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

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 20C 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-

Squamous cell carcinoma of the nasal planum

43

Surgery

Figure 1 Spray cryogenic unit. (Color version of figure is available

online.)

mors.7,8 Smaller lesions can be cured, with median survival

times of 12 to 16 months.7,8 The disadvantage of radiation
therapy is the limited availability, cost, and requirement of
multiple anesthetics.
Strontium-90 plesiotherapy involves the direct therapeutic application of a radiation source to the affected tissue. One
recent article describes the use of a strontium ophthalmic
applicator in 15 cats. Overall, 87% achieved complete remission (four cats required repeated treatments) with no local
recurrences reported. The cosmetic outcome was considered
excellent.9 Most lesions were 2 to 5 cm in diameter with
minimal invasion. Another abstract describes 25 cats with
lesions of the nasal planum of less than 3 mm diameter. They
were treated with strontium-90 plesiotherapy and 89% were
free of disease at 1 year.10

For more advanced lesions of the nasal planum, surgery provides the greatest cure rates. Complete resection of the nasal
planum in the dog and cat, as described by Withrow and
Straw,13 is a relatively straightforward procedure. My surgical
technique of choice is a modification of this technique. After
induction of anesthesia, the patient is placed in sternal recumbency, with the chin resting on a sandbag. It is important
to prevent the head from tilting, to achieve the most symmetrical result (Fig. 2). A bilateral infraorbital block is easily
performed by injecting bupivacaine at the exit points of the
infraorbital nerves. The hair is clipped around the nasal planum up to, but not including, the whiskers. The area is
minimally surgically prepared with chlorhexidine. A circular
drape is placed over the nasal region. Hemorrhage is significant after the first incision is made, and visibility is markedly
reduced. To avoid difficulties associated with this, you can
initially use a sterile marker pen to delineate the required
surgical site and then incise quickly. Using a size 15 scalpel
blade, the skin is incised full thickness at least 5 mm lateral to
visible or palpable tumor. 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. The entire aspect of the nasal planum is resected
in one piece, including a portion of deeper cartilaginous
turbinates, to the level of the bony aspect of the nasal
cavity. Normally a small strip of skin and buccal mucosa
can be preserved ventral to the philtrum, at the rostral lip
margin. Hemorrhage is usually controlled with direct digital pressure with gauze swabs. After inspection of the
surgical site, I use simple interrupted sutures of 4-0 or 5-0
nylon to suture the haired skin to the nasal mucosa. This is
performed circumferentially around the site, leaving an
orifice of about 1 cm. My personal experience has been
that a single purse-string suture, as described by Withrow
and Straw,13 is associated with a higher incidence of stenosis. The excised lesion is inked and submitted for histological examination of the margins and tumor assessment. Cats are maintained on intravenous fluids
overnight, and analgesia is supplied with methadone 0.3
mg/kg every 6 hours for 24 hours. 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. Cytotoxic free radicals are
formed after the lesion is irradiated with light of a wavelength
absorbed by the photosensitizer. In one study 9 of 10 nasal
planar lesions had a complete response to a single treatment,
but greater than 60% subsequently recurred.11
Intralesional chemotherapy with carboplatin has been described by Theon and coworkers, which resulted in an approximately 70% complete response rate.12 Local recurrence
occurred in about 30% of cases (7 of 23). Systemic toxicity
was markedly reduced by combining carboplatin with purified sesame oil.

Figure 2 Positioning and preparation of a cat for complete resection

of the nasal planum.

M. Thomson

44

Figure 3 Six-week postoperative appearance of a cat that has undergone complete nasal planar resection.

significantly improve the recovery of these patients, who

typically eat the following day and are discharged at this
time. Before the use of the infraorbital blocks, cats commonly were uncomfortable and refused to eat or drink for
24 to 48 hours, requiring longer hospitalization. I gener-

ally discharge patients with broad spectrum antibiotics for

7 days and meloxicam for 5 days. Use of meloxicam in cats
continues to be off-label at present and clients should be
informed of this. A crust forms over the surgical site,
which is typically removed with the sutures at 14 days
postoperatively. Sedation may be required, depending on
the temperament of the cat. The site has usually completely healed by 4 weeks. Often these cats will have a mild
increase in a clear nasal discharge, presumably associated
with loss of the protective aspect of the nasal planum. This
normally resolves or is not a clinical problem. Owners also
often report an increase in sneezing postoperatively. Cats
have acceptable to good cosmetic results postsurgery (Fig.
3). Patients with a complete excision after histological assessment of margins are expected to be cured. If the histology indicates that there is tumor remaining, recurrence
is highly likely. I then recommend radiation therapy, or
cryosurgery of recurrent lesions. If the pathology shows a
poorly differentiated tumor, or lymphatic invasion, I recommend chemotherapy with doxorubicin or carboplatin.
I commonly perform variations of the complete nasal
planar resection for less extensive lesions, which include
excision of the lesion and advancement of bipedicled skin
flaps. 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. (B)
Resection of the lesion involving the left lateral planum and surrounding skin. (C) Local advancement of the skin from
immediately dorsal to the defect. (D) Post operative appearance after suturing the skin with 4-0 nylon.

Squamous cell carcinoma of the nasal planum

Figure 5 Three-month postoperative appearance of a cat that has had

a left unilateral SCC removed.

ance and can be performed unilaterally or bilaterally when

lesions affect the more lateral aspects of the planum. The
skin can be advanced from the area dorsal or lateral to the
defect (Fig. 4). The cosmetic effect is excellent (Fig. 5).

Treatment of Nasal
Planar SCC in Dogs
Far less information is available in dogs due to the relatively
low numbers of cases treated. Lascelles and coworkers describe the treatment of 17 dogs with nasal planar SCC: 6
received surgery, 4 received radiation alone, and 7 received
surgery and radiation. Recurrence occurred in 10 of the 11
dogs undergoing radiation. Of the six receiving surgery, four
were cured and two recurred. The two recurrences occurred
in dogs with incomplete surgical margins.5 When combining
these results with other surgical cases treated,13,14 it appears
that the best chances of cure are surgical excision with complete margins. Postoperative radiation of cases with tumor cells
extending to the surgical margins did not prevent recurrence in
the seven cases treated by Lascelles, or the three cases treated by
Rogers and coworkers.15 Surgical excision of the nasal planum
in dogs can be performed similarly to cats, or Kirpensteijn and
coworkers described a technique for a combined resection of the
nasal planum and premaxilla for more extensive lesions.14 The
cosmetic appearance in the dog is poorer than compared with
the cat, but is usually acceptable to the owners.

Conclusions
Older cats with unpigmented nasal planums, presenting
with small, discrete, erosive lesions, are highly likely to
have SCC. There are numerous effective treatment options
at this time. The most cost-effective options are cryosurgery or minor excisional surgery. When available, strontium plesiotherapy, phototherapy, or radiation therapy are
all highly effective. As lesions are left untreated, they continue to grow in size and become more invasive. For discrete lesions of about 4 to 6 mm in diameter, I perform
surgical excision with skin advancement with excellent

45
results. For invasive tumors involving the entire planum,
complete excision of the nasal planum provides the greatest chance of cure. Highly advanced tumors that are too
large for surgical excision may be treated with intralesional
carboplatin. It is obvious that it is very important to educate clientele and referring veterinarians to seek treatment
for these lesions when they are small. Tattooing has not
proven to be effective in the prevention of these lesions,
predominantly because the ink is placed in the dermis,
and the lesion arises in the epidermis. It is possible that
Henna tattoos, that stain the epidermis, may provide some
protection against solar damage. It appears that the Henna
must be reapplied every 3 months and requires 20 minutes
of contact time to stain the skin. This has not been investigated in cats and dogs and may be of value as a preventative agent against solar damage.
Older dogs presenting with erosive lesions of the planum
should be initially biopsied to confirm the diagnosis of SCC,
as it occurs much less frequently in this species. Smaller
lesions can be treated with minor surgery; however, lesions
involving the entire planum are most effectively treated with
wide surgery involving resection of the planum with or without premaxillectomy.

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