Squamous cell carcinoma is the second most common skin cancer. It arises from the middle layers of the epidermis and occurs on all areas of the body, including the lips and nails. It is most frequently seen in areas that have been exposed to the sun such as the face, neck, scalp, hands, shoulders, arms and back. Squamous cell carcinomas vary in their behaviour, and the aggressive subtypes can metastasize with fatal outcomes. These lesions usually present as scaly bumps that tend to bleed.

Burns, immune suppression (for example, the use of steroids or drugs for organ transplantation) scars, long-standing sores, radiation and certain chemicals (such as arsenic and petroleum by-products) increase the incidence of squamous cell carcinoma. Squamous cell carcinomas typically appear as scaly bumps that grow or bleed. They usually arise among a field of precancerous growths known as actinic keratoses.

Sometimes, they grow rapidly and are painful (the keratoacanthoma subtype), and sometimes they smoulder.



If the lesion is suspicious, a biopsy should be performed. During a skin biopsy, a small piece of skin (typically smaller than a pencil eraser) is removed. The procedure uses local anaesthetic and takes a few minutes. The information obtained from the biopsy allows Dr McHugh to decide whether skin cancer surgery is indicated.



Excisional surgery refers to excising (cutting out with a scalpel) a lesion, and then suturing the area to close it. Dr McHugh often uses intra-operative histopathology to evaluate the edges of the tissue removed to determine whether the margins of the specimen are free of cancer.