A Functional Medicine Approach to Squamous Cell Skin Cancer

Squamous cell skin cancer (SCC) is a type of non-melanoma skin cancer that is the second most common type of skin cancer overall after basal cell carcinoma. Many years of chronic exposure to the sun’s UV rays increases the risk of this cancer developing.

The rate of SCC has risen significantly over the past 30 years, increasing by over 200%. Over 1 million people are diagnosed with this type of cancer each year in the US with the highest incidence in people over age 50. SCC is about two times more common in people assigned male at birth. 

Functional medicine helps to look at risk factors that contribute to why this type of cancer forms and addresses the whole person’s health with a personalized prevention and treatment approach. Nutrition, supplements, and lifestyle measures can all reduce skin damage from UV exposure to prevent and address SCC. This helps result in more favorable outcomes when SCC is found and treated early.

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What is Squamous Cell Skin Cancer?

Squamous cell skin cancers are tumors that form when there is an overproduction of squamous cells in your epidermis that form the outer layer of your skin. If not detected and treated early, these cutaneous tumors can sometimes start in the skin and then metastasize to other parts of your body.

The first signs of SCC are usually changes to the skin like the formation of a rough bump or growth that can crust over like a scab and bleed and may keep recurring chronically without truly healing. It may have a change in color or display dry and cracked skin. SCC can start as precursor lesions known as actinic keratosis that progress to SCC in about 5-10% of cases without treatment. When SCC occurs on the mucus membranes of the mouth, tongue, gums, or cheeks, it can present with leukoplakia that appears as white or pale spots.

This out-of-control growth of squamous cells is triggered by a mutation to the p53 gene. This tumor suppressor gene normally directs your cells to divide and replicate in order to replace cells as needed. When a mistake (mutation) occurs in these instructions, squamous cells divide and replicate too often forming excessive collections of cells or tumors. 

Most commonly, this occurs due to chronic exposure to UV radiation from sun exposure and/or sun damage/burns at a young age. As such, SCC most commonly occurs on areas of your skin on your head, face, arms, and legs that receive the most sun exposure. Squamous cell cancers can also form within mucous membranes that line body cavities in your mouth, lungs, and anus. 

People with certain traits like a pale complexion, blue or green eyes, or blonde or red hair and those with a weakened immune system or on immunosuppressant medications after an organ transplant are more likely to develop SCC. Exposure to certain environmental factors like arsenic or cigarette smoking further increases the risk of this type of skin cancer. 

The Functional Medicine Perspective

To address cancers like SCC, functional medicine identifies and addresses the root causes of diseases. This approach emphasizes prevention, addressing underlying factors that contribute to imbalances, and supporting the body's innate healing capacity. Holistic health care offers an empowering approach that can enhance quality of life and outcomes. 

The individualized approach provided by functional medicine starts by listening to the patient and investigating potential contributing factors to the disease. Looking at the root causes of disease not only improves treatment outcomes for acute disease but also aims to prevent future disease. 

Functional medicine also addresses lifestyle and environmental factors to treat the whole person with a holistic approach. This can support the patient during cancer treatment, decrease side effects, and increase the quality of life. 

For example, the immune system plays a key role in regulating inflammation and surveying the body for early signs of cancers like SCC. As shown by the elevated rates of SCC in those whose immune systems are suppressed, immune cells play critical roles in helping prevent a microenvironment in which cancer can grow and spread. 

SCC develops within a tumor microenvironment that is made up of immune cells like dendritic cells, macrophages, natural killer (NK) cells, CD4+ and CD8+ T cells, and T regulatory cells, along with blood vessels, nerve cells, fibroblasts, and the cancer cells themselves. These cells can exert effects that suppress or promote the formation of cancer depending on many factors. For example, immune cells including T-cells and macrophages can detect early cancer cells and secrete inflammatory signals and chemicals that suppress further tumor formation. On the other hand, chronic UV exposure can trigger the secretion of inflammatory cytokines that promote the growth and survival of the SCC tumor.

Identifying Root Causes of SCC in Functional Medicine

From a functional medicine viewpoint, many potential factors can contribute to the imbalances in the cellular microenvironment that allow SCC to form. These include nutritional deficiencies, toxin exposure, and inflammation. A comprehensive patient history and lifestyle assessment is a key component of a functional medicine approach that helps in identifying these root causes.

Environmental factors influence the cellular environment in which skin cancer develops. 

Repetitive exposure to ultraviolet (UV) radiation can directly damage DNA and result in increased oxidative stress and oxidative damage of DNA, proteins, and lipids. These impacts stimulate inflammation and can suppress immune system responses that normally prevent cancer from developing. X-rays and other sources of radiation can induce similar changes that may contribute to the formation of SCC. 

In addition to DNA damage that occurs due to chronic exposure to UV radiation from the sun or tanning lamps, toxic exposures can also play a role as root causes of SCC. These include toxins like alcohol, cigarettes, and arsenic which are carcinogens that can contribute to the development of skin cancers like SCC. Arsenic exposure most frequently occurs from drinking contaminated water or via occupational exposures. 

Exposure to other chemicals like insecticides, herbicides, and fungicides can also contribute to an increased risk of skin cancers like SCC. 

Preventative Strategies in Functional Medicine

Your skin is your largest organ, provides a barrier between you and the outside world, and helps you regulate your body temperature. Functional medicine helps keep the skin healthy by addressing the many ways that lifestyle, diet, and environment impact skin health. These include implementing sun protection strategies for safer sun exposure, implementing dietary measures to support immune health and balanced inflammation levels, and avoiding carcinogenic exposures. 

A key pathophysiologic process that leads to DNA damage underlying cancers like SCC involves oxidative stress caused by reactive oxygen species. These reactive molecules are created by metabolic processes and insults like UV radiation and can create DNA damage that leads to skin damage and cancer. 

UV damage is one of the largest risk factors for the development of skin cancers such as SCC. Practicing safe sun exposure can minimize the amount of UV radiation damage that occurs in your skin. Avoid unprotected sun exposure when the UVB rays are strongest between 10 a.m. and 4 p.m. Wear sun-protective clothing, sunglasses, and a wide-brimmed hat to protect the delicate skin of the face that is prone to developing SCC.

Dietary approaches can also help reduce the risk of SCC by increasing dietary antioxidants that help mitigate oxidative stress. People with SCC have increased oxidative stress and lower antioxidant levels. Eating a balanced anti-inflammatory diet rich in colorful fruits and vegetables supplies plenty of antioxidants like beta-carotene and vitamins C, E, and A that help combat free radicals and prevent UV damage to the skin that can lead to SCC. This way of eating supplies adequate nutrients to nourish and protect the skin from within.

In particular, antioxidant polyphenols like carotenoids help to scavenge free radicals to protect your skin from UV damage. These phytonutrients give rich color to foods like carrots, squash, and sweet potatoes so consuming a colorful variety of produce can help you get a range of antioxidant benefits. 

Plant-based foods strawberries, bell peppers, and broccoli are also good sources of vitamin C. This water-soluble vitamin is a powerful intracellular antioxidant and supports the formation of collagen to keep your skin healthy. Similarly, vitamin E is another antioxidant that mitigates damage to the skin that occurs from chronic exposure to UVB radiation. You can increase your intake of this fat-soluble vitamin by incorporating almonds, soybeans, and wheat germ into your diet.

Another nutrient that helps support skin health and can prevent SCC by reducing free radical damage caused by too much exposure to UV radiation is omega-3 fatty acids. Eating whole foods like salmon and walnuts supplies this skin-supporting nutrient. 

Functional Medicine Treatment Approaches to SCC

In addition to increasing skin health and mitigating oxidative stress through diet, supplementation and lifestyle measures can help to optimize immune function and reduce the risk of developing skin cancers like SCC. Functional medicine treatment for SCC integrates nutrition and supplementation support with lifestyle modifications like meaningful stress management as part of a personalized approach.  

The B vitamin nicotinamide can be used topically or taken orally to reduce oxidative stress, helping to mitigate the impacts of UV damage on the skin and supporting DNA repair. Nicotinamide can help prevent SCC in high-risk individuals and reduce new actinic keratoses from forming. Studies show that taking this form of vitamin B3 orally at a dose of 500 mg twice daily has been shown to reduce the number and severity of SCC. 

Another nutrient that can be consumed in the diet and/or taken in supplement form to reduce the risk of SCC is green tea (Camellia sinensis). Green tea is rich in polyphenols like epigallocatechin gallate (EGCG) that provide powerful antioxidant benefits to reduce free radical damage to DNA. EGCG and other polyphenols in green tea help to prevent SCC from forming or growing.

Another lifestyle factor that significantly impacts skin health and the chance of developing cancer is chronic stress. Over time, stress exposes the body to chronically elevated levels of hormones like cortisol that can suppress the immune system and reduce skin cell-mediated immunity that helps to prevent skin cancers from developing. Practicing mind-body methods like breathwork, yoga, meditation, and prayer can help you manage stress. 

Good skin health and immune function also require quality restorative sleep. Aim to get at least 7-9 hours of sleep each night and keep your bedroom quiet, cool, and dark. 

One way to manage stress, ensure better sleep, and support immune health to prevent skin cancers like SCC is to engage in regular exercise. Physical activity benefits immune function and cancer survival by boosting natural killer cell function and balancing inflammation. 

When to Seek Conventional Treatments

Conventional treatments for SCC generally begin with surgical excision of the cancerous lesion. To confirm the diagnosis of SCC, a skin biopsy is usually done that removes a sample of the lesion for examination of the affected skin under a microscope. Imaging studies like MRI or CT scans can be used to assess any metastatic spread beyond the skin.  

To remove localized SCC from the skin, various modalities can be used depending on the type, size, location, and depth of the tumor. Mohs micrographic surgery offers a precise surgical removal technique for skin cancers like SCC to help preserve healthy tissue while removing the entire cancer. This approach removes the tumor layer-by-layer with repeated microscopic examination of the edges of the surgical field to ensure complete removal. 

For early precursor actinic keratosis lesions, topical chemotherapy medications such as 5-fluorouracil (5-FU) cream, imiquimod cream, and tirbanibulin ointment are often used. 5-FU may also be injected into skin cancer lesions to induce resolution. Another topical option used to treat SCC precursor lesions is diclofenac sodium gel. This nonsteroidal anti-inflammatory drug (NSAID) is applied twice daily for 2 or 3 months.

Photodynamic therapy is another method used to address precursor or small lesions. This technique involves the application of photosensitizing agents followed by exposure to blue light to destroy cancer cells from the skin.

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Key Takeaways

SCC is a common type of non-melanoma skin cancer that most frequently forms after years of chronic sun exposure. This condition commonly presents as rough, scaly patches on the skin of the face, lips, ears, forearms, scalp, neck, or back of the hands that can scab or bleed. 

A functional medicine approach to SCC emphasizes a holistic approach to treating and preventing SCC. Consultation with a multidisciplinary team of healthcare professionals can offer comprehensive care tailored to each individual’s needs and preferences. Collaborative care involving dermatologists, oncologists, and functional medicine practitioners offers a personalized approach to caring for and preventing SCC.

Approaching prevention and treatment of skin cancers like SCC with functional medicine integrates dietary interventions, lifestyle changes, and targeted supplementation to strengthen the overall terrain of the body, mitigate oxidative stress, and reduce the chance of skin cancer forming. Creating a microenvironment in the skin with balanced inflammation and immune function makes it less likely that DNA damage will persist and allow tumors to form.