, and less than 1% after Mohs surgery^[5].

Early Detection and Follow-Up Care

The best way to handle a potential recurrence is by catching it early. Follow-up skin exams are a key part of post-treatment care. Regular check-ins allow for careful monitoring and quick action if any suspicious changes occur. If caught early, recurrent squamous cell carcinoma can often be treated with less invasive methods^[6].

After you have completed your treatment for squamous cell skin cancer, it is important to keep all follow-up medical appointments, because you are at risk of your squamous cell skin cancer returning as well as for developing a new squamous cell skin cancer. You are also at risk of developing other skin cancers, so it is important to be followed closely by your dermatologist^[20].

Patients are encouraged to perform monthly self-exams that observe skin on the entire body. A professional skin cancer screening can also provide a baseline and initial demonstration^[5]. Part of long-term health management involves creating a mindful practice in supporting patients in the area of lifelong health^[5].

Treatment Options for Recurrent Disease

Most studies assessing the efficacy of systemic treatments in advanced squamous cell carcinoma are nonrandomized and retrospective. Cisplatin-based chemotherapy forms the backbone of the treatment and high response rates have been reported in the literature^[2]. However, cisplatin-based chemotherapy is known for its commonly encountered adverse effects such as nausea and vomiting, low blood counts, and especially nephrotoxicity (kidney damage)^[2]. In addition, current chemotherapeutic protocols response rates are far from satisfactory^[2].

Recently cetuximab, a chimeric antibody against epidermal growth factor receptor, is increasingly being reported as an alternative treatment^[2]. There are reports of recurrent squamous cell carcinoma of the skin in elderly patients with poor performance status who had an excellent clinical response to single agent cetuximab therapy with complete resolution of the disease and minimal toxicity during the course of the treatment^[2].

When a squamous cell carcinoma of the skin has spread extensively or aggressively, or has resisted multiple treatments and repeatedly recurred, it is considered to be advanced. About 95 percent of squamous cell carcinomas of the skin are detected early, when they are easiest to treat and cure. The remaining 5 percent of cases have advanced to such an extent that they are far more dangerous and challenging to treat^[9].

Reducing the Risk of Recurrence

The same protocols that reduce risks of primary skin cancers can be implemented to manage long-term health^[5]. Preventing recurrence starts with protecting your skin. Wearing sunscreen daily, avoiding tanning beds, and covering exposed areas during peak sun hours can reduce risk^[6].

UV protection is a must and can be procured with a broad-spectrum sunscreen. Approximately two tablespoons of product are necessary to achieve adequate coverage^[5]. Personalized care plans help patients stay proactive about their skin health^[6].

Patients are encouraged to understand skin cancer and how to protect themselves through regular education and support from their healthcare providers^[5]. Greater availability and improved access to diagnostics contribute towards health systems strengthening^[5].