Squamous Cell Carcinoma: Pictures, Symptoms & Treatment
Squamous cell carcinoma (SCC) develops from keratinocytes in the outer layers of the skin, usually on sun-damaged areas. It accounts for about 20% of skin cancers, and unlike basal cell carcinoma it carries a real, if small, risk of spreading.
Quick answer
Squamous cell carcinoma typically appears as a firm red nodule, a rough scaly patch, or a crusted sore that does not heal, on skin with long-term sun exposure. Cure rates exceed 95% with early surgical treatment, but 2–5% of cases metastasise, so any persistent scaly or ulcerated lesion should be examined by a clinician.
Squamous cell carcinoma pictures
Compare with other types in our skin cancer pictures guide.
Early signs and symptoms
Common locations
- Face, ears and lips
- Bald scalp
- Neck and upper chest
- Forearms and backs of the hands
- Old scars, burns and chronic wounds
Warning signs
- Firm red nodule, sometimes tender
- Rough, scaly or crusted patch
- Sore that will not heal within four weeks
- Wart-like growth that bleeds
- New rough patch on the lip
- Any new lump arising in an old scar
SCC vs BCC vs actinic keratosis
| Condition | Typical look | Spread risk |
|---|---|---|
| Actinic keratosis | Rough, dry sandpaper-like patch; often easier to feel than see | Precancerous — 5–10% progress to SCC |
| Squamous cell carcinoma | Firm, scaly or crusted nodule; may ulcerate and bleed | 2–5% metastasise |
| Basal cell carcinoma | Pearly translucent bump with fine surface vessels | Under 0.1% metastasise |
Read the detailed comparison: squamous cell carcinoma vs actinic keratosis.
Risk factors and high-risk features
| Factor | Why it matters |
|---|---|
| Cumulative UV exposure | The dominant cause; outdoor workers are especially affected. |
| Existing actinic keratoses | Many SCCs arise from these precursor lesions. |
| Immunosuppression | Organ transplant recipients face up to 65× the risk and more aggressive tumours. |
| Location on lip or ear | These sites have a markedly higher metastatic risk. |
| Size over 2cm or deep invasion | Larger and deeper tumours recur and spread more often. |
| Chronic wounds and scars | Long-standing wounds can transform into SCC. |
| HPV infection | Associated with genital, periungual and some oral SCCs. |
Treatment options
Surgical excision
Standard care for most tumours, removing the lesion with a margin of healthy tissue and confirming clear edges under the microscope.
Mohs micrographic surgery
Highest cure rate, up to 99%. Used for high-risk tumours, recurrences, and lesions on the face, lips and ears where tissue preservation matters.
Curettage, radiotherapy and topical therapy
Curettage and electrodesiccation suit small, low-risk lesions. Radiotherapy is an option when surgery is not possible. Topical 5-FU or imiquimod may be used for SCC in situ.
Immunotherapy for advanced disease
Cemiplimab and pembrolizumab have substantially improved outcomes for locally advanced and metastatic SCC.
When to see a dermatologist
Get checked promptly for
- Any sore that has not healed in four weeks
- A scaly patch that thickens, hardens or becomes tender
- A growth that bleeds repeatedly or crusts over
- A new lesion on the lip or ear
- A rapidly enlarging lump, especially if you are immunosuppressed
After an SCC diagnosis, 30–50% of people develop another within five years, so ongoing skin surveillance is essential.
Frequently asked questions
What does squamous cell carcinoma look like?
SCC usually appears as a firm red nodule, a rough scaly patch, a crusted sore that will not heal, or a wart-like growth that bleeds. It is most common on sun-exposed skin: face, ears, lips, scalp, neck, forearms and backs of the hands.
How serious is squamous cell carcinoma?
Most SCCs are highly curable, with cure rates above 95% when treated early. Unlike basal cell carcinoma, SCC can spread — around 2–5% metastasise to lymph nodes or beyond — so it should not be left alone.
How fast does squamous cell carcinoma grow?
SCC grows faster than basal cell carcinoma, typically becoming noticeable over weeks to months. A lesion that enlarges quickly, becomes tender, or ulcerates should be assessed without delay.
Does actinic keratosis turn into squamous cell carcinoma?
It can. Actinic keratosis is a precancerous lesion and an estimated 5–10% of untreated lesions progress to SCC over a decade. Treating actinic keratoses and protecting the surrounding sun-damaged field is the main way to reduce that risk.
What makes an SCC high risk?
High-risk features include size over 2cm, poor differentiation, depth beyond the fat layer, perineural invasion, location on the lip or ear, arising in a scar or chronic wound, recurrence after treatment, and immunosuppression. These cases usually need Mohs surgery and close follow-up.
What is the treatment for squamous cell carcinoma?
Surgical excision with clear margins is standard. Mohs micrographic surgery is preferred for high-risk or cosmetically sensitive sites. Superficial SCC in situ may be treated topically or with curettage. Advanced or metastatic SCC is treated with immunotherapy such as cemiplimab or pembrolizumab.
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