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Squamous Cell Carcinoma

Specialties > Cancer

Background Knowledge 🧠

Definition

  • A type of skin cancer originating from squamous cells in the epidermis.
  • Commonly occurs in sun-exposed areas of the body.
  • Can invade local tissues and metastasise.
  • Frequently develops from actinic keratosis or other pre-cancerous lesions.

Epidemiology

  • Second most common type of skin cancer in the UK.
  • Higher incidence in older adults and fair-skinned individuals.
  • Male predominance.
  • Increased risk with immunosuppression and chronic sun exposure.

Aetiology and Pathophysiology

  • UV radiation exposure: Primary risk factor.
  • Human papillomavirus (HPV) infection linked to mucosal SCC.
  • Chronic inflammation or injury (e.g., scars, ulcers).
  • Genetic mutations affecting cell growth and repair.
  • Immunosuppression: Higher incidence in transplant patients.

Types

  • Cutaneous SCC: Arises in sun-exposed skin.
  • Mucosal SCC: Occurs in mucous membranes (e.g., oral cavity, oesophagus).
  • Verrucous carcinoma: Slow-growing variant with wart-like appearance.
  • Marjolin’s ulcer: SCC arising from chronic wounds or scars.
  • Bowen’s disease: SCC in situ, confined to the epidermis.

Clinical Features 🌡️

Symptoms

  • Non-healing ulcer or sore.
  • Pain or tenderness at the lesion site.
  • Itching or bleeding lesion.
  • Rapid growth of the lesion.
  • Lesion with a crusted or scaly surface.

Signs

  • Firm, red nodule or flat sore with a scaly crust.
  • Hyperkeratotic plaque with irregular borders.
  • Erosion or ulceration in advanced cases.
  • Induration or fixation to underlying structures.
  • Lymphadenopathy in cases of regional metastasis.

Investigations 🧪

Investigations

  • Biopsy: Histopathological confirmation.
  • Dermatoscopy: Assessment of lesion characteristics.
  • Imaging (CT/MRI): For suspected deeper invasion or metastasis.
  • Lymph node biopsy: If regional spread is suspected.
  • Routine blood tests: Baseline and preoperative assessment.

Management 🥼

Management

  • Surgical excision: Primary treatment modality.
  • Mohs micrographic surgery: For high-risk or recurrent lesions.
  • Radiotherapy: For inoperable cases or adjuvant therapy.
  • Cryotherapy: For superficial lesions.
  • Topical treatments: Imiquimod or 5-FU for Bowen’s disease.
  • Follow-up: Regular monitoring for recurrence.

Complications

  • Local recurrence.
  • Regional lymph node metastasis.
  • Distant metastasis (rare).
  • Secondary infections of the lesion.
  • Chronic pain or disfigurement.
  • Perineural invasion causing nerve damage.

Prognosis

  • Generally good if detected early and treated appropriately.
  • Higher risk of recurrence and metastasis in advanced cases.
  • Regular follow-up necessary to monitor for recurrence.
  • Better outcomes with Mohs surgery for high-risk lesions.
  • Survival rates lower with metastasis.

Key Points

  • Early detection and treatment are crucial for better outcomes.
  • Sun protection measures to reduce risk.
  • Patient education on self-examination and recognizing symptoms.
  • Regular dermatological check-ups for high-risk individuals.
  • Multidisciplinary approach for advanced cases.

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Cancer