112: Squamous Cell Carcinoma and Keratoacanthoma Flashcards
What are four high risk features for local recurrence and metastasis of squamous cell carcinoma (SCC)?
- Tumor thickness greater than 2 mm
- Clark level higher than IV
- Perineural invasion
- Lip or ear as primary site
What is the 5-year metastatic rate of squamous cell carcinoma (SCC)?
The 5-year metastatic rate of SCC is generally low, approximately 5%.
What are two geographic factors affecting the incidence of squamous cell carcinoma (SCC)?
- Inverse association with latitude
- Increased incidence in sun-exposed areas
What is the predominant etiologic risk factor for skin carcinogenesis?
Cumulative lifetime exposure to ultraviolet (UV) radiation is the predominant etiologic risk factor for skin carcinogenesis.
How does the incidence of squamous cell carcinoma (SCC) vary with sex?
The incidence of SCC is higher in males compared to females.
How does the incidence of squamous cell carcinoma (SCC) vary with race?
The incidence of SCC is approximately 3-fold less common in Blacks as compared to Whites.
What are the primary modes of therapy for localized squamous cell carcinoma (SCC)?
The primary mode of therapy for localized SCC is complete surgical excision, preferably microscopically controlled surgery (Mohs surgery).
What are the nonsurgical interventions for locally advanced, unresectable, or metastatic squamous cell carcinoma (SCC)?
Nonsurgical interventions include:
1. Radiation therapy
2. Systemic treatment with chemotherapy or targeted therapy
What is the role of niacinamide in the prevention of squamous cell carcinoma (SCC)?
Niacinamide is given at a dose of 500 mg as chemoprevention for SCC.
What are the topical therapeutic options for squamous cell carcinoma (SCC)?
- Topical chemotherapy agents (e.g., 5-fluorouracil)
- Imiquimod
- Photodynamic therapy
What is the significance of immunosuppression in the incidence of squamous cell carcinoma (SCC)?
Immunosuppressed patients have a 65-fold to 250-fold increased incidence of SCC compared to immunocompetent individuals.
What is the relationship between latitude and the incidence of squamous cell carcinoma (SCC)?
The closer to the equator, the higher the incidence of SCC in white individuals, with similar gradients for both genders and all ages.
How does age affect the incidence of squamous cell carcinoma (SCC)?
SCC incidence increases with age, primarily affecting individuals 60 years of age and older, due to cumulative lifetime exposure to UVR being a predominant risk factor.
What is the significance of UVR exposure in the development of squamous cell carcinoma (SCC)?
UVR exposure is recognized as the most important environmental risk factor for the development of SCC, with a strong dose-response association and specific UV signature mutations being a major contributor.
What are the precursor lesions associated with squamous cell carcinoma (SCC)?
SCCs typically arise from basal keratinocytes of the interfollicular epidermis, with most invasive SCCs developing from preinvasive lesions such as actinic keratosis (AK) or Bowen disease.
What genetic factors predispose individuals to squamous cell carcinoma (SCC)?
Genetic predisposition includes light skin complexion, variations in the melanocortin-1 receptor, single-nucleotide polymorphisms in pigmentation genes, and inherited defects in DNA repair mechanisms.
What are the implications of albinism in relation to squamous cell carcinoma (SCC)?
Albinism is associated with a high risk for SCC, even in black individuals, highlighting the relationship between skin carcinogenesis and sun exposure, as well as the protective effect of eumelanin.
What are the environmental risk factors for squamous cell carcinoma (SCC)?
Environmental risk factors include UVR exposure, arsenic in medications and water, and cutting oils in industrial occupations, all of which can stimulate skin carcinogenesis.
What is the estimated cumulative lifetime risk of developing SCC among patients with multiple actinic keratosis (AK)?
The estimated cumulative lifetime risk among patients with multiple AK is approximately 6% to 10%.
What is the relationship between UVR exposure and the incidence of squamous cell carcinoma (SCC) in different populations?
The incidence of SCC is higher in populations with greater UVR exposure, such as Australians, who have a reported rate of 387 per 100,000 person-years.
What role does genetic predisposition play in the risk of developing squamous cell carcinoma (SCC)?
Genetic predisposition significantly influences SCC risk. Individuals with light skin complexions and specific genetic variations, such as those in the melanocortin-1 receptor, are at higher risk.
What are the immunosuppressive effects of UVR that contribute to the development of squamous cell carcinoma (SCC)?
UVR exposure leads to immunosuppressive effects that promote SCC development, including:
1. Depletion of Langerhans cells from the epidermis.
2. Improper antigen presentation in skin-draining lymph nodes.
How does immunosuppression affect the risk of developing SCC in organ transplant recipients?
Immunosuppression significantly increases the risk of developing SCC in organ transplant recipients (OTRs), with SCC being the most frequent malignancy in these patients.
What role do photosensitizing drugs play in the risk of developing SCC?
The chronic use of photosensitizing drugs, such as antibiotics and triazole antifungals, increases the risk for SCC, particularly in patients with sun-sensitive skin types.