Squamous cell carcinoma

Question 1

How common

Answer 1

common variant of skin cancer. Metastases are rare but may occur in 2-5% of patients.

Question 2

What are the risk factors

Answer 2

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

Question 3

Where is it seen

Answer 3

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

Question 4

What is the management

Answer 4

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.

Question 5

What is a good prognosis

Answer 5

Well differentiated tumours
<20mm diameter
<2mm deep
No associated diseases

Question 6

What is a poor prognosis

Answer 6

Poorly differentiated tumours
>20mm in diameter
>4mm deep
Immunosupression for whatever reason