What happens if squamous cell carcinoma is left untreated

Time Is of the Essence: If you avoid seeing a dermatologist because of fear or denial, you’ll only feel worse. Knowledge gives you power and peace of mind. Credit: liseykina/iStock/Getty Images

Q: I’ve heard of people who put off surgery for years; do I have to get my skin cancer treated right away?

William Hanke, MD, MPH: Most of the time, skin cancers are caught early, when they are relatively small, and are treated with outpatient surgery, such as Mohs micrographic surgery. But sometimes they can grow to become very large. I have seen a few the diameter of a baseball or even larger!

These large skin cancers tend to be basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs). These skin cancers will continue to grow if nothing is done to stop them. Extended growth can result in involvement of vital structures like the nose, eyes, ears, bone, tendon or muscle and can become disfiguring or even life-threatening. Fortunately, most of the time they grow very slowly.

While it is rare to see very large skin cancers today, one of the largest I ever treated was a patient in his 60s, with a football-sized BCC involving his right shoulder. He was one of my first patients early in my career. I performed Mohs surgery, and the skin cancer was completely removed. It never recurred. After a long life, his obituary contained heartfelt thanks, both to me as well as to a lifeguard who saved his life when he was child. The lifeguard’s name was Ronald Reagan — yes, the one who became our 40th president.

There are many reasons that some skin cancers are left untreated. A frequent scenario that I have experienced is a patient who lives in a nursing home and has a growing skin cancer that goes undiagnosed for many years. Finally, a loved one will point it out to them and get them to a physician for a biopsy.

I have patients who share that they were in denial and didn’t want to have an evaluation because they didn’t want surgery. We also see patients who delay because of fear of going to the doctor, or perhaps because of a previous poor experience with a physician. During the pandemic, we saw a delay in patients receiving medical care, and even after restrictions lightened, many patients were still hesitant to leave their homes to see the doctor.

Other patients delay because they think eventually it will heal on its own. We also see some skin cancers that grow very rapidly, and even though the patient went in to see the physician as soon as they could, it can be very large by the time of surgery.

My overall message would be that the earlier skin cancers are treated, the better the outcome and the easier the recovery. If you or a loved one has a spot that easily bleeds or won’t heal, please have a dermatologist evaluate it. You will be glad you didn’t wait. — Interview by Elizabeth Sutton, MD

About the Expert:

Squamous cell carcinoma is cancer that occurs in the outermost part of the epidermis (skin surface) or the surface of certain portions of the body (areas of the head and neck or genitalia) known as squamous cells. If left untreated, squamous cell carcinoma can spread to nearby lymph nodes, bones or distant organs (such as the lungs or liver). Normal squamous tissue usually appears flat. When this tissue develops cancer it can appear as round masses that are can be flat, raised, or ulcerated.

What Causes Squamous Cell Carcinoma?

Squamous cell carcinoma can develop on skin that is often exposed to the sun, such as, skin on the head, neck and face. Squamous cell carcinoma is the second most common type of skin cancer in the United States, after basal cell carcinoma, with about 700,000 new cases diagnosed each year. It accounts for about 2,500 deaths per year.

Squamous cell carcinoma can also develop from the human papillomavirus (HPV) and can affect the surface lining of certain parts of the body, such as the head and neck (most commonly found in areas of the tonsil and base of tongue) and the genitals (vulva, cervix and penis).

Skin Cancer Awareness Month: What Can Happen If Your Skin Cancer Goes Untreated?

What to Expect with Untreated Skin Cancer

Skin cancer is the most common cancer in the United States. With treatment, most skin cancer is not life-threatening. But what can happen if skin cancer is left untreated? Here's what you need to know.

Basal Cell Carcinoma

Basal cell carcinoma is the most common form of skin cancer. In fact, there are almost 4 million cases diagnosed in the U.S. annually. Though it is a slow-growing cancer, that doesn't mean it can go untreated. Basal cell carcinoma is one of the least dangerous types of skin cancer because of its slow growth rate and the very rare chance that it will spread to other organs. This also means there is ample time to invest in effective skin cancer treatment. If left untreated, however, basal cell carcinoma will undoubtedly cause some serious damage. For one, untreated basal cell carcinoma can cause ulcers. In addition, it may result in permanent disfigurement. If it occurs on the face, which it often does, you could be facing reconstructive surgery or permanent facial disfigurement by leaving this type of skin cancer untreated.

Squamous Cell Carcinoma

Squamous cell carcinoma is the second most common skin cancer after basal cell carcinoma. Squamous cell carcinoma can be caused by over-exposure to UV radiation and, like basal cell carcinoma, most frequently occurs in sun-damaged areas of the body. It is potentially life-threatening if left untreated, particularly in areas like the face, lips, ears, nose, or neck. This is because as squamous cell carcinoma grows, it has the ability to spread into the lymph nodes and internal organs. Not only that, but squamous cell carcinomas are often painful to the touch. If left untreated, patients may be in significant pain for an extended period of time. In addition, waiting to receive treatment may result in more serious surgery being needed. If a large tumor develops, it's likely that reconstructive surgery will be necessary once the cancerous tissue is excised. On the face and neck, this may mean a patient never looks the same or has the same function in those areas again.

Melanoma

Melanoma is less common than basal and squamous cell carcinoma, but it is far more dangerous. The biggest reason for this is its ability to spread rapidly to other organs if not treated early. Melanoma can put a patient's life at risk in as little as six weeks if left to grow untreated. When melanoma spreads to other areas of the body, it can become much more difficult to treat. A small melanoma tumor, if caught early on, can be treated with procedures like excision surgery or Mohs micrographic surgery. If left untreated, melanoma can quickly spread to internal organs and require treatments like chemotherapy. At an advanced stage, however, even chemotherapy may not be able to successfully treat this type of skin cancer.

Skin cancer treatment saves lives, and truthfully, no skin cancer should be left untreated. Skin cancer screenings are an excellent tool to help detect skin cancer early on so patients can get effective treatment. If you have questions or want to set up a skin cancer screening, contact SE Dermatology Specialists today.

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