Doctor-led patient guide to squamous cell carcinoma (SCC) by Dr Chris Irwin at The Skin Doctor, Melbourne. SCC is the second most common skin cancer after BCC. It begins in epidermal squamous cells, appears scaly or crusted on sun-damaged skin, and is divided into in situ (Bowen's disease) and invasive forms. Standard excision cures ~95% of primary invasive SCCs.
- SCC is the second most common skin cancer (after BCC).
- It begins in the squamous cells of the epidermis — the flat "bricks" of the outer skin.
- Two main forms — SCC in situ (Bowen's disease / IEC, confined to epidermis) and invasive SCC (grown into dermis).
- Most common on sun-exposed skin (face, scalp, ears, lips, neck, forearms, backs of hands).
- SCC grows faster than BCC, and a minority can spread to lymph nodes — risk higher with larger, deeper, recurrent, lip/ear or immunosuppressed-patient lesions.
- Surgical excision is first-line for invasive SCC — cure rate ~95% for primary tumours.
- SCC in situ options include topical Efudix (~70%) and laser-assisted photodynamic therapy (>90–95%).
- Routine CT/PET scans and lymph node biopsy are not needed for most SCCs.
- About 50% of patients develop another non-melanoma skin cancer within 5 years — structured skin checks matter.
- Care provided across two Melbourne clinics — Ivanhoe and Diamond Creek.
Squamous Cell Carcinoma(SCC)
Squamous cell carcinoma (SCC) is the second most common type of skin cancer (after BCC). It begins in the squamous cells of the epidermis — the "bricks" that give the outer skin structure. SCC often appears as a scaly or crusty bump or patch on sun-exposed skin, and sometimes ulcerates. It tends to grow faster than BCC, but when found early it is highly curable and unlikely to spread. SCC is divided into in situ (only in the top layer) and invasive (growing into deeper layers) forms.
By Dr Christopher Irwin, MBChB, FRACGP, MMed (Skin Cancer), FACAM, MSCCA
Last reviewed 2026-06-06 · Editorial policy
Quick definition
Squamous cell carcinoma (SCC) is the second most common skin cancer (after BCC). It begins in the squamous cells of the epidermis and usually arises on sun-damaged skin. Unlike BCC, a minority of SCCs can spread to lymph nodes — risk is higher when the SCC is larger, deeper, on the lip or ear, recurrent, or in immunosuppressed patients. SCC is divided into in situ (Bowen’s disease — confined to the epidermis) and invasive (grown into the dermis). Standard excision cures ~95% of primary invasive SCCs; SCC in situ has even higher cure rates with topical Efudix or laser-assisted photodynamic therapy.
Squamous cell carcinoma (SCC) is a common skin cancer that usually arises on sun-damaged skin. Most SCCs are very treatable when diagnosed early — but unlike basal cell carcinoma, a minority of SCCs can spread, particularly if they are larger, deeper, recurrent, on higher-risk sites (like the lip or ear), or in people who are immunosuppressed.
This page explains SCC in plain English and links you to the two main SCC categories we manage.
Explore each type
SCC in Situ (Bowen’s Disease)
Surface-only SCC that has not invaded — confined to the epidermis. Also called Bowen’s disease or intraepidermal carcinoma (IEC). Excellent cure rate with topical Efudix, laser-assisted PDT or excision.
Learn more →Invasive SCC
SCC that has grown into the dermis. Standard surgical excision cures around 95% of primary tumours. Higher-risk sites (lip, ear) and immunosuppressed patients need closer follow-up.
Learn more →What does SCC look like?
SCC has a few classic patterns, but it can still be subtle early on. Common presentations include:
- A persistent scaly or crusted patch that doesn’t settle
- A tender, thickened “sandpaper” spot that keeps returning
- A firm, growing lump with scale or crust on top
- A non-healing sore that bleeds easily
- A wart-like growth that enlarges or becomes painful
SCC most often appears on face, scalp, ears, lips, neck, forearms, and backs of hands — but it can occur anywhere.
If a lesion is growing quickly, painful or tender, repeatedly bleeding, or not healing, it should be assessed promptly. If it’s on the lip or ear, or growing fast, book the soonest available appointment.
Is SCC dangerous?
Most SCCs are cured with appropriate treatment. The reason we take SCC seriously is that some SCCs can spread to lymph nodes. This risk is still low overall, but it increases when SCCs are:
- Larger or rapidly growing
- Deeper (invasive)
- Located on high-risk sites — especially lip, ear, and some facial zones
- Recurrent — previously treated and returned
- Arising in scarred or chronically inflamed skin
- Occurring in immunosuppressed people, eg. transplant recipients
That’s why identifying whether it is in situ or invasive matters — and why early treatment of higher-risk SCCs is important.
How SCC is diagnosed
A high-quality assessment usually includes:
- Clinical examination + history — growth rate, tenderness, bleeding
- Dermoscopy — magnified evaluation of structure
- Biopsy when needed to confirm diagnosis and guide treatment choice
If you have had a previous SCC, extensive sun damage, or lots of actinic keratoses, you often benefit from structured prevention and “field” management — not just treating individual spots one at a time. See also Actinic keratosis (pre-cancer) and How to reduce your chance of getting skin cancer again.
If you’re not sure which appointment to book:
- 1–3 spots you’re worried about → Book a targeted spot check
- History of skin cancer or multiple lesions → Book a full skin check
Symptoms
- A persistent scaly or crusted patch that doesn't settle
- A tender, thickened "sandpaper" spot that keeps returning
- A firm, growing lump with scale or crust on top
- A non-healing sore that bleeds easily
- A wart-like growth that enlarges or becomes painful
- Most common on face, scalp, ears, lips, neck, forearms and backs of hands — but can occur anywhere
Causes & contributors
- Cumulative ultraviolet (UV) exposure from sunlight and solariums
- Fair skin, light eyes, easy burning
- Older age (although younger patients with heavy sun damage are common in Australia)
- A field of multiple actinic keratoses (sun-damage pre-cancer)
- Immunosuppression — transplant recipients have substantially higher SCC risk
- Chronic wounds, scars or burns
- HPV infection in selected sites
Diagnosis
Diagnosis is made on clinical examination and dermatoscopy and confirmed on histology after biopsy or excision. The histology report names whether the SCC is in situ (Bowen's disease, intraepidermal carcinoma) or invasive, and describes features such as depth, differentiation (well / moderately / poorly differentiated) and presence of perineural or lymphovascular invasion — all of which guide treatment intensity and follow-up.
Treatment options
Surgical excision (most common)
For invasive SCC. The tumour is removed with a margin of normal skin under local anaesthetic. Cure rate around 95% or more for a first-time SCC with clear margins.
Topical 5-fluorouracil (Efudix) →
For SCC in situ — applied over six weeks. Around 70% effective.
Laser-Assisted Photodynamic Therapy (PDT) →
For SCC in situ. Laser ablates the lesion, sensitising cream is absorbed into remaining cells, and an LED light activates the cream to destroy them. >90–95% success with short downtime.
Curettage and electrodessication
Sometimes used for very small, thin SCCs or pre-cancers — more often used for BCC. Invasive SCC is usually better removed by standard surgery.
Radiation therapy
When surgery is not feasible (eg. frail patient, certain anatomical sites) or as adjunctive therapy in selected advanced cases (eg. perineural invasion, incomplete margins).
Immunotherapy / chemotherapy (rare)
For SCCs that have spread or cannot be removed surgically. Only needed for a very small minority of patients.
When to see a doctor
See a doctor early if you have a scaly, crusted, ulcerated or non-healing spot on sun-exposed skin — especially on the face, ears, lips, scalp or hands. SCCs grow faster than BCCs, so prompt treatment matters. If a lesion is on the lip or ear, or rapidly growing, painful, tender or repeatedly bleeding, book the soonest available review.
Frequently asked questions
-
What is squamous cell carcinoma (SCC)?
SCC is the second most common skin cancer (after BCC). It begins in the squamous cells of the epidermis — the flat "bricks" that give the outer skin its structure. SCC most often arises on sun-damaged skin and appears as a scaly, crusted, ulcerated or non-healing patch or lump. It is divided into in situ (Bowen's disease, confined to the epidermis) and invasive (grown into the dermis) forms. -
What does SCC look like?
SCC has several common patterns — a persistent scaly or crusted patch, a tender thickened "sandpaper" spot, a firm growing lump with scale or crust on top, a non-healing sore that bleeds easily, or a wart-like growth that enlarges or becomes painful. SCC most often appears on sun-exposed skin (face, scalp, ears, lips, neck, forearms, backs of hands) but can occur anywhere. -
How is SCC different from basal cell carcinoma (BCC)?
BCC is more common (~80% of skin cancers) and almost never spreads; SCC (~15–20%) tends to grow faster and a small minority can spread to lymph nodes, especially on high-risk sites (lip, ear). BCC typically looks pearly with visible blood vessels; SCC looks scaly, crusted or ulcerated. Both are highly curable when caught early. -
Does SCC spread to lymph nodes or other organs?
A minority of SCCs can spread. Risk is higher when the SCC is larger, deeper (invasive), rapidly growing, on high-risk sites (especially lip, ear), recurrent, arising in scarred/inflamed skin, or in immunosuppressed patients (eg. transplant recipients). For low-risk SCCs caught early, the risk of spread is very small. -
Is SCC in situ the same as Bowen's disease?
Yes — they are the same condition under different names. SCC in situ, Bowen's disease, and intraepidermal carcinoma (IEC) all refer to a squamous cell carcinoma confined to the epidermis. It has not crossed into the dermis, so it does not spread as an in-situ lesion — but it can progress to invasive SCC if untreated. -
What is the cure rate for SCC?
Around 95% or more for a primary (new) invasive SCC treated by surgical excision with clear margins. SCC in situ (Bowen's disease) has even higher cure rates — laser-assisted photodynamic therapy achieves >90–95% success and topical Efudix around 70%. Higher-risk SCCs may require wider margins, Mohs surgery, or adjunctive radiation. -
Can SCC be mistaken for a wart or eczema?
Yes. Early SCC can resemble eczema, psoriasis, a persistent sunspot or a wart-like growth — especially if it is scaly and inflamed. The key warning signs are persistence (not healing in 6–8 weeks despite treatment) and change over time (enlarging, ulcerating, repeatedly bleeding). If in doubt, get it checked. -
How urgent is SCC?
More urgent than BCC. SCCs grow faster, and a small minority can spread — so prompt assessment matters. If a lesion is rapidly enlarging, painful or tender, bleeding repeatedly, or on the lip or ear, book the soonest available review. For most SCCs, treatment within a few weeks of diagnosis is appropriate.
References
- Clinical practice guidelines for keratinocyte cancer. Cancer Council Australia. (NHMRC-approved 2019.)
- Guidelines of care for the management of cutaneous squamous cell carcinoma. J Am Acad Dermatol. 2018. (American Academy of Dermatology.)DOI: 10.1016/j.jaad.2017.10.007
- Cutaneous squamous cell carcinoma. Hematol Oncol Clin North Am. 2019.DOI: 10.1016/j.hoc.2018.08.001
Related
Related conditions
Medically reviewed by Dr Christopher Irwin, MBChB, FRACGP, MMed (Skin Cancer), FACAM, MSCCA · Last reviewed 2026-06-06 · Editorial policy