Understanding Skin Cancer- Squamous Cell Carcinoma

Squamous Cell Carcinoma (SCC) is the second most common type of skin cancer, but is rarely discussed. Unlike the characteristics of melanomas SCCs usually show up as red or dome-shaped bumps that are scaly and rough sometimes resembling warts. They may also bleed easily when scraped.


These skin legions tend to manifest on areas of cumulative exposure to UV rays (lips, ears, feet and backs of hands). As with all skin cancers exposure to the sun is the number one cause, especially tanning beds or history of severe burns. 

While Squamous Cell Carcinoma is highly treatable when caught early it can spread to the bones, tissue and lymph-nodes if left untreated. In most cases excision or MOHs surgery will be used to successfully remove all the cancerous tissue.

If you notice any new lesions, changes in existing areas or spots of concern take action and make an appointment to see one of our expert medical doctors at Germain Dermatology. 

Skin Cancer & Mohs Surgery

We’ve talked a lot about the truth of skin cancer, the importance of protecting yourself from the sun and prevention tactics this month but what about treatment? The fact is that 1-in-5 Americans will suffer from skin cancer during their lifetime. 

While understanding ways to be proactive in the fight is very important, being knowledgeable in ways to treat skin cancer is also important.  Being aware of your options and choices is integral to battling any type of cancer.

With that being said we are lucky to have two highly skilled mohs surgeons on our Germain team– Dr. Germain and Dr. McGowan. Mohs Surgery is the most effective treatment option for skin cancers with a 99% cure rate! This surgery is a tissue-sparing technique, done layer by layer, examining 100 percent of the tumor margin in order to trace out the cancer using a microscope.  

“The benefits of Mohs surgery are twofold: One, you’re going to remove just the cells you need to without having to take a lot of unnecessary tissue, and two, Mohs surgery can tout cure rates of 99 percent,” says Dendy Engelman, MD, a dermatologist and Mohs surgeon in New York City and the director of dermatologic surgery at New York Medical College.

By using this technique surgeons can check each layer for roots. Once the roots are no longer visible doctors can be sure the tumor is entirely removed. Mohs surgery is most often used to treat basal and squamous cell cancers, but in certain cases is also effective for the treatment of Melanoma (like in Hayley’s case discussed earlier this month). 

You’ll notice in the before and afters provided by Dr. McGowan that scarring is very minimal, an important factor since a large percentage of skin cancers are found on the face, ears and scalp. 




Dr. McGowan IV is a board certified dermatologist specializing in Mohs Micrographic and Dermatologic Surgery. He obtained his fellowship in Mohs Microhraphic Skin Cancer Surgery at the Dayton Skin Surgery Center in Dayton, Ohio. He has written countless articles on the technique, advancements and importance of Mohs Surgery.

What is a Mohs Surgeon?

We loved this article from EverydayHealth.com. Having an annual checkup and a spot or two removed is definitely less scary than battling skin cancer. If you are seeking treatment for skin cancer or need guidance with an irregular mole visit Dr. Germain, certified Mohs surgeon, for the best care in Charleston.

5 Reasons Why Skin Cancer Surgery Isn’t So Scary
•By Christina Heiser

Get the inside scoop on Mohs surgery, the most popular treatment option for basal and squamous cell carcinomas.

Wear a wide-brimmed hat to minimize your sun exposure.
Veva Vesper has dealt with more than her fair share of skin cancer in the last 25 years. The 69-year-old Ohio resident has had more than 500 squamous cell carcinomas removed since the late 1980s, when the immunosuppressant medication she was taking for a kidney transplant caused her to develop them all over her body — everywhere from the corner of her eye to her legs.

While Vesper’s story is unusual, skin cancer is the most common cancer in the United States. In fact, it’s currently estimated that one in five Americans will get skin cancer in his or her lifetime.
Mike Davis, a 65-year-old retired cop, and like Vesper, a patient at The Skin Cancer Center in Cincinnati, Ohio, has a more familiar story. Earlier this year, he had a basal cell carcinoma removed from his left ear — the side of his face most exposed to UV damage when driving on patrol.
The buildup of sun exposure over your lifetime puts you at greater risk for developing basal and squamous cell skin carcinomas as you age. Both Vesper and Davis had Mohs surgery, the most effective and precise way to remove the two most common types of skin cancer.

“The benefits of Mohs surgery are twofold: One, you’re going to remove just the cells you need to without having to take a lot of unnecessary tissue, and two, Mohs surgery can tout cure rates of 99 percent,” says Dendy Engelman, MD, a dermatologist and Mohs surgeon in New York City and the director of dermatologic surgery at New York Medical College.

We asked top experts to answer the most common questions about Mohs surgery.

1. What exactly is it? 
Mohs surgery is named after Frederic Mohs, a professor of surgery at the University of Wisconsin, who developed the treatment in the 1930s. “It’s a very tissue-sparing technique, where we go layer by layer, examining 100 percent of the margin in order to trace out the cancer using a microscope,” says Engelman.

You’ll be awake for the procedure, which is done under local anesthesia. The surgeon starts by cutting out a small piece of the tumor with a scalpel. A lab technician then freezes and stains the tissues for the surgeon to look at under a microscope. “Cancer grows like roots of a tree,” explains Brett Coldiron, MD, the founder of The Skin Cancer Center in Cincinnati and an assistant clinical professor at the University of Cincinnati. “What we do [during Mohs surgery] is cut out a disc of skin and check for roots poking through. It’s very obvious under the microscope.”

“Mohs surgery can tout cure rates of 99 percent.”Dendy Engelman, MD, dermatologist and Mohs surgeon. If a root is visible, the surgeon will go back and remove another layer of the tumor, repeating the same process until the entire cancer is gone.  “Very rarely do we go past three passes,” says Coldiron.

2. Who should get it?
“Moh’s surgery is very useful around the eyes, nose, mouth, and ears,” says Coldiron. “It’s also useful around the cheek if it’s a larger tumor.” Additionally, Mohs surgery can be performed on the hands, feet, and neck — areas where you’d want to preserve as much tissue as possible, says Engelman.
While Mohs surgery is generally used on basal and squamous cell cancers, in some cases it can be used to treat melanoma, especially if the cancer is thin or confined to the outer layer of skin. “Patients should ask their Mohs surgeon if this a procedure they offer, as not all Mohs specialists treat melanoma with Mohs,” says Engelman.

3. How long does it take?
Expect to be at the doctor’s office for approximately one to three hours. After your surgeon removes the first layer of tissue, which takes about 10 minutes, you’ll be sent to the waiting room for about a half hour while the surgeon examines the tumor.  Then, you’ll be brought back to the exam room to either get stitched up, which takes another 20 minutes, or have another piece of the tumor removed.

4. Will it hurt? 
No more than a biopsy, says Engelman. The area is numbed with enough lidocaine, a local anesthetic that reduces pain, to last for about two and a half to three hours. “The discomfort is minimal — there’s just that initial stick [of the needle],” says Engelman. “You may feel a little bit of pressure [during the procedure], but you don’t feel pain.”

Afterwards, most patients only experience minimal pain. “Certain areas like the scalp, legs, or areas under tension (like skin over joints) may be more sensitive and may require prescription strength pain medication for one to three days post-surgery, but the vast majority of surgeries do not require prescription analgesics,” says Engelman.

5. Will there be a scar?
Yes — but it’ll become less noticeable over time. “It may take six months for the redness to fade and for the scar to settle down, but six months down the road, most patients are happy with the final result,” says Coldiron.

To ensure the wound heals nicely, follow the post-operative care instructions given to you by your doctor, says Engelman. “Moist wounds have been found in studies to heal faster than those left exposed to air,” she says. “The scar formed tends to have a better aesthetic appearance when kept moist and covered with a bandage.”

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