Squamous Cell Carcinoma of the Skin: When a Wound Won’t Heal
When 68-year-old Robert noticed a crusty spot on his ear that kept bleeding and scabbing over, he dismissed it as a stubborn irritation from his reading glasses. After six months of the sore refusing to heal, his wife finally insisted he see a dermatologist. Biopsy revealed squamous cell carcinoma—the second most common skin cancer. “The doctor said if I’d waited much longer, it could have spread to my lymph nodes,” Robert recalled. “I had no idea a little sore could be cancer.”
Squamous cell carcinoma (SCC) or cutaneous squamous cell carcinoma (CSCC) is the second most common form of skin cancer after basal cell carcinoma. It starts in squamous cells in the outer layer of your skin, the epidermis. Over 1 million people receive a squamous cell carcinoma diagnosis in the U.S. each year. The rate of SCC has risen about 200% over the past 30 years Cleveland Clinic. This dramatic increase reflects cumulative sun exposure in aging populations and heightened awareness leading to more diagnoses.
The Hallmark Sign: A Sore That Won’t Heal
Symptoms of squamous cell carcinoma include skin changes like: A rough-feeling, bump or growth, which might crust over like a scab and bleed. A growth that’s higher than the skin around it but sinks down (depression) in the middle. A wound or sore that won’t heal, or a sore that heals and then comes back. An area of skin that’s flat, scaly and red that’s larger, about 1 inch (2.5 centimeters) Cleveland Clinic.
The non-healing wound represents SCC’s most characteristic presentation. Unlike ordinary scrapes or cuts that heal within a week or two, squamous cell carcinomas persist for weeks or months. They may bleed easily, form crusty scabs, then break open again in a frustrating cycle. The spot might feel tender or painful, or it might cause no discomfort at all—making it easy to ignore.
SCC typically appears on sun-exposed areas: face, ears, neck, lips, backs of hands, forearms, and bald scalps. However, it can develop anywhere, including inside the mouth, on genitals, or even on the soles of feet in people with darker skin tones. Males are about two times more likely to develop squamous cell carcinoma. People over the age of 50 are most likely to get SCCs, but the incidence has been rising in people younger than 50 Cleveland Clinic.
When And Why It Spreads
Most squamous cell carcinomas remain localized and highly treatable. Overall, squamous cell carcinoma of the skin spreads, or metastasizes, only 5% of the time. Larger tumors, though, have a higher risk of metastasis. Tumors around the head and neck, including the ears, eyelid and lips, are also more likely to spread MD Anderson Cancer Center.
Cutaneous squamous cell carcinoma (cSCC) is the second most common nonmelanoma skin cancer, accounting for 20% of all skin cancers. Although cSCC is one of the most common skin cancers, reported having 1 million cases per year in the United States, there is inconsistency with its reported metastatic rate. Research exploring cSCC metastasis found an overall rate of 1.2-5% but this range varies PubMed.
High-risk features that increase metastasis likelihood include: tumor depth greater than 2mm, diameter exceeding 2cm, poorly differentiated cells under the microscope, perineural invasion (cancer growing along nerves), location on ears or lips, arising from chronic wounds or scars, and occurring in immunosuppressed patients. Organ transplant recipients—who take immunosuppressive medications to prevent rejection—face dramatically elevated risk. Some studies show they develop SCC 65-100 times more frequently than the general population, with higher rates of aggressive behavior.
Metastatic squamous cell carcinoma is often referred to as a neck cancer because it tends to travel to the lymph nodes in the neck and around the collarbone. Because of this, signs of metastasis may include a painful or tender lump in the neck or a sore throat that doesn’t improve or go away Moffitt.
Prognosis: Stage Matters Enormously
Once squamous cell carcinoma has spread beyond the skin, the five-year survival rate drops to less than 50 percent. Fortunately, it’s fairly rare for squamous cell carcinoma to metastasize. Plus, when metastasis does occur, the malignancy generally spreads slowly, with the majority of cases being diagnosed before the cancer has spread past the skin’s upper layer (epidermis) Moffitt.
Squamous cell carcinoma is most curable in the early stages before it spreads. If it’s diagnosed early, the five-year survival rate is approximately 99%. Stage 0 cancer is only present on the epidermis. Stage 1 cancer has grown deep into the skin but has not spread to nearby lymph nodes or healthy tissues. Stage 2 cancer displays one or more high-risk features but has not spread to nearby lymph nodes Aurora Health Care.
The dramatic survival difference between localized (99%) and metastatic (under 50%) disease underscores why early detection matters so profoundly. A small sore caught and removed promptly almost never causes problems. That same cancer ignored for months or years can become life-threatening.
Treatment: Usually Straightforward
Most squamous cell carcinomas are treated with simple surgical excision—cutting out the cancer with a margin of surrounding normal skin. Cure rates exceed 90-95% when performed appropriately. The procedure typically occurs in a dermatologist’s office under local anesthesia, with stitches removed a week later.
For high-risk SCCs or those in cosmetically sensitive areas, Mohs micrographic surgery offers superior outcomes. The surgeon removes cancer layer-by-layer, examining each immediately under the microscope until clear margins are achieved. This tissue-sparing approach maximizes cure rates (up to 99%) while minimizing scarring.
Other options include electrodesiccation and curettage (scraping and burning), cryotherapy (freezing for very small superficial lesions), radiation therapy (for patients who cannot undergo surgery), and topical chemotherapy creams for certain superficial cases.
Treatment for metastatic cSCC is similar to primary lesions and includes surgery, radiotherapy, and chemotherapy. Patients undergoing combined therapy had lower rates of recurrence (20% vs. 43%) and a higher five-year disease-free survival rate (73% vs. 54%) than surgery alone. Furthermore, targeted therapies, including EGFR inhibitors, PD-1 inhibitors (cemiplimab), and p53 inhibitors, are and continue to emerge as novel and effective therapies PubMed Central.
For advanced or metastatic disease, immunotherapy with cemiplimab (a PD-1 inhibitor) has revolutionized treatment, offering hope for patients previously facing limited options. According to the American Cancer Society, each year about 2,000 people in the U.S. die of squamous cell carcinoma of the skin and basal cell carcinoma (the most common skin cancer) combined, making the disease very treatable and curable MD Anderson Cancer Center.
The message: that persistent sore deserves medical attention. What seems like a minor irritation could be squamous cell carcinoma—highly curable when caught early, potentially serious if ignored.
References
- Cleveland Clinic. Squamous Cell Carcinoma: What it is, Causes & Treatment. https://my.clevelandclinic.org/health/diseases/17480-squamous-cell-carcinoma
- PMC. Metastatic Squamous Cell Carcinoma: A Cautionary Tale. https://pmc.ncbi.nlm.nih.gov/articles/PMC7652363/
- MD Anderson. Squamous Cell Carcinoma of the Skin. https://www.mdanderson.org/cancer-types/skin-cancer/squamous-cell-carcinoma-of-the-skin.html
- PubMed. The risk of metastases from squamous cell carcinoma of the skin. https://pubmed.ncbi.nlm.nih.gov/35324009/
- Moffitt Cancer Center. Squamous Cell Carcinoma Survival Rate. https://www.moffitt.org/cancers/squamous-cell-carcinoma/survival-rate/
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