Best Way to Remove Squamous Cells on Chest?

Question

I just received the biopsy report on 3 areas from my chest. The locations are: 1 at the top of my cleavage, 1 to the left center of my cleavage and 1 centered just below my collar bone. These all came back as squamous cells. My dermatologist wants to scrape more and feels that this would be much better than a Moh's surgery. The location of these has gotten me very concerned about the appearance afterwards. What other treatments can you advise that would leave me with the least amount of scarring?

William Ting, MD · Answer

Skin cancer removal options depend on the type, size, histology, and equally importantly, the location of the tumors. With malignant melanoma, wide-excision with adequate margins must be performed. You have more options with squamous cell carcinoma (SCC) or basal cell carcinoma (BCC); both of which are known as non-melanoma skin cancer (NMSC). For NMSC on face, scalp, and neck and those with aggressive histology, Mohs micrographic surgery is advisable. For a cosmetic sensitive area such as the upper chest, one must balance the desire to achieve a cure and best aesthetic outcome. If you only have one to deal with at a time on the upper chest, curettage followed by excision by a skilled dermatologic surgeon should be fine. However, if you have 3 to work with on the chest at one time, electrodessication and curettagematologist recommended is reasonable. I would also recommend application of imiquimod for 4-6 weeks afterwards to maximize cure rate as well as the cosmetic outcome.

Raffy Karamanoukian, MD, FACS · Answer

Options for skin cancer removal include surgery, which may afford a more conservative approach to skin cancer removal and diagnosis. Scar therapy is important after surgery. Raffy Karamanoukian Los Angeles

Ron Shelton, MD · Answer

Scraping and burning procedures usually leave flat but white scars. Sometimes the chest is prone to develop raised scars and if this over healing (your body may produce too much collagen as a response to healing and is referred to as hypetrophic or keloidal scarring) occurs, you may see that the scar is red, raised and tender or itchy for a few months to years. The same applies to excisional (surgical removal) surgery. Usually the surgery involves removing the skin cancer in the shape of an ellipse which is longer than wide. This is to prevent raised bumps on the ends of the scar. The excision may result in a beautiful fine line which can look much better than the flat white scar from the scraping procedure, but if the excision heals with a raised or spread scar then it will look worse than the scraping discoloration. The most important aspect is to make sure that the level of pathology in your biopsies indicate that the scraping procedure is adequate for the disease. Your dermatologist can help advise you of this.

Shawn Allen, MD · Answer

There are many ways to treat skin cancers. There are also 4 different types of squamous cells all of which can be managed differently. As a starting point, Mohs surgery offers the highest cure rates of all the options available. So if cure is your goal this may make the most sense. In addition, if you do elect for a surgical procedure then Mohs surgery has been shown to conserve 180% more tissue than standard surgery and so will leave the smallest area to sew and hence a smaller scar. These are just quoting the literature but each patient and each cancer needs to be decided upon by the patient and the doctor. Some of the more superficial squamous cell cancers are sometimes managed with scraping and burning or even creams but again you need to know the real cure rates, risk of scarring, risks and benefits etc for these before deciding and this can all be provided by your dermatologist.

Steven Hacker, MD · Answer

You have several options concerning the treatment of squamous cell carcinoma. The options vary in relevance based upon your age, location of tumor, severity of histology of tumor (ie if it is well differentiated vs moderate vs poorly differentiated) , size of tumor and whether or not it represents a recurrence. Options vary from routine excision, edc (electrodessication and curettage), radiation therapy, and Mohs surgery. You must rely upon your dermatologist to advise you for the most appropriate therapeutic approach.

Bryan K. Chen, MD · Answer

Squamous cell skin cancers can be treated with simple excision, Mohs surgery (tissue sparing surgery), a scrape & burn procedure (ED&C) and in some cases, freezing with liquid nitrogen. The excision procedures (simple excision and Mohs) will tend to leave linear scars whereas the scrape & burn tend to leave flat whitish scars. A linear scar in the long run may be less noticeable than a flat white scar. If your squamous cell skin cancers are superficial, they may respond well to topical therapeutic agents including 5-Fluorouracil or Aldara which would be ideal since scarring would be minimal with these nonsurgical treatments. It is not appropriate, however, to treat invasive squamous cell skin cancers with creams.
	I hope this helps.
	Good luck.

Richard P. Rand, MD, FACS (retired) · Answer

The area you are describing is prone to poor scar formation. You would do well to have your dermatologist determine what would be the best and least invasive way to treat your skin cancer and coordinate closure efforts with a plastic surgeon. Drs. Mike Beasley and Paul Waterson are in your town and are superb plastic surgeons.

Best Way to Remove Squamous Cells on Chest?

Answers (7)

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