Squamous Cell Cancer is considered a “worse” cancer than Basal Cell Cancer as it has a higher rate of metastasis, however those Squamous Cell Cancers detected at an early stage and size rarely metastasize and behave very similar to the more indolent Basal Cell Cancer. The anatomic location of a Squamous Cell Cancer effects the likelihood of metastasis. Squamous Cell Cancers arising from scars have highest rate of metastasis at 38%. The rate of metastasis from the lip is 14% and those arising from the ear is 9%. Squamous Cell Cancers larger than 2cm and deeper than 4mm are also at increased risk of metastasis. The histological pattern also impacts the aggressiveness of Squamous Cell Cancers as those that are poorly differentiated or desmoplastic have very high rates of metastasis as well as the finding of perineural invasion. Typically, adjuvant radiation is recommended after surgical excision for clear surgical margins in patients with these histological findings. In patients who develop Squamous Cell Cancers from non UV causes such as burns, HPV, and tobacco there is also an increased risk for metastasis. Additionally, immunosuppressed patients who develop Squamous Cell Cancers are also predisposed to metastasis. The lymph nodes are usually the first site of metastasis. As many factors can lead to Squamous Cell Cancer metastasis, I encourage and recommend all of my patients in my The Woodlands dermatology and Conroe dermatology practices with a history of Squamous Cell Cancer to follow up routinely every 3 to 6 months for a skin exam.
