Dermatological Malignancies - Squamous Cell Carcinoma

Question 1

Comparison of SCC vs BCC (2).

Answer 1

1. BCC = Slow Growth.

2. BCC = No Pain, Bleeding or Tenderness.

Question 2

Risk Factors of Squamous Cell Carcinoma.

Answer 2

1. Excessive Exposure to Sunlight.
2. Actinic Keratosis, Bowen’s Disease.
3. Smoking, Immunosuppression.
4. Long-Standing Ulcers e.g. Marjolin’s Ulcer.
5. Genetic Conditions e.g. Xeroderma Pigmentosum, Oculocutaneous Albinism.

Question 3

Importance of Immunosuppression in Squamous Cell Carcinoma.

Answer 3

1. Organ Transplant Recipients (BIG Factor).

2. Length of Immunosuppression.

Question 4

What is Actinic (Solar) Keratosis?

Answer 4

Premalignant lesion - atypical keratinocytes in epidermis : rough, erythematous papule with a white-yellow scale clustered at sites of chronic exposure.

Question 5

Management of Actinic Keratosis.

Answer 5

Same as other Dermatological Malignancies : Surgery to prevent development into an SCC.

Question 6

What is Bowen’s Disease?

Answer 6

SCC in Situ - tumour cells are confined to the epidermis.

Question 7

Clinical Presentation of Bowen’s Disease.

Answer 7

Erythematous Scaling Patch/Elevated Plaque arising on Sun-Exposed Skin in elderly patients.

Question 8

Pathophysiology of Bowen’s Disease.

Answer 8

1. De Novo.
2. Pre-Existing Actinic Keratosis.
3. Full-Thickness Atypica of Dermal Keratinocytes over Broad Zone.

Question 9

Clinical Presentation of Invasive SCC.

Answer 9

1. Erythematous Keratotic Papule/Nodule.
2. Ulceration.
3. Regional Lymphadenopathy.
4. Pain, Tenderness or Bleeding.

Question 10

Pathophysiology of Invasive SCC.

Answer 10

Downward proliferation of malignant cells and invasion of basement membrane.

Question 11

Management of Squamous Cell Carcinoma (3).

Answer 11

Surgical (WLE) :

1. Lesion <20mm : With 4mm Margin.
2. Lesion >20mm : With 6mm Margin.
3. Mohs Micrographic Surgery : Cosmetically Important Sites.

Question 12

What is Marjolin’s Ulcer?

Answer 12

SCC occurring at sites of chronic inflammation e.g. burns, osteomyelitis after 10-20 years - mainly affecting the lower limb.