What Does Squamous Cell Carcinoma Look Like?

When caught early, most cases of squamous cell carcinoma (SCC)—the second most common type of skin cancer—are curable. Knowing the early warning signs is critical to receiving an early diagnosis and treatment. 

Where Squamous Cell Carcinoma Occurs

SCC can be found anywhere on the body, but is most commonly seen in sun-exposed areas. Common SCC sites include the face, ears, lips, scalp, shoulders, neck, hands, and forearms. It’s also possible to be diagnosed with SCC in areas without sun exposure, such as inside the mouth, under fingernails or toenails, on the genitals, or in the anus. 

Precancerous Stage

The earlier SCC is caught and treated, the higher the likelihood that it will be cured. While it’s important to be able to recognize the signs of cancer, it’s also essential to be able to identify the signs and symptoms of precancer.

As areas of our skin are damaged by the sun, their shape and color begin to change. Knowing what these changes look like can help you seek treatment from your dermatologist early. It’s possible to treat and remove precancerous growths before they ever turn into skin cancer.

Early Signs of Sun Damage 

Age spots, discolored skin, and deep wrinkles are all signs of damage to the skin caused by the sun’s UV rays. These symptoms can also be related to tanning bed use. A loss of skin firmness and elasticity is another sign of sun damage. Changes to the skin can later turn into precancerous growths. 

Precancerous Lesions

Precancerous lesions are changes to the skin that result from sun damage. It’s estimated that 40% to 60% of all SCC cases first begin as precancers.  

The most common form of SCC precancer is actinic keratosis, also called solar keratosis. These growths form mainly because of exposure to UV rays (photo cancerization), and once you develop one, you are at high risk of developing more. Estimates of the 10-year rate of malignant transformation of actinic keratosis (the likelihood that they'll become cancerous) range from 6% to 10%, with approximately 60% of squamous cell carcinomas arising from actinic keratosis.

An actinic keratosis looks like a small, rough patch of skin. It may be scaly and crusty as well. Possible colors of these lesions include reddish or brownish hues. Some of these growths can also be invisible to the naked eye. Actinic keratoses are often easier to feel than to see. They most often appear on sun-exposed areas like the face, ears, lips, scalp, shoulders, neck, and hands. 

Other types of SCC precancerous lesions include:

• Actinic cheilitis: A precancerous growth usually affecting the lower lip. It appears as a patch of dry, scaly skin that is pale or white.
• Leukoplakias: White patches found inside the mouth. They usually affect the tongue, lips, gums, and cheeks. They may be caused by sun damage or chronic irritation from tobacco or alcohol.
• Bowen’s disease: Also known as squamous cell carcinoma in situ, this is an early, noninvasive phase of SCC. The affected patch of skin resembles eczema, and is often scaly and red. It is usually caused by sun damage or exposure to chemicals. 

Scaly Red Patches

SCC can first appear as a thick, rough patch of skin. It is often red and scaly. While it is usually painless, it may ooze or bleed. The scaly patch of skin, also known as hyperkeratosis, will have irregular borders and may be itchy. 

This feature can help differentiate between squamous cell carcinoma and basal cell carcinoma, the most common form of skin cancer. Basal cell carcinoma most commonly appears as a pearly white, dome-shaped papule (bump) with prominent telangiectatic surface vessels (meaning you can see tiny dilated blood vessels), while squamous cell carcinoma most commonly appears as a firm, smooth, or thickened papule or plaque, often with a break on the skin in the middle. 

Open Sores

SCC lesions can develop in open sores or scars that you already have. They can also progress to resemble an open sore on their own. The sore may bleed and ooze, then crust over. If you notice a sore that never seems to heal, it’s time to get it checked out. You may also notice that the lesion appears to get better, but then quickly returns. This is another sign that it’s time to see the dermatologist. 

Elevated Growths

As SCC lesions progress, they may appear elevated, especially around the edges. While the edges are raised, the center of the sore looks sunken or depressed. The elevated growth is usually pink or red, but can also be flesh-colored. At this point in the disease, the lesion can start to spread more quickly.

Wart-Like Nodule

Finally, an SCC lesion can start to resemble a wart with raised edges. The area may bleed and crust over, but never heal. The lesion usually appears as a single wart and may grow in size. Advanced cases of SCC can appear as a small horn-shaped growth that turns brown.

A Word From Verywell

The earlier squamous cell carcinoma is diagnosed and treated, the better the outcome. Perform monthly skin self-checks to look for new skin growths, warts, or sores that don’t heal. While most cases of SCC are curable, this cancer can become disfiguring and even lead to death when left untreated. If you have any new skin growths that you’re concerned about, see your healthcare provider right away.