Advanced cSCC
Cutaneous squamous cell carcinoma (cSCC) begins with the development of abnormal squamous cells in the skin that create a scaly pink patch called an actinic keratosis or precancerous skin lesion. The abnormal cells can then fill the entire epidermal layer of the skin, known as squamous cell carcinoma in situ. Further growth of the abnormal cells results in growth to the deeper layer of the dermis, and this is known as invasive cSCC (Figure).1
Primary or early stage cSCC is contained to the upper layers of the skin and can usually be treated with surgery. However, some cases can become more aggressive, growing larger, spreading to other parts of the body, or being difficult to remove. These cases are known as locally advanced cSCC and metastatic cSCC.1
- Locally advanced cSCC: This cancer can invade nearby healthy tissues, such as fat, muscle, or bone, depending on its location. It may also affect the nerves of the skin or spread along the nerve sheath.1
- Metastatic cSCC: This occurs when the cancer spreads to parts of the body beyond the skin, such as the lymph nodes or organs.1
These advanced cancers are more challenging to treat and often require a combination of treatments including surgery, chemotherapy, radiation therapy, and/or immunotherapy. If you suspect any skin changes or growths, consult your healthcare provider for an evaluation and appropriate treatment plan.2,3
Doctors will evaluate several factors affecting a patient’s outlook and treatment options. These include4:
- The location of the tumor
- How fast the tumor is growing
- How well-defined the borders of the tumor are
- If the tumor is new or has come back (recurred)
- If the tumor has been causing symptoms, such as pain or itching
- How the cancer cells look under a microscope
- If the cancer cells have invaded small nerves, blood vessels, or lymph vessels in and around the tumor
- If the cancer is in a place that was previously treated with radiation
- If the person has a weakened immune system
They also use these factors to determine how likely the skin cancer will return after treatment or spread to other parts of the body.4
References
- Arron ST. Fast Facts for Patients and Their Supporters: Advanced Cutaneous Squamous Cell Carcinoma: Information + Taking Control = Best Outcome. Basel, Switzerland: S. Karger AG; 2019. doi:10.1159/isbn.978-1-912776-37-5
- American Academy of Dermatology Association. Skin Cancer Types: Squamous Cell Carcinoma Treatment. Last updated January 13, 2026 (https://www.aad.org/public/diseases/skin-cancer/types/common/scc/treatment).
- Aboul-Fettouh N, Morse D, Patel J, Migden MR. Immunotherapy and Systemic Treatment of Cutaneous Squamous Cell Carcinoma. Dermatol Pract Concept. 2021;11(suppl 2):e2021169S. doi:10.5826/dpc.11S2a169S
- American Cancer Society. Basal and Squamous Cell Skin Cancer Stages and Risk Groups. Last revised Oct. 31, 2023 (https://www.cancer.org/cancer/types/basal-and-squamous-cell-skin-cancer/detection-diagnosis-staging/staging.html).
All URLs accessed April 15, 2026
