Overview

Squamous cell carcinoma (SCC) is the second most common skin cancer, arising from squamous cells in the outer skin layer. Unlike BCC, SCC has a higher risk of spreading to lymph nodes and other organs if not treated early. In Kuwait, closely linked to high UV exposure and commonly occurs on sun-exposed areas: scalp, face, ears, lips, and hands.

Symptoms

• Firm red nodule on sun-exposed skin; flat lesion with scaly or crusted surface
• New sore or raised area on an old scar; rough scaly patch on the lip
• Any rapidly growing, non-healing, or bleeding lesion must be seen urgently

Causes & Risk Factors

• Cumulative UV radiation damage; actinic keratosis — most common SCC precursor
• HPV infection; immunosuppression (organ transplant recipients at very high risk)
• Chronic scarring conditions; radiation therapy history

Complications

• Metastasis to lymph nodes (2-5% of cases; higher in immunosuppressed patients)
• Local tissue destruction; high risk of developing a second skin cancer

Diagnosis

Skin biopsy to confirm diagnosis and determine tumour grade and depth. Dermoscopy. CT/PET imaging if metastasis is suspected.

Treatment

• Surgical excision with clear margins; Mohs surgery for high-risk SCCs (face, ears, lips)
• Radiation therapy for inoperable cases
• Cemiplimab (Libtayo) and pembrolizumab: PD-1 immunotherapies approved for advanced/metastatic SCC
• Treat actinic keratoses early: 5-FU cream, imiquimod, cryotherapy, photodynamic therapy

Prevention

• Daily SPF 50+ sunscreen; avoid 10am-4pm sun; wear protective clothing in Kuwait
• Regular dermatology skin checks; treat actinic keratoses promptly
• HPV vaccination protects against HPV-related SCC

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