Following excision with margins, will any further treatment (e.g. surgery) be required? The risk factors in the pathology report for an aggressive SCC are:
- Invading nerves in the skin (‘Perineural invasion’) – up to 5% of SCC shows perineural invasion.
- ‘Poorly differentiated’ (see pathology report below) SCC.
- SCC Invading deep into the skin (dermis).
- Unusual pathological variants (e.g. “spindle cells”).
The latest guidelines highlight the importance of the depth of an SCC. Depth is measured using the “Breslow thickness,” which is the distance from the top of the skin (almost) to the deepest level of The SCC. The Breslow thickness is also used to stage melanoma, and its use to help stage SCC is a recent development. A Breslow thickness of at least 2mm indicates an SCC that may be more aggressive.
Further treatment (Surgery) will often be required when the above pathological features are identified.
The excision margin required for SCC will tend to be greater than for a BCC