Surgical intervention remains the gold standard for treating squamous cell carcinoma because it allows for the physical removal of the tumour and a precise laboratory analysis of the tissue margins. In the United Kingdom, most patients are offered surgical excision as their primary treatment to ensure the highest possible chance of a definitive cure. However, surgery is not the only clinical pathway available. Non-surgical options exist and are frequently used for patients who may not be suitable for an operation due to underlying health conditions, or for those with tumours located in areas where surgery would cause significant functional or cosmetic issues. The choice between a surgical or non-surgical approach is a collaborative decision made by the patient and their specialist medical team based on the specific characteristics of the cancer.
What We’ll Discuss in This Article
- Why surgical excision is the preferred clinical treatment
- Radiotherapy as a primary non-surgical alternative
- The use of curettage and cautery for superficial lesions
- Systemic treatments including immunotherapy for advanced disease
- Factors that influence the choice of treatment pathway
- The role of the multidisciplinary team in treatment selection
The clinical preference for surgical excision
Surgical excision is the most common and reliable method for treating squamous cell carcinoma within the British healthcare system. The primary advantage of this approach is that it provides a tissue sample that a pathologist can examine under a microscope to confirm that all cancer cells have been removed. The National Health Service explains that surgery is the main treatment for squamous cell carcinoma and involve cutting out the cancer along with a small area of healthy skin around it.
By achieving clear margins, the risk of the cancer returning in the same location is significantly reduced. Surgery is typically a quick procedure performed under local anaesthetic, allowing the patient to return home on the same day. While it does result in a permanent scar, modern surgical techniques are designed to place incisions along the natural lines of the skin to ensure the best possible aesthetic result. For the majority of localised skin cancers, this one-off procedure is sufficient to achieve a complete cure without the need for further intervention.
Radiotherapy as a non-surgical alternative
Radiotherapy is the most significant non-surgical alternative for patients with squamous cell carcinoma. It uses high-energy X-rays to target and destroy cancer cells by damaging their DNA, preventing them from multiplying. This option is frequently recommended for individuals who are elderly or have complex medical needs that make surgery or anaesthesia riskier. It is also a vital tool for treating tumours on the face, such as on the nose or eyelids, where an operation might be particularly complex.
A typical course of radiotherapy involves several short treatment sessions delivered over a few weeks. NICE clinical guidelines suggest that radiotherapy should be offered as a primary treatment for squamous cell carcinoma when surgery is not feasible or would result in unacceptable cosmetic or functional damage. While the treatment itself is painless, the skin in the treated area may become red and sore, similar to a sunburn, before healing over several weeks. Radiotherapy offers cure rates that are often comparable to surgery for appropriately selected tumours, making it a robust pillar of skin cancer care in the UK.
Curettage and cautery for minor lesions
Curettage and cautery is a minor surgical technique that is often viewed as a less invasive alternative to a formal excision. It is typically reserved for very small, superficial, or early-stage squamous cell carcinomas that have not grown deeply into the skin layers. The procedure involve the clinician numbing the area and then using a sharp, spoon-shaped instrument called a curette to scrape away the abnormal cells. Following the scraping, an electric needle (cautery) is used to stop any bleeding and destroy any remaining malignant cells at the base.
This method is quick and does not require stitches, making it a convenient option for patients with multiple small lesions on the trunk or limbs. Because it relies on the clinician being able to feel the difference between the softer cancerous tissue and the firmer healthy skin, it is only suitable for specific low-risk subtypes. If there is any concern that the cancer has invaded deeper into the dermis, a formal excision is generally preferred to ensure that the full depth of the tumour is addressed and verified by a pathologist.
Systemic therapies and immunotherapy
For a small number of patients with advanced squamous cell carcinoma that has spread to other parts of the body or cannot be managed with surgery or radiation, modern systemic treatments are available. Immunotherapy is a significant development in this field, using medications such as cemiplimab to stimulate the patient’s own immune system to recognise and attack the cancer cells. These treatments are delivered as an intravenous infusion in a hospital setting and represent a major shift in how advanced skin cancer is managed.
Unlike surgery, which targets a specific spot, systemic therapies work throughout the entire body. They are often used when a tumour is too large for surgery or if the cancer has reached the regional lymph nodes or distant organs. These medications are managed by consultant oncologists who monitor the patient for any side effects related to an overactive immune response. While these are not considered standard first-line treatments for simple skin cancers, they provide a vital safety net for patients with complex or metastatic disease, offering hope where traditional options may be limited.
Factors influencing the choice of treatment
The decision between a surgical or non-surgical approach is based on a thorough clinical assessment of several key factors. The medical team will consider:
- The location of the tumour: Facial lesions often require different considerations than those on the legs or arms.
- Tumour size and depth: Larger or deeper tumours are more likely to require formal surgery to ensure total clearance.
- General health and age: A patient’s ability to undergo minor surgery and heal effectively is a major consideration.
- Patient preference: Some individuals may prefer the immediate result of surgery, while others may opt for the non-invasive nature of radiotherapy.
- Previous treatments: If a cancer has returned in an area that has already had surgery or radiation, the alternative method may be recommended.
In the UK, complex cases are often discussed in a multidisciplinary team meeting. This involve dermatologists, surgeons, and oncologists reviewing the patient’s diagnostic results to agree on the safest and most effective treatment plan. This collaborative approach ensures that the chosen pathway is tailored to the individual, balancing the clinical need for a cure with the patient’s quality of life and personal circumstances.
Conclusion
While surgery is the primary and most frequent treatment for squamous cell carcinoma in the UK, it is not the only option. Radiotherapy provides a highly effective non-surgical alternative, especially for those in high-risk locations or with complex health needs. Minor techniques like curettage and cautery, and advanced systemic therapies like immunotherapy, ensure that every patient has access to a treatment plan that is appropriate for their specific diagnosis. If you experience severe, sudden, or worsening symptoms, call 999 immediately.
Is radiotherapy as effective as surgery for SCC?
For many tumours, radiotherapy offers cure rates that are very similar to surgery, although it does not provide the same histological confirmation of clear margins.
Can I have cream to treat my SCC?
Medicinal creams are usually reserved for pre-cancerous conditions or very superficial cancers; invasive squamous cell carcinoma generally requires more definitive treatment like surgery or radiation.
What happens if I cannot have surgery due to my health?
If surgery is not a safe option for you, your specialist will discuss other effective treatments such as radiotherapy to manage the cancer.
Does a non-surgical treatment take longer?
Yes, while surgery is often a one-off procedure, non-surgical options like radiotherapy typically require multiple visits to the hospital over several weeks.
Will my skin look better after radiotherapy than surgery?
This depends on the location; in some areas, radiotherapy can offer a superior cosmetic result by avoiding the need for complex skin grafts or flaps.
Is immunotherapy available for all types of SCC?
No, immunotherapy is specifically reserved for advanced or metastatic squamous cell carcinoma that cannot be treated with surgery or radiation.
How do I decide between surgery and radiation?
Your specialist will provide you with the clinical evidence for both options, helping you to weigh up the benefits and risks based on your individual case.
Authority Snapshot (E-E-A-T)
This article is designed to provide clear and factual information regarding skin health for the general public. The content is written by the Medical Content Team and has been reviewed by Dr. Stefan Petrov. He is a UK-trained physician with an MBBS and postgraduate certifications including Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), and the UK Medical Licensing Assessment (PLAB 1 & 2). He has hands-on experience in general medicine, surgery, anaesthesia, ophthalmology, and emergency care. Dr. Petrov has worked in both hospital wards and intensive care units, performing diagnostic and therapeutic procedures, and has contributed to medical education by creating patient-focused health content and teaching clinical skills to junior doctors.
