Assessing Cutaneous Squamous Cell Carcinoma in People of Color

Sponsored by Regeneron

An estimated 3.3 million people are diagnosed with non-melanoma skin cancer (NMSC) in the U.S. each year.¹ While these cases can be caught at an early stage when the cancer is highly treatable,^2,3 people of color who present with NMSC are often diagnosed at a later stage, leading to worse overall prognosis and outcomes.⁴

The reasons for later diagnosis in people of color may be multifactorial, ranging from lack of awareness about their risk factors to lower accessibility to care.^4,5 As such, healthcare providers should make an effort to discuss skin cancer risks more often with their patients of color to increase awareness and early detection and diagnosis,⁴ especially of NMSCs such as cutaneous squamous cell carcinoma (CSCC), which is the most common form of skin cancer in Black people and is very common in Asian people.^6,7

Identification of CSCC in People of Color

Skin cancer is far more common in white people than people of color,⁵ which has led to a misconception that people of color are not susceptible to skin cancer. With so many other health factors to consider, sometimes even healthcare providers may not initially look for a potential skin cancer diagnosis,⁴ which is why it is so important for patients and doctors alike to recognize the different ways that skin cancer can present.

In light-skinned people, CSCC usually appears in sun-exposed areas of the skin as elevated, wart-like growths or scaly lesions that look crusted, red, and bumpy or like non-healing sores that occasionally bleed.^4,6

However, in people of color, the lesions can be more darkly pigmented and are eight times more likely to occur in areas of the skin that get less sun exposure, such as the lower extremities and anogenital region.^8,9 In fact, in Black and Asian people, 60 to 70 percent of skin cancer arises on areas of the skin that are less pigmented and exposed.⁴ The soles of the feet are the most common site of origin.⁴

Previous trauma—such as cuts, burns, or other wounds—ulcers, and scars are the most significant predisposing factors for CSCCs in the lower limb and on the scalp.⁶ About 20 to 40 percent of CSCC that develops in Black patients occurs at sites of chronic inflammation or scarring, and skin cancer that originates at these locations is more likely to metastasize.⁵

Early Detection of CSCC

Regular self-exams and exams by a healthcare professional can help promote earlier detection of skin cancer.² And since lesions may occur on less exposed parts of the body, where they are less likely to be noticed, a professional skin exam could potentially be very important for people of color at high risk of skin cancer.⁴

People of color may face challenges in accessing healthcare specialists,⁴ which highlights the importance of facilitating necessary exams. Collaborations between primary care physicians and local dermatology clinics could enhance access to specialized care.

During regular checkups, it can be beneficial to discuss sun protection habits, such as the use of sunscreen, and to emphasize that anyone—regardless of skin tone—can be at risk for skin cancer. It is also important to be aware of any new growths, lesions or changes in skin color and to seek medical advice promptly if any are noticed.

Treatment Options for CSCC

In its early stages, CSCC may be treated surgically with a variety of techniques or topical medicines,¹⁰ as well as radiation therapy or systemic chemotherapy for tumors that are larger or less accessible.¹¹

Approximately 2-4% of CSCC cases in the U.S. become advanced.¹² CSCC may be considered advanced if the tumor grows larger than 4 cm, becomes invasive, or metastasizes.¹³ Advanced CSCC is associated with high mortality,¹² resulting in approximately 7,000 deaths annually in the U.S.^14,15

When CSCC is advanced—as it often is when diagnosed in people of color—different treatment approaches have to be considered. For example, these may include surgery, radiation or systemic therapies such as chemotherapy or immunotherapy.^16,17

A Multidisciplinary Approach to CSCC

Due to the varied presentation of CSCC and numerous potential treatment options, patients often require a multidisciplinary team to evaluate and treat their condition.¹⁸ Coordination of care between specialists in dermatology, radiology, surgery, and oncology can be key when establishing a treatment plan.¹⁸ In addition to physicians, other professionals like pathologists and pharmacists are important parts of the care team.¹⁸

When considering multidisciplinary approaches to CSCC management, it’s important to keep in mind the socioeconomic and geographic factors that can impact a patient’s ability to reach certain screening or treatment facilities or access pharmacies to refill prescriptions. Given these barriers, it might be a good idea to connect with local providers such as primary care physicians and pharmacists to secure plausible avenues of follow-up care for patients of color when their access to specialists is more limited.

Tied with consideration for the difference in risk factors and CSCC manifestation, recognizing and addressing the special circumstances that limit a person of color’s access to healthcare is an important part of managing inequities and improving patient outcomes.

References:

1. Basal & Squamous Cell Skin Cancer Statistics. American Cancer Society. October 31, 2023. Accessed February 28, 2025. https://www.cancer.org/cancer/types/basal-and-squamous-cell-skin-cancer/about/key-statistics.html
2. Basal and Squamous Cell Skin Cancer Early Detection, Diagnosis, and Staging. Published online October 31, 2023. Accessed February 28, 2025. https://www.cancer.org/content/dam/CRC/PDF/Public/8820.00.pdf
3. Migden MR, Chang ALS, Dirix L, Stratigos AJ, Lear JT. Emerging trends in the treatment of advanced basal cell carcinoma. Cancer Treatment Reviews. 2018;64:1-10. doi:10.1016/j.ctrv.2017.12.009
4. Gupta AK, Bharadwaj M, Mehrotra R. Skin Cancer Concerns in People of Color: Risk Factors and Prevention. Asian Pac J Cancer Prev. 2016;17(12):5257-5264. doi:10.22034/APJCP.2016.17.12.5257
5. Shao K, Feng H. Racial and Ethnic Healthcare Disparities in Skin Cancer in the United States: A Review of Existing Inequities, Contributing Factors, and Potential Solutions. J Clin Aesthet Dermatol. 2022;15(7):16-22.
6. Gloster HM, Neal K. Skin cancer in skin of color. Journal of the American Academy of Dermatology. 2006;55(5):741-760. doi:10.1016/j.jaad.2005.08.063
7. Jackson BA. Nonmelanoma skin cancer in persons of color. Semin Cutan Med Surg. 2009;28(2):93-95. doi:10.1016/j.sder.2009.04.010
8. Bradford PT. Skin Cancer in Skin of Color. Dermatol Nurs. 2009;21(4):170-178.
9. Skin Cancer in People of Color. Skin Cancer Foundation. February 2025. Accessed February 24, 2025. https://www.skincancer.org/skin-cancer-information/skin-cancer-skin-of-color/
10. Squamous Cell Carcinoma Treatment. The Skin Cancer Foundation. January 2025. Accessed February 24, 2025. https://www.skincancer.org/skin-cancer-information/squamous-cell-carcinoma/scc-treatment-options/
11. Treating Basal & Squamous Cell Skin Cancer | Squamous Cell Treatment. American Cancer Society. 2025. Accessed February 24, 2025. https://www.cancer.org/cancer/types/basal-and-squamous-cell-skin-cancer/treating.html
12. Burton KA, Ashack KA, Khachemoune A. Cutaneous Squamous Cell Carcinoma: A Review of High-Risk and Metastatic Disease. Am J Clin Dermatol. 2016;17(5):491-508. doi:10.1007/s40257-016-0207-3
13. AJCC Cancer Staging Manual. In: AJCC Cancer Staging Manual. Springer International Publishing; 2017. doi:10.1007/978-3-319-40618-3_15
14. Rogers HW, Weinstock MA, Feldman SR, Coldiron BM. Incidence Estimate of Nonmelanoma Skin Cancer (Keratinocyte Carcinomas) in the US Population, 2012. JAMA Dermatol. 2015;151(10):1081. doi:10.1001/jamadermatol.2015.1187
15. Clayman GL, Lee JJ, Holsinger FC, et al. Mortality risk from squamous cell skin cancer. J Clin Oncol. 2005;23(4):759-765. doi:10.1200/JCO.2005.02.155
16. Alam M, Armstrong A, Baum C, et al. Guidelines of care for the management of cutaneous squamous cell carcinoma. Journal of the American Academy of Dermatology. 2018;78(3):560-578. doi:10.1016/j.jaad.2017.10.007
17. Basal & Squamous Cell Immunotherapy | Non Melanoma Immunotherapy. American Cancer Society. December 16, 2024. Accessed February 24, 2025. https://www.cancer.org/cancer/types/basal-and-squamous-cell-skin-cancer/treating/immunotherapy.html
18. Kamowitz B. Building Your Skin Cancer Team. The Skin Cancer Foundation. December 12, 2023. Accessed February 24, 2025. https://www.skincancer.org/blog/building-your-skin-cancer-team/

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