Squamous cell carcinoma is a type of skin cancer that develops when cells in the outer layer of the skin grow out of control, usually after years of sun exposure. While most cases can be successfully treated when caught early, understanding your treatment options—from established surgical methods to innovative therapies being tested in clinical trials—can help you make informed decisions about your care.

When Skin Cancer Needs Treatment: Understanding Your Options

When someone receives a squamous cell carcinoma diagnosis, the primary goal of treatment is to completely remove the cancer and prevent it from spreading to other parts of the body. The treatment approach depends heavily on several factors, including the size and location of the tumor, how deeply it has grown into the skin, whether it has spread to lymph nodes or other areas, and the patient’s overall health condition.^[1][2]

Most squamous cell carcinomas are highly treatable, especially when detected early. The cancer typically appears on sun-exposed areas such as the face, ears, scalp, hands, and arms, making early detection more feasible through regular skin checks.^[3] Treatment planning also considers whether the cancer is classified as low-risk or high-risk, which affects the choice of therapy and the intensity of follow-up care needed afterward.^[4]

Medical societies and dermatology organizations have established clinical guidelines that help doctors determine the most appropriate treatment for each patient. These guidelines are based on years of research and clinical experience, ensuring that patients receive care that has been proven effective.^[5] Beyond standard treatments that have been used successfully for many years, researchers continue to develop and test new therapies in clinical trials, offering hope for patients with more advanced or difficult-to-treat cases.

Standard Treatment Approaches for Squamous Cell Carcinoma

Surgery remains the cornerstone of treatment for squamous cell carcinoma. The goal is to remove all cancer cells while preserving as much healthy tissue as possible. Several surgical techniques are available, and the choice depends on the tumor’s characteristics and location.^[7]

Surgical excision is one of the most common treatments. During this procedure, the surgeon removes the entire tumor along with a margin of surrounding normal tissue to ensure no cancer cells are left behind. The removed tissue is then examined under a microscope in a laboratory. If cancer cells are found at the edges of the removed tissue, additional surgery may be necessary.^[8] This method is particularly effective for small, early-stage squamous cell carcinomas that have not spread beyond the skin’s surface.

Mohs surgery, also called Mohs micrographic surgery, is considered the gold standard for treating squamous cell carcinoma, especially when the cancer is located on cosmetically sensitive areas like the face, neck, hands, or genitals. This specialized technique removes the cancer layer by layer. After each layer is removed, the surgeon immediately examines it under a microscope to check for cancer cells. This process continues until no cancer cells remain.^[6][8] Mohs surgery has the highest cure rates—often exceeding 95% for primary tumors—and spares as much healthy tissue as possible, minimizing scarring. However, it requires specialized training and typically takes longer than standard surgical excision.

Curettage and electrodesiccation is a procedure where the doctor scrapes off the cancer using a sharp, spoon-shaped tool called a curette, then uses an electric needle to destroy any remaining cancer cells. This treatment is often used for small, superficial squamous cell carcinomas with low risk of spreading, including a form called squamous cell carcinoma in situ (where the cancer is only in the top layer of skin).^[7][9] While this method is quick and relatively simple, it may have higher recurrence rates compared to surgical excision or Mohs surgery, particularly for larger or deeper cancers.

Cryosurgery uses extreme cold, typically liquid nitrogen, to freeze and destroy cancer cells. This treatment is often reserved for small tumors on the surface of the skin with clear, smooth borders. It may also be used when other types of surgery cannot be performed due to the patient’s health condition or age.^[7][8] Cryosurgery is performed in the doctor’s office without requiring anesthesia, but it may not be suitable for deeper or more aggressive cancers.

Radiation therapy uses high-energy rays or particles to destroy cancer cells. This treatment may be recommended for patients who cannot undergo surgery due to advanced age, medical conditions, or when the tumor is located in an area where surgery would significantly affect appearance or function.^[6][13] Radiation therapy can also be used after surgery if the cancer could not be completely removed, or to treat high-risk cancers that may have spread to lymph nodes. Treatment typically involves daily sessions over several weeks. While effective, radiation therapy may cause skin irritation, fatigue, and long-term changes to the treated area.

For very small, superficial skin cancers with low risk of spreading, less invasive options may be considered. Laser therapy uses an intense beam of light to destroy cancer cells with minimal damage to surrounding tissue. Topical medications—creams or gels applied directly to the skin—may also be used for certain cases of squamous cell carcinoma in situ.^[7][8] However, these non-surgical treatments generally have higher recurrence rates and require careful patient selection and close monitoring.

If squamous cell carcinoma has spread to lymph nodes, a lymph node dissection may be necessary. This surgical procedure removes the affected lymph nodes to prevent further spread of cancer. Imaging tests and physical examination help determine which lymph nodes need to be removed.^[13]

Innovative Therapies Being Tested in Clinical Trials

While standard treatments are effective for most patients, researchers are continuously working to develop new therapies for squamous cell carcinoma, particularly for advanced cases where the cancer has spread to other parts of the body or cannot be treated with surgery or radiation. Clinical trials test these new treatments to determine their safety and effectiveness before they become widely available.

Immunotherapy is one of the most promising areas of research for advanced squamous cell carcinoma. This type of treatment helps the body’s own immune system recognize and attack cancer cells. Unlike chemotherapy, which directly kills cancer cells, immunotherapy works by enhancing or restoring the immune system’s natural ability to fight cancer.^[11][13]

One type of immunotherapy being studied for squamous cell carcinoma involves drugs called checkpoint inhibitors. These medications block proteins that prevent immune cells from attacking cancer cells. When these checkpoint proteins are blocked, the immune system can more effectively identify and destroy cancer cells. Clinical trials have shown promising results for patients with advanced or metastatic squamous cell carcinoma who did not respond to standard treatments. However, like all treatments, immunotherapy can cause side effects, including fatigue, skin rash, inflammation of organs, and immune system overactivity.

Targeted therapy represents another innovative approach being explored in clinical trials. These treatments specifically target molecules or pathways that cancer cells need to grow and survive. Because targeted therapies focus on specific characteristics of cancer cells, they may cause fewer side effects than traditional chemotherapy, which affects both cancerous and healthy rapidly dividing cells.^[13] Researchers are studying various targeted therapy drugs that interfere with specific proteins or genes involved in the growth of squamous cell carcinoma.

Clinical trials for squamous cell carcinoma are conducted in phases. Phase I trials primarily test the safety of a new treatment and determine the appropriate dose. These early studies typically involve a small number of patients and focus on understanding how the body processes the medication and what side effects may occur. Phase II trials examine whether the treatment is effective against the cancer and continue to monitor safety in a larger group of patients. Phase III trials compare the new treatment with standard treatments to determine if it is more effective, equally effective with fewer side effects, or provides other advantages. Only after a treatment successfully completes all phases and receives regulatory approval does it become a standard treatment option.^[5]

Patients interested in participating in clinical trials should discuss this option with their healthcare team. Eligibility for trials depends on many factors, including the stage and characteristics of the cancer, previous treatments received, overall health, and specific requirements of each study. Clinical trials are conducted at major medical centers and cancer research institutions in the United States, Europe, and other regions around the world. While clinical trials offer access to cutting-edge treatments, participants must carefully consider the potential risks and benefits, including the possibility that the experimental treatment may not work or may cause unexpected side effects.

For patients with very advanced squamous cell carcinoma that has not responded to other treatments, systemic therapy—treatment that travels through the bloodstream to reach cancer cells throughout the body—may be necessary. This can include chemotherapy, immunotherapy, or targeted therapy. The choice depends on the specific characteristics of the cancer, the patient’s overall health, and whether the cancer has certain molecular markers that make it more likely to respond to particular treatments.^[13]

Most common treatment methods

• Surgical treatments
  • Surgical excision removes the tumor with a margin of healthy tissue and is commonly used for most squamous cell carcinomas
  • Mohs surgery removes cancer layer by layer with microscopic examination, offering the highest cure rates and tissue preservation
  • Curettage and electrodesiccation scrapes away cancer and uses electrical current to destroy remaining cells, suitable for small, superficial cancers
  • Cryosurgery freezes and destroys cancer cells using liquid nitrogen, often used for small surface tumors
  • Lymph node dissection removes affected lymph nodes when cancer has spread beyond the skin
• Radiation therapy
  • Uses high-energy rays to destroy cancer cells when surgery is not possible or as additional treatment after surgery
  • Typically delivered in daily sessions over several weeks
  • Can treat cancers in areas where surgery would affect appearance or function
• Less invasive options
  • Laser therapy uses concentrated light beams to destroy small, superficial cancers
  • Topical medications (creams or gels) may be applied directly to very early, superficial cancers
  • These options generally have higher recurrence rates and require careful patient selection
• Immunotherapy
  • Helps the immune system recognize and attack cancer cells
  • Checkpoint inhibitors block proteins that prevent immune cells from fighting cancer
  • Used primarily for advanced or metastatic squamous cell carcinoma in clinical trials
• Targeted therapy
  • Focuses on specific molecules or pathways that cancer cells need to survive
  • Being studied in clinical trials for advanced squamous cell carcinoma
  • May cause fewer side effects than traditional treatments