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Painful Squamous Cell Carcinoma in Situ?

dolphin99

Hello CRUK Nurses,

I'm terribly sorry to trouble you.

I recently had two rapidly evolving squamous cell carcinoma lesions on my scalp. Both were intensely painful when touched, however gently.

In June 2026 the referring GP who specialised in dermatology was clearly concerned about this. At my initial Dermatology appointment in September 2026 the consultant told me pain like this caused him to be very worried.

Both lesions were removed in excisional biopsies in October 2026.

When the surgeon gave me the lab results at the start of November 2026 I was told both lesions were in situ and no further treatment was necessary. This came as a surprise because I thought the agonising pain I'd experienced suggested nerve involvement beneath the dermis.

I'd therefore be really grateful if you could kindly help me understand how the mechanism of pain like this can be exclusively confined to the dermis.

Thanks so much in advance and very best wishes.

  • Hi there and thanks for your post

    I am very sorry to hear about your situation and the pain you have experienced.

    Pain is a very difficult thing to assess and is very individual to each patient, which is why it is important to speak with your doctor if the pain is on-going. If necessary they can refer you onto a specialist pain clinic to be assessed.

    Pain can be triggered by many different things and even if skin cancers are superficial if there are nerve endings close by this can cause pain. The scalp is also a very sensitive part of the body and this may also have enhanced the intensity of pain for you.

    I am sorry we can't answer your question more specifically on this occasion but do get back in touch if needed.

    Best wishes

    Naomi

  • in reply to CRUK Nurse Naomi

    Thanks, Naomi.

    Sorry, I now realise my question was poorly phrased.

    I should have asked if perineural invasion can be confined to the dermis without it spreading deeper. I wonder if you might have any thoughts about this?

    Thanks once again and best wishes. 

  • in reply to dolphin99

    Hi there dolphin99 and thanks for getting back in touch

    It sounds like this is playing on your mind quite alot. From what I can see perineural invasion occurs when the cancer cells have spread into nearby nerve endings. This is usually picked up by the pathologist when looking at the tissue samples under the microscope.

    There are small dermal nerves in the upper dermis as deeper down and it is my understanding if surgical removal is successful with clear margins the outlook is usually very good.

    If you remain worried I suggest speaking with the dermatologist to talk this and any other concerns with them.

    I hope this helps

    Naomi

  • in reply to CRUK Nurse Naomi

    Hi again, Naomi.

    Thanks so much for your swift response and very helpful explanation. Greatly appreciated.

    Thanks again and best wishes.

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