Squamous Cell Carcinoma: Symptoms, Risks, and Treatment in New Braunfels, TX

Squamous cell carcinoma treatment in New Braunfels, TX is a significant part of what we do at Elect Dermatology. SCC is the second most common skin cancer in the United States after basal cell carcinoma — and unlike BCC, it carries a meaningful risk of spreading to lymph nodes and distant organs if not diagnosed and treated promptly. Texas’s year-round ultraviolet exposure, combined with the region’s history of outdoor work and recreation, places Comal County residents at above-average lifetime risk. Understanding what SCC looks like, who is most at risk, and what your treatment options are can be genuinely life-saving.

What Is Squamous Cell Carcinoma?

Squamous cell carcinoma arises from keratinocytes — the cells that make up the bulk of the epidermis. When cumulative UV radiation causes mutations in these cells’ DNA, they begin to divide uncontrollably and form a tumor. Unlike basal cell carcinoma, which originates in deeper basal cells and very rarely metastasizes, SCC can invade surrounding tissue and spread to lymph nodes and distant organs in a clinically significant percentage of cases.

The American Cancer Society estimates approximately 1.8 million cases of SCC are diagnosed in the United States annually, making it one of the most common cancers of any type. Approximately 15,000 Americans die from SCC each year — making it the second deadliest skin cancer after melanoma. These are not statistics to dismiss.

SCC vs. Basal Cell Carcinoma: Key Differences

Both cancers are primarily UV-driven, but they differ meaningfully in metastatic potential. SCC carries an overall metastatic risk of approximately 2–5%, rising to 10–15% for SCCs arising on the lip, in immunosuppressed patients, or in areas of chronic inflammation or scarring. BCC, by contrast, metastasizes in fewer than 0.1% of cases. SCC also tends to grow faster than BCC and is more frequently found on highly UV-exposed areas like the lower lip, ears, hands, and scalp. For more information on BCC, see our basal cell carcinoma post.

Who Is at Risk for Squamous Cell Carcinoma?

Risk factors for SCC in New Braunfels and across Texas include:

• Cumulative UV exposure: The primary driver. Texas has some of the highest ambient UV indices in the continental United States. Outdoor workers — ranchers, construction workers, landscapers, and farmers throughout Comal County — face elevated occupational risk accumulated over decades.
• Fair skin (Fitzpatrick types I–II): Less melanin means faster DNA damage accumulation from UV exposure.
• Prior actinic keratoses: AKs are considered premalignant lesions that may progress to SCC. The rate of progression is estimated at approximately 0.025–0.1% per lesion per year — but patients with many AKs carry meaningfully elevated cumulative risk.
• Immunosuppression: Organ transplant recipients have 65–250 times the SCC risk of the general population due to immunosuppressive medications. HIV infection, hematologic malignancies, and long-term corticosteroid therapy also significantly elevate risk.
• Human papillomavirus (HPV): Certain high-risk HPV strains are associated with SCC of the anogenital region and other mucosal sites. HPV vaccination in adolescents provides meaningful protection.
• Radiation and chemical exposure: Prior radiation therapy at a skin site, chronic arsenic exposure, and coal tar product exposure all increase SCC risk.
• Chronic wounds and scars (Marjolin’s ulcer): SCC arising in burn scars, chronic ulcers, or areas of chronic inflammation tends to be particularly aggressive.

Squamous Cell Carcinoma Symptoms: What to Look For

SCC is more variable in appearance than BCC. Warning signs include:

• A firm, red nodule or plaque that grows over weeks to months
• A rough, scaly patch that bleeds easily or won’t fully heal
• A flat lesion with a crusted surface — especially on the lip, ear, or scalp
• A new growth in an existing scar, burn, or chronic wound
• A wart-like growth that bleeds or enlarges
• A sore inside the mouth that doesn’t heal

The classic warning sign across all skin cancers: any lesion that does not heal, keeps bleeding or crusting, or changes in size or character over weeks deserves immediate evaluation. Do not wait to see if it resolves on its own.

From Actinic Keratosis to SCC: Understanding the Precancer Connection

Actinic keratoses are the most common premalignant skin lesions, considered direct precursors to SCC. An AK represents keratinocytes that have accumulated UV-induced DNA mutations but have not yet broken through the basement membrane. Clinically, AKs feel like rough, sandpaper-like patches on sun-exposed skin — most commonly the scalp in men, the face, the backs of the hands, and the forearms.

The presence of multiple AKs signals significant cumulative UV damage and warrants comprehensive treatment of all visible lesions — not just the most prominent spots. Field treatment with 5-fluorouracil cream, imiquimod, photodynamic therapy, or tirbanibulin (Klisyri) is now standard of care for patients with widespread AK burden.

SCC In Situ (Bowen’s Disease)

SCC in situ — also called Bowen’s disease — represents full-thickness squamous cell dysplasia that has not yet invaded through the basement membrane. It typically appears as a well-demarcated, red, slightly scaly plaque that grows slowly over months to years. While not invasive at this stage, SCC in situ carries a 3–5% risk of progression to invasive SCC if left untreated. Treatment options include surgical excision, cryotherapy, topical imiquimod, or photodynamic therapy.

Squamous Cell Carcinoma Diagnosis

A skin biopsy is required to diagnose SCC — clinical appearance alone is insufficient. A shave or punch biopsy under local anesthesia provides tissue for pathology, which determines whether the lesion is in situ or invasive, tumor depth, degree of differentiation (well- vs. poorly-differentiated), perineural invasion status, and margin status.

High-risk features — tumor size greater than 2 cm, deep invasion, perineural invasion, poorly differentiated histology, immunosuppression, or location on the lip, ear, or periorbital region — prompt consideration of sentinel lymph node evaluation and multidisciplinary management.

Squamous Cell Carcinoma Treatment in New Braunfels, TX

Standard Surgical Excision

Appropriate for low-risk primary SCCs. Wide margins of typically 4–6 mm are taken and sent to pathology. Cure rates exceed 92% for appropriately selected low-risk tumors in favorable locations.

Mohs Micrographic Surgery

The gold standard for high-risk SCC — large or recurrent tumors, tumors on the face (especially the nose, ears, lips, and periorbital region), and those with perineural invasion. Mohs surgery in New Braunfels achieves the highest published cure rates for high-risk SCC while preserving maximum surrounding normal tissue — critical for facial locations where cosmetic outcome and function matter.

Electrodesiccation and Curettage (ED&C)

Appropriate for selected low-risk SCC in situ or superficial SCC on the trunk and extremities in non-critical locations. Not appropriate for invasive SCC, high-risk locations, or recurrent tumors.

Radiation Therapy

For non-surgical candidates, or as adjuvant therapy after surgery when high-risk pathological features are present. Cure rates are lower than surgical options but represent an important alternative for appropriate patients.

PD-1 Checkpoint Inhibitors (Cemiplimab, Pembrolizumab)

For locally advanced or metastatic SCC not amenable to surgery or radiation, FDA-approved PD-1 inhibitors cemiplimab (Libtayo) and pembrolizumab (Keytruda) have demonstrated significant response rates in clinical trials, representing a major advance over prior systemic options for advanced disease.

Surveillance After SCC Diagnosis

After an SCC diagnosis, follow-up visits are essential. The American Academy of Dermatology recommends:

• Every 3–6 months for the first two years (highest risk period for local recurrence and metastasis)
• Every 6–12 months thereafter
• Annual lymph node examination
• Aggressive sun protection and comprehensive photoprotection counseling

The risk of developing a second SCC within 5 years after a first diagnosis is approximately 30–50% in high-risk patients. Field treatment of residual actinic keratoses and daily broad-spectrum sunscreen use remain the most important secondary prevention strategies.

Frequently Asked Questions: Squamous Cell Carcinoma

Is squamous cell carcinoma curable?

Yes, when caught early. Low-risk SCC treated with surgery achieves cure rates exceeding 92%. High-risk SCC treated with Mohs surgery achieves the highest published cure rates for high-risk locations. Advanced or metastatic SCC requires systemic therapy and multidisciplinary management.

How fast does SCC grow?

Faster than BCC. Many SCCs develop over weeks to months. Rapid growth — especially in immunosuppressed patients — can indicate aggressive histology. Any new or growing lesion should be evaluated promptly rather than observed at home.

What is the difference between SCC and melanoma?

Both are serious skin cancers, but they arise from different cell types. Melanoma originates from melanocytes (pigment-producing cells) and carries a higher overall metastatic risk. SCC arises from keratinocytes and is typically red, pink, or flesh-colored with a crusted surface. Melanoma is typically more pigmented — brown, black, or multicolored. Both require biopsy for definitive diagnosis.

Can SCC appear in areas not exposed to the sun?

Yes. While most SCCs are UV-driven, they can also arise from HPV infection (anogenital and oral sites), chronic wounds, burn scars, and areas of chronic inflammation — all without direct UV exposure as the inciting event.

What makes an SCC high-risk?

High-risk features include: tumor size greater than 2 cm, invasion depth greater than 2 mm, poorly differentiated histology, perineural invasion, location on the lip or ear, recurrence after prior treatment, and patient immunosuppression. High-risk SCCs have significantly higher metastatic rates and require more aggressive surgical margins and follow-up.

Schedule Your Skin Cancer Screening in New Braunfels

If you’ve noticed a rough, crusted, or non-healing spot — especially on sun-exposed skin — don’t wait. Squamous cell carcinoma caught early is highly curable. Left untreated, it can spread to lymph nodes and require significantly more intensive treatment.

Patients across New Braunfels, Seguin, Canyon Lake, and San Marcos trust Dr. Hockley and Dr. Stahr at Elect Dermatology for comprehensive skin cancer screenings and the full range of skin cancer removal options including Mohs micrographic surgery.

📞 Call (833) 353-2875 to schedule your appointment.
📍 2154 Gabriels Pl, Ste 103, New Braunfels, TX 78130

References

1. American Cancer Society. Basal and Squamous Cell Skin Cancer Statistics. Accessed 2025.
2. American Academy of Dermatology. Squamous Cell Carcinoma: Overview. Accessed 2025.
3. Schmults CD, et al. “Guidelines of care for the management of cutaneous squamous cell carcinoma.” Journal of the American Academy of Dermatology. 2023;88(4):e1–e13. PubMed.
4. Waldman A, Schmults C. “Cutaneous squamous cell carcinoma.” Hematology/Oncology Clinics of North America. 2019;33(1):1–12. PubMed.
5. Migden MR, et al. “PD-1 Blockade with Cemiplimab in Advanced Cutaneous Squamous-Cell Carcinoma.” New England Journal of Medicine. 2018;379(4):341–351. PubMed.
6. Skin Cancer Foundation. Squamous Cell Carcinoma. Accessed 2025.

Related: Who Is Most at Risk for Skin Cancer in Texas?