Squamous Cell Carcinoma Treatment

Squamous cell carcinoma (SCC) may be treated by a variety of means, depending upon its size, location, and type. For those patients needing to avoid surgery, radiation therapy is an option. Because this treatment is protracted ( carried out over a period of weeks), and does not produce cure quite as often as does surgery, most patient choose some form of excision. Because SCC has some potential to spread ("metastasize") if neglected, adequate excision is even more important than in the case of basal cell carcinoma.
Surgical excision involves the removal of a wedge of skin and fat with a surrounding border of normal tissue. The tissue removed ( called the "specimen") can then be examined microscopically to see if the tumor has been completely removed. When all the edges of the resection are microscopically normal, the treatment is presumed to be adequate. Standard surgical excision is best used when the edges of the tumor are fairly easy to see, making total excision likely in one try. Some surgeons will employ a rapid pathological examination known as "frozen section" to examine the tissues while the patient is still in the operating room. Although this may be helpful in cases where complex reconstruction will be needed immediately, it probably adds little in cases where the surgical defect can be approximated with sutures. The reason for this is that frozen sections are relatively inaccurate and may be contradicted by the "permanent section" pathology results which become available days later. Happily, when pathological examination of the tissue shows a "positive margin" indicating the need for further tissue removal, the patient's cure has not been compromised. If a prompt second procedure succeeds in removing the remaining tumor, cure rates are as high as in those cases where complete removal was accomplished in one try.

For tumors with indistinct edges located in cosmetically sensitive areas ( e.g. the nose or corner of the eye), a technique known as Moh's surgery may be best. Moh's surgery (also called "micrographic" surgery) is practiced by a dermatologist or plastic surgeon who has studied the appropriate excision techniques as well as dermatopathology. These doctors will remove tumors in "slices," examining each immediately under the microscope to learn where more tumor needs to be resected. This piece-meal technique will often allow complete tumor removal while minimizing the sacrifice of normal, surrounding tissues. The disadvantages of the technique include its expense and the frequent need of a secondary reconstructive procedure when the physician performing the excision is not trained in complex reconstruction.


2/21/00

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