In brief

Treatment Options for Squamous Cell Carcinoma of the Dorsal Hand Including Mohs Micrographic Surgery

Cryosurgery

Cryosurgery with liquid nitrogen (–195.8°C) can be performed quickly in an outpatient setting with minimal specialized equipment. Curettage or debulking may be required prior to therapy to ensure rapid tumor freeze to a goal of –50°C to –60°C at the base of the tumor. Temperature must be measured with a thermocouple needle or estimated with 2 freeze-thaw cycles of 40 to 90 seconds each to ensure sufficient destruction.² One study demonstrated a 5-year cure rate of 94% for squamous cell

Electrodessication and Curettage

Electrodessication and curettage is an effective method of treatment for squamous cell carcinoma with indications similar to those for cryotherapy. For nonaggressive tumors, electrodessication and curettage is an alternative first-line treatment with up to 99% cure rate after 4-year follow-up.⁴ However, cure rates are technique dependent and improve with the practitioner's experience. The treatment's success is based on tumor tissue being more friable than normal skin. Typically, a

Photodynamic Therapy

Photodynamic therapy is frequently used to treat actinic keratoses. Photodynamic therapy involves the application of a topical photosensitizer with subsequent exposure of the lesion to visible light, resulting in damage to neoplastic cells. Based on current evidence, photodynamic therapy is recommended only for squamous cell carcinoma in situ or in nonsurgical candidates. Invasive squamous cell carcinoma should not be treated with photodynamic therapy. Photodynamic therapy is advantageous when

Radiation Therapy

Radiation therapy is an important alternative to surgical treatment of squamous cell carcinoma, especially for older patients, patients with multiple comorbidities, and for treatment of large lesions that are not amenable to surgical excision. The 5-year cure rate for primary squamous cell carcinoma is approximately 90%.⁵ Radiation therapy lacks margin control, has a prolonged course of treatment, and increases the risk of future squamous cell carcinoma within the radiation field. It can be

Medical Treatment

Several studies have shown success in treating squamous cell carcinoma in situ with both topical 5-fluorouracil and imiquimod; however, both topical medications are currently only Food and Drug Administration–approved to treat actinic keratosis and superficial basal cell carcinoma. Although intralesional agents including 5-fluorouracil, bleomycin, and interferon-α are not widely used to treat squamous cell carcinoma, these therapies remain as additional nonsurgical alternatives.

Standard Excision

Unlike the therapeutic modalities for squamous cell carcinoma addressed until this point, standard surgical excision performed in an outpatient clinic setting or in the operating room allows for margin control through histopathologic evaluation. Current practice is based on the pivotal study from Brodland and Zitelli, which demonstrated that 6-mm margins are required for high-risk squamous cell carcinoma (in this study, high-risk lesions were defined as those with size >2 cm, poor

Mohs Micrographic Surgery

Since the 1930s when Dr. Frederick Mohs pioneered the technique that bears his name, its procedural components and indications have continued to evolve. Today, Mohs micrographic surgery offers the highest cure rates for nonmelanoma skin cancers, including for squamous cell carcinoma. It not only permits histologic verification of complete tumor removal while maximizing tissue conservation but is also cost-effective when compared with excisions that require hospital operating room time.

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