Squamous Cell Carcinoma in Older Adults: Understanding, Symptoms, and Management

Squamous cell carcinoma (SCC) is a common type of skin cancer that arises from the squamous cells, which are the flat cells located in the outer layer of the skin (epidermis). Although SCC can occur in younger individuals, it is particularly prevalent among older adults. This article provides an overview of SCC, its causes, symptoms, diagnostic methods, and treatment options, with a focus on older adults.

What is Squamous Cell Carcinoma?

Squamous cell carcinoma originates from the squamous cells in the skin’s outer layer. It can also develop in other parts of the body where squamous cells are present, such as the mouth, throat, and lungs. SCC typically arises on sun-exposed areas of the skin, including the face, ears, neck, and hands. It is generally less aggressive than melanoma but can cause significant problems if left untreated.

Causes and Risk Factors

The primary cause of squamous cell carcinoma is prolonged exposure to ultraviolet (UV) radiation from the sun or artificial sources such as tanning beds. Other risk factors include:

1. Sun Exposure: Chronic sun exposure is a major risk factor for SCC. Repeated sunburns and long-term sun exposure increase the likelihood of developing SCC.

2. Age: The incidence of SCC increases with age, particularly in individuals over 60, due to cumulative UV exposure over a lifetime.

3. Skin Type: Individuals with fair skin, light hair, and light-colored eyes are at higher risk due to lower levels of melanin, which provides some protection against UV radiation.

4. Previous Skin Cancer: A history of skin cancer or precancerous skin lesions increases the risk of developing SCC.

5. Immunosuppression: People with weakened immune systems, such as those undergoing immunosuppressive therapy or with certain medical conditions, have a higher risk of SCC.

6. Chronic Skin Conditions: Conditions such as actinic keratosis (precancerous skin lesions caused by sun damage) and chronic wounds or scars can increase the risk of SCC.

7. Exposure to Carcinogens: Long-term exposure to carcinogenic substances, such as arsenic, coal tar, or certain chemicals, can increase the risk of SCC.

Symptoms of Squamous Cell Carcinoma

The symptoms of squamous cell carcinoma can vary based on the tumor's location and stage. Common signs and symptoms include:

1. Persistent Sores: Sores or wounds that do not heal or frequently recur. These lesions may bleed, ooze, or form a crust.

2. Red, Scaly Patches: Flat, red patches or plaques with a scaly or rough texture. These patches may be tender or itchy.

3. Elevated Growths: Raised, firm growths that may appear wart-like or ulcerated in the center. These growths can be sensitive or painful.

4. Ulceration: Deep, open sores with a raised, hardened border. The ulcer may be surrounded by inflamed or discolored skin.

5. Bleeding or Discharge: Lesions that bleed easily or produce a discharge, which may be an indication of an advanced or aggressive SCC.

Diagnosis of Squamous Cell Carcinoma

Diagnosis of SCC involves a comprehensive evaluation by a healthcare provider:

1. Medical History: Review of the patient’s medical history, including any history of sun exposure, skin cancer, and family history of skin conditions.

2. Physical Examination: A thorough examination of the skin to identify suspicious lesions or abnormalities.

3. Skin Biopsy: A definitive diagnosis is made through a skin biopsy, where a sample of the suspicious lesion is removed and examined under a microscope to determine if cancerous cells are present.

4. Imaging Studies: For advanced or suspected metastatic SCC, imaging studies such as CT scans or MRIs may be used to assess the extent of the disease and identify any spread to other areas.

Treatment and Management of Squamous Cell Carcinoma

Treatment for squamous cell carcinoma aims to remove the cancerous cells and prevent recurrence while preserving as much healthy tissue as possible. Treatment options include:

1. Surgical Treatments:
- Excisional Surgery: Removal of the cancerous tissue along with a margin of healthy skin. This is the most common treatment for SCC.
- Mohs Micrographic Surgery: A specialized technique where cancerous tissue is removed layer by layer and examined microscopically to ensure complete removal. This method is often used for SCCs in cosmetically sensitive areas.

2. Non-Surgical Treatments:
- Cryotherapy: Freezing the cancerous cells with liquid nitrogen to destroy them. This method is typically used for superficial SCCs.
- Topical Chemotherapy: Application of chemotherapy creams or ointments directly to the affected area. This approach is used for superficial or low-risk SCCs.
- Photodynamic Therapy: Combining a light-sensitive medication with a specific type of light to destroy cancer cells. This treatment is generally used for superficial SCCs.

3. Radiation Therapy:
- External Beam Radiation: Used for patients who cannot undergo surgery or for cancers in areas difficult to treat surgically. Radiation therapy targets cancer cells with high-energy beams and is often used for non-surgical candidates or those with recurrent SCC.

4. Targeted Therapy:
- EGFR Inhibitors: Medications that target specific molecules involved in the growth of SCC cells. These are used for advanced or metastatic SCCs.

Prevention and Monitoring

Preventing squamous cell carcinoma involves reducing sun exposure and protecting the skin:

1. Sun Protection:
- Use Sunscreen: Apply broad-spectrum sunscreen with a high SPF regularly, particularly before outdoor activities.
- Wear Protective Clothing: Use hats, sunglasses, and long-sleeved clothing to shield the skin from UV radiation.
- Seek Shade: Avoid direct sunlight, especially during peak hours between 10 a.m. and 4 p.m.

2. Regular Skin Examinations:
- Self-Exams: Perform regular skin self-exams to detect any new or changing lesions and consult a healthcare provider if any abnormalities are noted.
- Professional Skin Exams: Schedule regular skin check-ups with a dermatologist to monitor for potential skin cancers and ensure early detection and treatment.

Challenges in Managing Squamous Cell Carcinoma

Managing squamous cell carcinoma in older adults may present several challenges:

- Aging Skin: Changes in skin elasticity and healing capacity with age can affect treatment outcomes and recovery.
- Multiple Lesions: Older adults may have multiple SCCs due to cumulative sun exposure, requiring ongoing monitoring and treatment.
- Comorbidities: The presence of other health conditions may complicate treatment options and decision-making.
- Adherence to Preventive Measures: Ensuring consistent use of sun protection and follow-up care can be challenging for some individuals.

Squamous cell carcinoma is a common skin cancer that primarily affects older adults and can lead to significant health issues if not managed appropriately. Understanding the symptoms, causes, and available treatment options is essential for effective management and prevention. By implementing sun protection measures, monitoring for suspicious skin changes, and seeking timely medical care, individuals can reduce their risk of SCC and ensure early detection and treatment. Through proactive management and regular dermatological care, older adults can maintain their skin health and overall well-being.