Giuseppe Spinelli

Squamous cell carcinoma


Oncological surgery

They are second frequency tumors compared to basaliomas, they show a particular incidence in Australia also due to their close association with the following factors:

  • Chronic exposure to solar radiation; therefore they are tumors that arise in photo-exposed regions of the body, as can be seen in the case of solar keratosis, therefore on the face, ears, scalp, lips.
  • An example is the farmer who during his whole life devotes himself to his field and exposes himself to large quantities of ultraviolet radiation, on this level one can already see the difference with respect to melanoma, which instead arises in subjects who for example practice “recreational” sun exposure and perhaps practice UV lamp sessions to maintain a tan.
  • Subjects characterized by a clear skin type.
  • Ulcer or wound that does not heal or as a result of burns.
  • Immunodepression states, so they can be observed in transplant patients.
  • Patients with xeroderma pigmentosum.

This tumor comes in the form of plaques or nodules, depending on the size it may or may not ulcerate. The classic sporadic squamous cell tumor, if well excised, does not relapse. Recurrences can occur in cases of incomplete excision, in case of large lesions and in case of lesions with low degree of differentiation.

Several histopathological variants are distinguished: acantholytic (spindle-shaped, adenoid-scaly), small cell, warty.

The squamous cell tumor metastasizes via the lymphatic system and only if the dimensions become noticeable even by blood (lung, liver, bones and brain).

The risk of neoplastic progression is greater when the carcinoma arises on skin that is not photo-exposed, therefore: the probability of having a squamous cell carcinoma on solar keratosis is 0.5%; if the skin is not photoexposed it becomes 2-3%. These percentages change if the carcinoma arises at the level of the lip, in a patient who is immunosuppressed or on chronic osteomyelitis.

As far as staging is concerned, this is based on the TNM.


Surgery is the therapy for squamous cell cancer. The objective is the complete surgical excision of the neoplasm without fear of damaging the anatomical structures involved. It will then be the task of the maxillofacial surgeon to provide reconstruction that can preserve the aesthetic-functional integrity of the structures involved.

In the case of a squamous cell tumor, surgical therapy may include the removal of the lymph nodes downstream of the anatomical district involved (laterocervical emptying) depending on the size and location.

The Radiotherapy can be used as a complementary treatment to surgery. Radiotherapy can be performed both on the tumor and on the neck, on both sites it has the function of “sterilizing” the surgical field according to the histological result (positive resection margins, involvement of one or more lymph node stations).

This type of cancer is not very sensitive to Chemotherapy, and this has a role that is almost exclusively palliative

Clinical cases
Case 1 - Cutaneous tumor SQUAMOUS CELL CARCINOMA - Attention, contains images of intervention

Squamous cell tumor – neoformazione removal – reconstruction with reconstructive flap


Typical appearance of squamous cell carcinoma. The upper eyelid is affected by the lateral half. carcinoma has a tendency to grow by invading neighboring structures.


On the RMN the involvement of the lateral orbital frame is highlighted.


Removal of the tumor and design of the reconstructive flap based on the anterior branches of the superficial temporal artery.


Cutaneous suture with rotation of the pedunculated cutaneous flap.


Preliminary post-operative result.

Case 2 - Cutaneous tumor SQUAMOUS CELL CARCINOMA - Attention, contains images of intervention

Squamous cell carcinoma of the nasal root and of the medial chant – excision of the neoformation – removal of the laterocervical metastases – reconstruction with deltopectoral flap


Squamous cell carcinoma of the nasal root and of the right eye medial chant.


Right laterocervical metastasis – at nasal level the results of removal of squamous cell carcinoma.


To the right lymph node metastasis TC with involvement of the parotid and mandibular branch.


Preoperative image – delineated metastasis resection margins.


Metastasis resection with part of the mandibular branch.


The pectoralis major muscle that will be transferred to its vessels in the region of the surgical defect.


The surgical defect – resection resulted in the removal of the branch and part of the mandibular body.


Setting up of a large deltopectoral flap.


The pectoral muscle flap at the site to fill the surgical defect.


Postoperative image – absence of part of the mandibular branch.