Squamous cell carcinoma of the skin

Squamous cell carcinoma is a common variant of skin cancer. Metastases are rare but may occur in 2-5% of patients.

Risk factors include:

excessive exposure to sunlight / psoralen UVA therapy
actinic keratoses and Bowen's disease
immunosuppression e.g. following renal transplant, HIV
smoking
long-standing leg ulcers (Marjolin's ulcer)
genetic conditions e.g. xeroderma pigmentosum, oculocutaneous albinism

Features

typically on sun-exposed sites such as the head and neck or dorsum of the hands and arms
rapidly expanding painless, ulcerate nodules
may have a cauliflower-like appearance
there may be areas of bleeding

Image gallery

Squamous cell carcinoma

Treatment

Surgical excision with 4mm margins if lesion <20mm in diameter. If tumour >20mm then margins should be 6mm. Mohs micrographic surgery may be used in high-risk patients and in cosmetically important sites.

Prognosis

Good Prognosis	Poor prognosis
Well differentiated tumours	Poorly differentiated tumours
<20mm diameter	>20mm in diameter
<2mm deep	>4mm deep
No associated diseases	Immunosupression for whatever reason

+PassMedicine Notes

Squamous cell carcinoma is a common variant of skin cancer. Metastases are rare but may occur in 2-5% of patients.

Risk factors include:

excessive exposure to sunlight / psoralen UVA therapy
actinic keratoses and Bowen's disease
immunosuppression e.g. following renal transplant, HIV
smoking
long-standing leg ulcers (Marjolin's ulcer)
genetic conditions e.g. xeroderma pigmentosum, oculocutaneous albinism

Features

typically on sun-exposed sites such as the head and neck or dorsum of the hands and arms
rapidly expanding painless, ulcerate nodules
may have a cauliflower-like appearance
there may be areas of bleeding

Image gallery

Treatment

Surgical excision with 4mm margins if lesion 20mm then margins should be 6mm. Mohs micrographic surgery may be used in high-risk patients and in cosmetically important sites.