Squamous Cell Carcinoma

of the Nasal Planum in Cats and Dogs
Maurine Thomson, BVSc, FACVSc
The purpose of this article is to review the therapeutic options available for the treatment
of squamous cell carcinoma of the nasal planum in cats and dogs. The techniques of
complete and partial nasal planum resection in the cat are described in detail. Surgical
treatment offers the greatest chance of cure, although several options are available for
early, less invasive lesions.
Clin Tech Small Anim Pract 22:42-45 © 2007 Elsevier Inc. All rights reserved.
KEYWORDS squamous cell carcinoma, nasal planum, cat, dog

S

quamous cell carcinoma (SCC) of the nasal planum is
common in the cat but rare in the dog. SCC most commonly affects the nasal planum, pinnae, and eyelids of cats,
and the most frequently affected sites in the dog are the flank,
abdomen, and nail bed. It is usually a disease of older animals, with a mean age of 12 years in the cat and 8 years in the
dog.1,2 There is typically a chronic solar exposure, resulting
in progression from actinic changes to carcinoma in situ
(noninvasive carcinoma confined to the epidermis) to invasive carcinoma. White-haired cats have 13.4 times the risk of
developing SCC than other colored cats.3 Mutations of the
tumor-suppressor gene p53 have been found in greater than
50% of cats with nasal planar SCC.4 In dogs there is a high
incidence of nasal planar SCC reported in Labradors and golden
retrievers, with male dogs more frequently presented.5 SCC may
appear as either a proliferative or an erosive lesion. These
tumors of the nasal planum are generally locally invasive over
a long period of time from months to years, though slow to
metastasize. I have recognized several cases of a more aggressive lesion in cats that grows quickly and is associated with a
more aggressive histological subtype with the potential for
stromal lymphatic invasion. Metastases to local lymph nodes
and lungs can occur in advanced or poorly differentiated
lesions. Examination of patients involves a full physical examination, palpation of submandibular nodes, with cytology
or biopsy for definitive assessment of metastases. These patients are typically older animals, and full biochemical panels
and complete blood cell counts are advised before treatment.
Biopsy of the lesion is the only definitive method of diagnosis,
as cytology typically shows inflammation and superficial ulceration. A high index of suspicion of a SCC in cats is usually

Queensland Veterinary Specialists, Queensland, Australia.
Address reprint requests to Maurine Thomson, BVSc, FACVSc, Queensland
Veterinary Specialists, 263 Appleby Road, Stafford Heights, 4053
Queensland, Australia. E-mail: majthomson@optusnet.com.au

42

1096-2867/07/$-see front matter © 2007 Elsevier Inc. All rights reserved.
doi:10.1053/j.ctsap.2007.03.002

based on appearance and location, and treatment is often
instigated without a definitive diagnosis. I would recommend
initial biopsy in a nasal lesion in a dog as SCC is seen rarely in
this species, and other diseases are more likely.

Treatment of Feline
Nasal Planar SCC
Many treatment options are available in the early stage of the
disease, which include cryosurgery, radiation therapy, strontium-90 plesiotherapy, photodynamic therapy, intralesional
carboplatin, and excisional surgery.1,2,5-15

Cryosurgery
Cryosurgery is the destruction of tissue by the controlled use
of freezing and thawing. Cooling to ⫺20°C causes the death
of cells by the formation of intracellular and extracellular ice
crystals. This is maximized by rapid freezing and slow thawing over three cycles. Liquid nitrogen and nitrous oxide are
the two most commonly used cryogens. Spray freezing is
considered the most effective method of delivery (Fig. 1). In
one study of 90 cats with nasal planar lesions treated with
cryosurgery, 84% were tumor free at 12 months and 81%
were tumor free at 36 months, although many required multiple treatments.6 In a recent article, 73% of cases developed
recurrence after cryosurgery.8 I routinely use this modality
on superficial lesions of 4 mm diameter or smaller, but lesions greater than this usually are associated with a high local
recurrence. The advantage of this technique is that it is costeffective and readily available; the disadvantage is the higher
recurrence rate associated with tumors greater than 0.5 cm.

Radiation Therapy
Differing protocols have been published; patients with a
small volume of tumor have considerably longer disease-free
intervals and survival times than larger, more invasive tu-

but greater than 60% subsequently recurred. Another abstract describes 25 cats with lesions of the nasal planum of less than 3 mm diameter. Figure 2 Positioning and preparation of a cat for complete resection of the nasal planum. In one study 9 of 10 nasal planar lesions had a complete response to a single treatment. (Color version of figure is available online. Hemorrhage is significant after the first incision is made. Overall. and requirement of multiple anesthetics. One recent article describes the use of a strontium ophthalmic applicator in 15 cats.10 For more advanced lesions of the nasal planum. 2).) mors.9 Most lesions were 2 to 5 cm in diameter with minimal invasion. cost. Normally a small strip of skin and buccal mucosa can be preserved ventral to the philtrum. After inspection of the surgical site. as described by Withrow and Straw. with median survival times of 12 to 16 months. including a portion of deeper cartilaginous turbinates. My personal experience has been that a single purse-string suture. but not including.8 Smaller lesions can be cured. at the rostral lip margin. After induction of anesthesia. The cosmetic outcome was considered excellent. A circular drape is placed over the nasal region. The infraorbital blocks Photodynamic Therapy and Chemotherapy Photodynamic therapy and chemotherapy involves the systemic or local application of a photosensitizer that is preferentially taken up by tumor tissues. surgery provides the greatest cure rates. The area is minimally surgically prepared with chlorhexidine. Cats are maintained on intravenous fluids overnight. Cytotoxic free radicals are formed after the lesion is irradiated with light of a wavelength absorbed by the photosensitizer. to the level of the bony aspect of the nasal cavity. They were treated with strontium-90 plesiotherapy and 89% were free of disease at 1 year. Hemorrhage is usually controlled with direct digital pressure with gauze swabs. the patient is placed in sternal recumbency. It is important to prevent the head from tilting. the skin is incised full thickness at least 5 mm lateral to visible or palpable tumor. Using a size 15 scalpel blade. The entire aspect of the nasal planum is resected in one piece. and analgesia is supplied with methadone 0.Squamous cell carcinoma of the nasal planum 43 Surgery Figure 1 Spray cryogenic unit. Strontium-90 plesiotherapy involves the direct therapeutic application of a radiation source to the affected tissue. This is performed circumferentially around the site.7.11 Intralesional chemotherapy with carboplatin has been described by Theon and coworkers. Systemic toxicity was markedly reduced by combining carboplatin with purified sesame oil. The excised lesion is inked and submitted for histological examination of the margins and tumor assessment. To avoid difficulties associated with this.13 is a relatively straightforward procedure. to achieve the most symmetrical result (Fig. 87% achieved complete remission (four cats required repeated treatments) with no local recurrences reported.3 mg/kg every 6 hours for 24 hours. It is important in more infiltrative lesions to carefully palpate the dorsally located junction between the cartilaginous and bony nasal tissue and to excise at this level. you can initially use a sterile marker pen to delineate the required surgical site and then incise quickly.8 The disadvantage of radiation therapy is the limited availability. which resulted in an approximately 70% complete response rate.12 Local recurrence occurred in about 30% of cases (7 of 23). . as described by Withrow and Straw.7. the whiskers. The hair is clipped around the nasal planum up to. Complete resection of the nasal planum in the dog and cat. I use simple interrupted sutures of 4-0 or 5-0 nylon to suture the haired skin to the nasal mucosa. with the chin resting on a sandbag. My surgical technique of choice is a modification of this technique.13 is associated with a higher incidence of stenosis. and visibility is markedly reduced. leaving an orifice of about 1 cm. A bilateral infraorbital block is easily performed by injecting bupivacaine at the exit points of the infraorbital nerves.

The site has usually completely healed by 4 weeks. requiring longer hospitalization. Often these cats will have a mild increase in a clear nasal discharge. or lymphatic invasion. These techniques have an excellent cosmetic appear- Figure 4 (A) Positioning and surgery for the resection of a SCC involving the left side of the nasal planum only. . which include excision of the lesion and advancement of bipedicled skin flaps. Sedation may be required. Owners also often report an increase in sneezing postoperatively.M. cats commonly were uncomfortable and refused to eat or drink for 24 to 48 hours. I gener- ally discharge patients with broad spectrum antibiotics for 7 days and meloxicam for 5 days. (B) Resection of the lesion involving the left lateral planum and surrounding skin. Cats have acceptable to good cosmetic results postsurgery (Fig. A crust forms over the surgical site. recurrence is highly likely. depending on the temperament of the cat. which is typically removed with the sutures at 14 days postoperatively. (C) Local advancement of the skin from immediately dorsal to the defect. Patients with a complete excision after histological assessment of margins are expected to be cured. significantly improve the recovery of these patients. I recommend chemotherapy with doxorubicin or carboplatin. Before the use of the infraorbital blocks. or cryosurgery of recurrent lesions. This normally resolves or is not a clinical problem. I then recommend radiation therapy. If the pathology shows a poorly differentiated tumor. Use of meloxicam in cats continues to be off-label at present and clients should be informed of this. (D) Post operative appearance after suturing the skin with 4-0 nylon. presumably associated with loss of the protective aspect of the nasal planum. 3). Thomson 44 Figure 3 Six-week postoperative appearance of a cat that has undergone complete nasal planar resection. If the histology indicates that there is tumor remaining. I commonly perform variations of the complete nasal planar resection for less extensive lesions. who typically eat the following day and are discharged at this time.

For discrete lesions of about 4 to 6 mm in diameter. 2000 6.5 When combining these results with other surgical cases treated. 1971 4. they continue to grow in size and become more invasive. The skin can be advanced from the area dorsal or lateral to the defect (Fig. 5). Saunders. four were cured and two recurred. VanVechten MK. Langmack K: Photodynamic therapy of feline superficial squamous cell carcinoma using a topical 5-aminolaevulinic acid. 1990 14. discrete. Theon AP. Schneider R: Sunlight exposure and risk of developing cutaneous and oral squamous cell carcinomas in white cats. pp 233-260 2. 1998. et al: A retrospective study of (90) Strontium plesiotherapy for feline squamous cell carcinoma of the nasal planum.14 it appears that the best chances of cure are surgical excision with complete margins. 4 received radiation alone. horses.15 Surgical excision of the nasal planum in dogs can be performed similarly to cats. Smaller lesions can be treated with minor surgery. Lana SE. and the lesion arises in the epidermis. Proc Vet Can Soc 107. 1995 . cats and dogs. Ruslander D. Madewell BR. Stell AJ. ance and can be performed unilaterally or bilaterally when lesions affect the more lateral aspects of the planum. J Comp Pathol 114:205-210. Parry AT. lesions involving the entire planum are most effectively treated with wide surgery involving resection of the planum with or without premaxillectomy. 1994 15. References 1. et al: Squamous cell carcinoma of the nasal planum in 17 dogs.14 The cosmetic appearance in the dog is poorer than compared with the cat. Shearn VI: Prognostic factors associated with radiotherapy of squamous cell carcinoma of the nasal plane in cats. and 7 received surgery and radiation. Withrow SJ: Tumours of the skin and subcutaneous tissues. VanVechten MK. Taylor DO.13. et al: Feline cutaneous squamous cell carcinoma of the nasal planum and the pinnae: 61 cases. Of the six receiving surgery. may provide some protection against solar damage. Aust Vet Pract 21:148-153. Treatment of Nasal Planar SCC in Dogs Far less information is available in dogs due to the relatively low numbers of cases treated. Withrow SJ. It is possible that Henna tattoos. Clarke RE: Cryosurgical treatment of cutaneous squamous cell carcinoma. Lascelles and coworkers describe the treatment of 17 dogs with nasal planar SCC: 6 received surgery. Theon AP: Strontium-90 plesiotherapy for treatment of early squamous cell carcinoma of the nasal planum in 25 cats. It is obvious that it is very important to educate clientele and referring veterinarians to seek treatment for these lesions when they are small. Dorn CR. Murphy S. or the three cases treated by Rogers and coworkers. Comp Cont Ed 19:1119-1129. 1997 9. 2006 10. Philadelphia. Rogers KS. I perform surgical excision with skin advancement with excellent 45 results. Goodfellow M. however. This has not been investigated in cats and dogs and may be of value as a preventative agent against solar damage. in Withrow SJ. The most cost-effective options are cryosurgery or minor excisional surgery. 1993 11. 2001 12. For invasive tumors involving the entire planum. complete excision of the nasal planum provides the greatest chance of cure. Straw RC: Resection of the nasal planum in nine cats and five dogs. Kirpensteijn J. There are numerous effective treatment options at this time. Theon AP. Helman RG. or radiation therapy are all highly effective. are highly likely to have SCC. Sardinas JC: Cutaneous squamous cell carcinoma in cats. 1997 3.Squamous cell carcinoma of the nasal planum Figure 5 Three-month postoperative appearance of a cat that has had a left unilateral SCC removed. Straw RC: Combined resection of the nasal planum and premaxilla in three dogs. It appears that the Henna must be reapplied every 3 months and requires 20 minutes of contact time to stain the skin. Withrow SJ. The cosmetic effect is excellent (Fig. As lesions are left untreated. as it occurs much less frequently in this species. Am J Vet Res 57:205-210. Conclusions Older cats with unpigmented nasal planums. Withrow SJ. phototherapy. Postoperative radiation of cases with tumor cells extending to the surgical margins did not prevent recurrence in the seven cases treated by Lascelles. Vail DM. strontium plesiotherapy. erosive lesions. Tattooing has not proven to be effective in the prevention of these lesions. that stain the epidermis. 1991 7. but is usually acceptable to the owners. J Feline Med Surg 8:169-176. J Am Anim Hosp Assoc 26:219-223. Older dogs presenting with erosive lesions of the planum should be initially biopsied to confirm the diagnosis of SCC. 1995 8. Teifke JP. Highly advanced tumors that are too large for surgical excision may be treated with intralesional carboplatin. When available. Lascelles BDX. J Am Anim Hosp Assoc 33:329-332. Madewell BR: Intratumoral administration of carboplatin for treatment of squamous cell carcinomas of the nasal plane in cats. or Kirpensteijn and coworkers described a technique for a combined resection of the nasal planum and premaxilla for more extensive lesions. Walker MA: Squamous cell carcinoma of the canine nasal planum: eight cases (1988-1994). Kaser-Hotz B. J Small Anim Pract 42:164-169. Ogilvie GK. Recurrence occurred in 10 of the 11 dogs undergoing radiation. Stidworthy MF. presenting with small. Lohr CV: Immunohistochemical detection of p53 overexpression in paraffin wax-embedded squamous cell carcinomas of cattle. Vet Rec 147:473-476. Vet Surg 23:341-346. MacEwen EG (eds): Small Animal Clinical Oncology (ed 3). predominantly because the ink is placed in the dermis. 1996 5. PA. Hayes A. 1996 13. Dobson JM. J Natl Cancer Inst 46:1073-1078. J Am Anim Hosp Assoc 31:373-378. 4). The two recurrences occurred in dogs with incomplete surgical margins. J Am Vet Med Assoc 206:991-995.