Squamous Cell Carcinoma (SCC) ICD-10: C44.9

Skin cancer

Often searched as: skin sore that won't heal, scaly patch on face that bleeds, crusty spot on skin, non healing wound on skin, rough red patch on ear or face, skin cancer on sun damaged skin, wart like growth that grows fast, scab that keeps coming back…

Clinical urgency level

lowmediumhigh

Systems Affected

skinlymph nodes (in metastatic disease)internal organs (in advanced metastatic disease)

Severity Levels

mild

Well-differentiated, small (<2cm), localized SCC on low-risk site — excellent prognosis with surgical excision, >95% cure rate.

moderate

Larger lesion (>2cm), high-risk location (ear, lip, temple), or poorly defined borders — requires wider excision, possible Mohs surgery, and sentinel node consideration.

severe

Deeply invasive SCC, perineural invasion, lymph node involvement, or distant metastases — requires multidisciplinary oncologic care including surgery, radiation, and possibly immunotherapy (cemiplimab).

Red Flags

A scaly, crusted, or ulcerated spot that doesn't heal after 4–6 weeks
A sore that bleeds easily with minor contact
Rapid growth of a skin lesion over weeks to months
A wart-like growth on the lip, ear, or face that is firm and enlarging
Numbness, tingling, or pain in skin near a lesion (possible perineural invasion)
A swollen lymph node near a known or suspicious skin lesion

Clinical Presentation

Squamous cell carcinoma — ulcerated, crusted lesion on the ear

Source: Wikimedia Commons (CC BY-SA 3.0 )

SCC image gallery — DermNet NZ

View gallery on DermNet NZ (image gallery reference)

When to See a Doctor

See a dermatologist promptly for any non-healing skin sore, scaly or crusty patch, or growing bump — especially on sun-exposed areas like the face, ears, scalp, or hands. Early SCC is highly curable; delay significantly worsens prognosis. Immunosuppressed patients (transplant recipients, HIV) should have regular skin checks as SCC can be aggressive.

Differential Diagnosis

Actinic keratosis (precancerous — SCC in situ predecessor)
Basal cell carcinoma (pearlescent border, less likely to metastasize)
Keratoacanthoma (rapidly growing but often self-resolving — histologically similar)
Melanoma (pigmented lesions)
Merkel cell carcinoma (rare, aggressive neuroendocrine)
Chronic ulcer or wound
Verruca vulgaris (wart — viral)

Comorbidities

Actinic keratosis (direct precursor lesion)
Organ transplant immunosuppression (100x increased SCC risk)
HIV / AIDS
Xeroderma pigmentosum
Chronic skin inflammation (HS, burn scars — Marjolin's ulcer)
Albinism
Previous SCC or basal cell carcinoma

Prognosis

When caught early, SCC has a cure rate exceeding 95% with surgery. High-risk features — size >2cm, depth >4mm, perineural invasion, immunosuppression, or location on ear/lip — significantly worsen prognosis. Metastatic SCC occurs in 2–5% of cases but carries a 5-year survival of only ~30–50%. Immunotherapy (cemiplimab, pembrolizumab) has transformed treatment for advanced or metastatic SCC. Transplant recipients have the highest risk and require lifelong dermatologic surveillance.

Detailed Overview

Causes, Symptoms, and When to Take Action Squamous cell carcinoma (SCC) of the skin is a common skin cancer that arises from keratinocytes. It ranges from early, localized tumors to advanced, invasive disease. Early detection and proper management are essential. How It Looks Texture: May appear as a scaly or crusted patch, ulcer, or nodule; surface can be rough or firm Color: Red, flesh-colored, or brown; may also be pigmented in some cases Shape: Irregular borders, possible ulceration, or bleeding; may grow over time Location: Commonly on sun-exposed skin — face, ears, neck, arms, and hands Why Does It Appear? Ultraviolet (UV) exposure: Long-term sun damage is a major risk factor Skin type: Lighter skin, freckling, and history of sunburns increase risk Immune status: Weakened immune defenses can make disease more likely or severe Age: More common in older adults Other factors: Chronic wounds, inflammation, or previous skin damage may contribute Should You Be Concerned? Yes — while many cases are treated successfully when found early, SCC can cause local tissue damage, disfigurement, or, in more advanced cases, spread to other parts of the body. Professional evaluation is required in cases of suspected SCC, especially if: the lesion increases in size, changes colour or shape, the lesion bleeds or does NOT heal, pain, ulceration, or progressive symptoms are present. Can You Prevent It? Complete prevention isn't always possible, but risk can be reduced by: Protecting skin from UV exposure (e.g., minimizing direct sun, using shade) Avoiding repeated skin trauma Monitoring your skin regularly for new or changing lesions 👉 How Piel AI Can Help Piel AI allows you to track suspicious skin lesions over time with regular images. While it does not diagnose, it can help you notice changes that warrant medical evaluation. Summary Squamous Cell Carcinoma is a common skin cancer arising from durable skin cells. It often appears as a scaly, ulcerated, or crusted lesion on sun-exposed areas. Risk factors include UV exposure, light skin, age, immune suppression, and chronic skin damage. Early detection and protective measures are key.

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