Squamous Cell Carcinoma

Surgery is the standard first-line treatment for most localized tumors. The surgeon removes a margin of skin around the tumor and checks the tissue edges. High-risk tumors need a plan that confirms clear edges.⁴ For high-risk, recurrent, or critical-site tumors, a margin-controlled technique, known as Mohs surgery, checks the entire edge of the removed tissue under the microscope during the procedure; guidelines reserve it for those situations.³

Radiation may be used when surgery is unsuitable. A specialist may consider it after surgery for concerning nerve involvement or other high-risk features; an involved margin needs an individual plan. Scraping and cautery may suit selected small, low-risk tumors. Freezing has a narrower role when more effective treatments are unsuitable or impractical.³

Drug treatment led by an oncology team

These treatments serve different goals. Shrinking a tumor that cannot be removed, lowering the risk of return, and clearing cancer cells before surgery are not the same outcome. The percentages below should not be compared as if they came from one trial.

If surgery and radiation cannot cure the cancer. Anti-PD-1 infusions help immune cells attack SCC. In early cemiplimab studies, response rates were 50% in a phase 1 group and 47% in a phase 2 group with distant spread.⁵ A separate study of cancer grown far into nearby tissue found a 44% response rate, including 13% with a complete response.⁶ A pembrolizumab trial found a response in 34.3%. Disease control, which also counted stable cancer, was 52.4%.⁷ These were single-group trials, not comparisons between the drugs. Response does not mean cure. Some responses last, but some cancers do not respond or later grow.

After surgery and radiation for certain high-risk tumors. The C-POST trial compared cemiplimab with placebo in 415 people. At two years, 87.1% of the cemiplimab group and 64.1% of the placebo group were alive without the cancer returning. The hazard ratio for return or death was 0.32. Local and distant returns were both less common. That report showed a disease-free benefit, not proof of longer overall survival. Grade 3 or worse adverse events occurred in 23.9% versus 14.2%; adverse events led 9.8% versus 1.5% to stop treatment. These results apply to the trial's high-risk group after both surgery and radiation, not every SCC.⁸

Before surgery for selected tumors that can still be removed. In a single-group study of 79 people, cemiplimab left no live cancer cells in the removed tissue in 51%. Another 13% had a major response, with very few live cancer cells left. This is a tissue response, not proof of cure or longer survival. Surgery remained part of the plan. This approach is still investigational and is not FDA-approved before surgery. It is not a substitute for surgery or a routine choice for small, low-risk SCC.⁹ At the final follow-up, about four and a half years later, 76.2% were alive without an event such as cancer growth, return, or death. Overall survival was 79.4%. None of the 40 people with a complete tissue response had a return of cancer. No new grade 3 or worse adverse events were reported. These are encouraging results, but there was no control group. They cannot show how much the drug added to surgery and later care. Only 70 of the 79 people went on to surgery. In two, the cancer grew so much that surgery could not be done.¹⁰

Immune treatment can harm healthy organs. People with a transplant need special care because it can also threaten the transplanted organ. Discuss risks and benefits with the cancer and transplant teams before treatment.³

Other options patients ask about

Black salve or Cansema. Do not use these products for SCC. Tissue studies show dead or damaged healthy skin and cancer left behind. A scab falling off does not show that all the cancer is gone. The evidence shows harm, without a proven safe cure.¹¹¹²

Home removal or leftover creams. Do not cut, burn, freeze, or apply acids to a spot that might be cancer. A biopsy is needed to learn its type and depth. Creams used for precancers or SCC in situ are not a standard treatment for invasive SCC. The same rule applies to light therapy: an option for some surface disease is not proof of a cure for invasive cancer.³¹³

Natural cures, herbs, diets, or supplements. None has been shown to cure invasive SCC. Products can cause harm or interact with treatment. Tell your care team what you take. Relief of symptoms and support during care are useful goals, but do not replace cancer treatment.¹⁴

Delaying or declining treatment. Some SCCs grow deep or spread. Do not assume that a small or painless spot is safe to leave. If illness, frailty, cost, or fear makes treatment hard, ask for a plan that weighs those concerns. Comfort-focused care is a valid goal when chosen with your team; it differs from leaving a cancer unchecked.³

Special note for people with a weakened immune system

Organ-transplant recipients and others on long-term immune-suppressing medicine get many more SCCs, and the tumors tend to behave more aggressively.² If this is you, regular skin checks and prompt treatment of new spots are especially important, and care is usually coordinated with your transplant or specialty team.

Lowering your risk and catching new ones early

Most of the risk comes from ultraviolet light, so sun protection lowers the chance of new skin cancers over time. Treating precancers (actinic keratoses) also helps. For high-risk patients, a daily vitamin (nicotinamide) lowered new skin cancers in a trial, and selected transplant patients may be offered a prescription retinoid.

Having one SCC raises the chance of getting another, so regular skin checks are an important part of care after a diagnosis.

When to see a doctor

See a clinician for any spot that is growing, scaly, tender, bleeding, or not healing, especially on sun-exposed skin like the face, ears, lips, scalp, or hands. If you have had a SCC before, or you take immune-suppressing medicine, keep up with regular skin checks.

Frequently asked questions

Is SCC dangerous? Most are cured when treated early. The concern is the higher-risk minority that can grow deep or spread, usually first to nearby lymph nodes. The tumor's risk features guide how closely it is treated and followed.²

How is it different from BCC? Both come from sun damage, but SCC grows faster and is more likely to spread, while BCC almost never spreads. Both are usually cured with surgery when caught early.

Will it come back? Most tumors are cured. Cancer left at the edge raises the chance of recurrence, so margins are checked and an involved edge is re-removed.¹⁵ Having one SCC also raises the chance of getting another, so ongoing skin checks matter.

Do I need Mohs surgery? Not for every tumor. Mohs is a margin-controlled technique that guidelines reserve for high-risk, recurrent, or critical-site tumors.³ Your clinician can tell you whether your tumor falls into that group.

Why does my immune system matter? People on immune-suppressing medicine, such as transplant recipients, get many more SCCs and more aggressive ones.² They need closer skin checks and prompt treatment.

Questions to ask your clinician

• What risk group is my tumor, and does it need imaging or a lymph node check?
• Which treatment fits this spot, and will the edges be checked for clear margins?
• Do I need radiation after surgery for any reason?
• How often should I have skin checks now?
• I take immune-suppressing medicine, so how does that change my plan?

SCC is one of several skin cancers and precancers. Related guides cover actinic keratosis (its common precancer), BCC, and the treatments above, including surgical excision. A thorough skin cancer screening is the place to start.

Reviewed by Tyler Long, DO. Last reviewed November 3, 2026.