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Skin Cancer

High Risk SCC

Understanding High-Risk Squamous Cell Carcinoma

At Apex Skin Center, we are dedicated to providing our patients with the highest level of care when it comes to skin cancer diagnosis and treatment. One of the most common types of skin cancer is squamous cell carcinoma (SCC), which arises from the squamous cells (keratinocytes) in the outer layer of the skin. While most cases of SCC are highly treatable, some cases are classified as high-risk SCC, meaning they have a greater chance of spreading, recurring, or becoming life-threatening.

Understanding what makes some squamous cell carcinomas more dangerous than others is key to early detection and proper treatment. With the expertise of Dr. Thomas Knackstedt and our team at Apex Skin Center, we offer comprehensive care for all forms of skin cancer, including high-risk SCC.

Several factors can increase the likelihood that a squamous cell carcinoma will behave aggressively. These factors are related to the size, location, depth, cell characteristics, and patient’s overall health.

Larger tumors are generally more dangerous, especially if they are more than 2 centimeters (about the size of a peanut) in diameter. Deeper tumors that extend beyond the skin’s outer layer into the fat, muscle, or even bone have a higher risk of spreading.

Squamous cell carcinomas that develop on high-risk areas of the body tend to behave more aggressively. These areas include the ears, lips, nose, scalp, fingers, and genitals, as well as sites where the skin is already damaged by chronic inflammation, burns, or scars. SCCs in these locations have greater access to blood vessels and lymphatic channels, increasing the risk of spreading to lymph nodes or other parts of the body.

When a squamous cell carcinoma is examined under a microscope, certain features can indicate how aggressive the tumor is. Some SCCs have poorly differentiated or undifferentiated cells, meaning they look less like normal skin cells, appear more primitive, and behave more erratically. These tumors are more likely to grow rapidly and metastasize.

Some SCCs exhibit perineural invasion, which means that cancer cells are growing along nerves within the skin. This can make treatment more challenging, as the cancer may spread along nerve pathways to deeper tissues, increasing the risk of recurrence.

Lastly, some SCC may exhibit lymphovascular invasion, which means that cancer cells are growing into blood vessels. While uncommon in SCC of the skin, this feature can increase the risk of a cancer spreading to other organs.

If a squamous cell carcinoma has been previously treated but returns in the same area, it is considered higher risk. Recurrent SCCs often behave more aggressively and require more extensive surgical treatment.

Similarly, SCCs that develop in areas that have undergone radiation therapy or chronic scarring from burns, wounds, or inflammatory skin conditions tend to be more resistant to treatment and more prone to recurrence.

The immune system plays a crucial role in preventing and controlling the spread of cancer. Patients who are immunosuppressed—such as those who have had organ transplants, are undergoing chemotherapy, or have conditions like HIV/AIDS—are at a significantly higher risk of developing aggressive SCCs.

People taking long-term immunosuppressive medications, such as those used after organ transplantation, are at 100 times the risk of developing SCC compared to the general population. These patients require closer monitoring and more aggressive treatment strategies.

When you are concerned about a skin lesion, don’t wait. At Apex Skin Center, we are here for you and your skin. Early skin cancer diagnosis and treatment are the keys to a successful outcome and your peace of mind. Board-certified dermatologist and fellowship trained Mohs surgeon Dr. Thomas Knackstedt and the team at Apex Skin Center in Fuquay Varina look forward to serving you. Contact Apex Skin Center to schedule a consultation or book your visit online in a few easy steps.

At a Glance

Dr. Thomas Knackstedt

  • Double board certified in dermatology and Mohs Surgery
  • Over ten years of experience providing evidence-based care
  • Nationally renowned physician leader with numerous publications, lectures, and academic affiliations
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