The end stage of squamous cell carcinoma (SCC) is Stage 4, meaning the cancer has become advanced or metastatic, spreading from the skin to distant organs like the lungs, liver, or brain, or invading deeply into local structures and large lymph nodes, often requiring systemic therapies like chemotherapy, immunotherapy, or targeted drugs for management, though it may not always be curable, focusing on quality of life.
For a patient with stage IV cancer, age must also be considered to prognose survival. For a patient who is 67 years or older, the expected median survival is a little more than 1 year. If this patient were younger than 67 years, then the expected median survival would be about 2 years.
SCC can metastasize through connective tissues, lymph nodes, or bloodstream, leading to the potential for local, regional, and distant metastasis. Research indicates that metastatic SCC accounts for more skin cancer-related deaths each year than melanoma.
Metastatic squamous neck cancer with occult primary is a disease in which squamous cell cancer spreads to lymph nodes in the neck and it is not known where the cancer first formed in the body. Signs and symptoms of metastatic squamous neck cancer with occult primary include a lump or pain in the neck or throat.
Squamous cell cancers can metastasize to nearby lymph nodes or other organs, and can invade both small and large nerves and local structures. Biopsy can help determine if the squamous cell cancer is a low-risk tumor or a high-risk tumor that requires more aggressive treatment.
The incidence of squamous cell carcinoma on the scalp is on the rise, but the intracranial extension is rare. Cranial invasion is rare in SCC of the scalp, but when present, it is associated with a poor prognosis.
Mohs surgery is a specialized technique often used to treat skin cancers on the scalp. This precise procedure involves meticulously removing cancerous tissue layer-by-layer and examining each layer under a microscope until no cancer cells remain.
Signs and symptoms of squamous cell skin cancer
They can also develop in scars or skin sores elsewhere. These cancers can appear as: Rough or scaly red (or darker) patches, which might crust or bleed. Raised growths or lumps, sometimes with a lower area in the center.
Treatment overview
In July 2021, the FDA expanded this approval to include SCC that is locally advanced and not curable by radiation or surgery. In 2024, the FDA approved cosibelimab-ipdl (UnloxcytTM) for adults with locally advanced or metastatic squamous cell carcinoma that is not curable with surgery or radiation.
Squamous cell carcinomas appear as red scaly patches, scaly bumps, or open sores. Left alone, they become larger and destroy tissue on the skin. They can also spread to other areas of the body.
Learn more about the symptoms of squamous cell carcinoma and what you can do to keep yourself safe. Fatigue, usually described as feeling tired, weak or exhausted, affects most people during cancer treatment.
Squamous cell carcinoma is a common type of skin cancer. Squamous cell carcinoma of the skin is usually not life-threatening. But if it's not treated, squamous cell carcinoma of the skin can grow large or spread to other parts of the body. The growth of the cancer can cause serious complications.
At Stage 4, which is the most advanced stage, squamous cell carcinoma has spread to at least one distant organ (for example, the brain, the lungs or another area of the skin).
Stage 4: End-of-life care begins
Stage 4 is when end-of-life care begins. The focus shifts to making you as comfortable as possible in the final phase of life, while also offering emotional and spiritual support for you and your loved ones.
Metastasis of cutaneous squamous cell carcinoma (cSCC) is rare. However, certain tumor and patient characteristics increase the risk of metastasis. Prior studies have demonstrated metastasis rates of 3-9%, occurring, on average, one to two years after initial diagnosis [6].
Mohs Surgery
Mohs micrographic surgery is considered the gold standard for SCC treatment. This is especially the case for lesions on cosmetically sensitive areas like the face, neck, and hands. It involves removing the cancer layer by layer while examining each layer under a microscope.
While you can't prevent all types of squamous cell carcinoma, you can take steps to reduce your risk by: Avoiding excessive sun exposure. Avoid using tanning beds. Using sunscreen when you're outdoors.
A high-risk SCC is considered when the diameter of the tumor is larger than 2 cm as tumors of this size double the risk of SCC recurrence and triple the rate of metastasis compared to the smaller lesion. Therefore, a larger margin for excision is required on the high-risk SCC.
Many doctors will order a PET or CT scan once a squamous cell carcinoma diagnosis has been reached to ensure the cancer has not spread to other parts of the body and is contained within the layers of the skin. Your doctor may also test your lymph nodes near the tumor site.
Treatment should happen as soon as possible after diagnosis, since more advanced SCCs of the skin are more difficult to treat and can become dangerous, spreading to local lymph nodes, distant tissues and organs.
They can differ greatly in their appearance, but most usually appear as a scaly or crusty area of skin or a lump, with a red, inflamed base. Squamous cell carcinomas are often tender, but most small SCCs are not usually painful.
Chemotherapy. Chemotherapy uses strong medicines to kill cancer cells. If squamous cell carcinoma spreads to the lymph nodes or other parts of the body, chemotherapy can be used alone or with other treatments, such as targeted therapy and radiation therapy.
Skin cancer can return even after complete removal and reconstruction. Basal and squamous cell carcinoma have recurrence risks, especially in high-risk areas. Clear margins reduce risk but don't guarantee recurrence won't happen. Regular follow-ups and early detection are key to long-term outcomes.
Location on the Body
Squamous cell carcinomas that develop on high-risk areas of the body tend to behave more aggressively. These areas include the ears, lips, nose, scalp, fingers, and genitals, as well as sites where the skin is already damaged by chronic inflammation, burns, or scars.