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Yr 3 - Dermatology > Squamous cell carcinoma > Flashcards

Squamous cell carcinoma Flashcards

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Dermatology Board Prep flashcards
1
Q

What is squamous cell carcinoma?

A

Cancer of the epidermal keratinocytes (Or its appendages)

a locally invasive malignant tumour of keratinocytes with the potential to metastasise

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2
Q

What cells do SCC affect?

A

Squamous keratocytes ( in the epidermis)

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3
Q

How common is SCC?

A

2nd most common cancer

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4
Q

What are the 4 types of SCC?

A
  1. Actinic keratosis
  2. SCC in situ (Bowen’s disease)
  3. Invasive SCC
  4. Metastatic SCC
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5
Q

What is actinic keratosis?

A
  1. It is the most common precursor lesion to SCC
  2. Occurs due to chronic UV exposure and affects sun-exposed sites
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6
Q

How does Actinic keratosis often present?

A

It commonly presents in multiple lesions
The lesions are erythematous, scaly papules or plaques
- they may spontaneously resolve

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7
Q

Are there different types of actinic keratosis?

A

Yes - presents in various types eg Actinic keratosis -actinic keratosis of the lips

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8
Q

How is actinic keratosis usually treated?

A

with cryotherapy

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9
Q

What is Bowen’s disease?

A

Squamous cell carcinoma in situ, often called Bowen’s disease, is a growth of
cancerous cells that is confined to the outer layer of the skin
- Whole epidermis contains atypical keratinocytes

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10
Q

Does Bowen’s disease present as one or multiple lesions?

A

Usually one but may be multiple

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11
Q

What does Bowen’s disease look like?

A

*Slowly enlarging scaly erythematous plaque

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12
Q

What are the treatment options for Bowen’s disease?

A

Treatment options include surgery, cryotherapy, photodynamic therapy and topical therapy (fluorouracil, imiquimod)

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13
Q

What is invasive SCC?

A

Definition: SCC is a type of skin cancer that develops from squamous cells in the epidermis
Characteristics: It can become invasive by growing deeper than its originating area, penetrating additional layers of the skin, and potentially spreading to other parts of the body

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14
Q

What is metastatic SCC?

A

Metastatic squamous cell carcinoma is a form of nonmelanoma skin cancer that originates in the squamous cells and spreads beyond the primary cancer site.

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15
Q

What is the most common causative factor of SCC?

A

UV light

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16
Q

What are the other aetiological causes of SCC?

A
  1. Exposure to chemical carcinogens
  2. Prior radiation therapy
  3. Site of chronic trauma/ inflammation (*e.g. leg ulcers, and HPV e.g. genital area or periungual *In draining infectious sinuses in osteomyelitis)
  4. Arsenic exposure ( Cause of multiple SCC’s in a palmoplantar distribution)
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17
Q

What are the risk factors for SCC?

A
  1. Exposure to UV radiation
  2. Older individuals (>40)
  3. Males
  4. Smoking
  5. History of skin cancer
  6. Pre-malignant disease (eg Actinic keratosis)
  7. Chronic inflammation/wounds (Leg ulcers)
  8. Immunosuppression
  9. Human papilloma virus (HPV)
  10. Genetics
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18
Q

What are some clinical features typically found within history and examination?

A
  1. Keratotic nodule - A keratotic nodule is a rough, scaly, or firm growth on the skin
  2. Ill-defined borders
  3. May ulcerate
  4. May crust, bleed, itch and be painful
  5. Usually found in sun-exposed sites (May be smoking-related if on the lip)
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19
Q

What are 4 differential diagnosis’ for SCC?

A
  1. Actinic keratosis
  2. Bowen’s disease
  3. Keratoacanthoma
  4. Basal cell carcinoma
20
Q

How do we diagnose SCC?

A

Diagnosed by clinical suspicion and confirmed by biopsy, which is necessary for accurate diagnosis and appropriate therapeutic planning

21
Q

What investigations are used to diagnose SCC?

A

Biopsy

22
Q

What are the treatment option for SCC?

A
  1. Surgical excision
  2. Mohs micrographic surgery
  3. Radiology
23
Q

What is the gold standard treatment for SCC?

A

Excision

24
Q

What is Mohs micrographic surgery?

A

microscopic surgery for close excision and identification of clear tumor margins

25
Q

When is mohs microscope surgery used?

A

May be necessary for ill-defined, large, recurrent tumours

26
Q

When is radiotherapy used for SCC?

A

used for large, non-respectable tumours
Lesions with high metastatic potential may require additional radiation or chemotherapy

27
Q

How is prognosis of SCC determined?

A

➢Tumour size, site and extent of invasion
*E.g. SCCs on sun-exposed sites have a better prognosis than those on ears/lips
➢ Diameter ≥2cm and/or thickness ≥2mm = high-risk SCC

28
Q

What is the most common genetic mutation associated with squamous cell carcinomas?

A

p53 tumour suppressor gene

29
Q

What are the 4 areas where SCC are most common?

A

1) lips
2) backs of the hands
3) upper part of the face
4) scalp
(sun exposed areas but can occur anywhere)

30
Q

Give 3 non-dermatological signs/symptoms associated with squamous cell carcinomas:

A

1) malaise
2) weight loss
3) lymphadenopathy

31
Q

What device can be used to evaluate skin lesions by magnifying them?

A

dermatoscope

32
Q

What are the three biopsy techniques used in SCC investigations?

A

1) excisional
2) punch
3) incisional

33
Q

What staging system is used for SCCs?

A

American Joint Commission on Cancer TNM System

34
Q

What depth is considered ‘high risk’ for SCCs?

A

> 2mm deep

35
Q

What width is considered ‘high risk’ for SCCs?

A

> 20mm wide

36
Q

Give 5 SCC sites which are considered ‘high risk’:

A

1) face
2) ear
3) genitals
4) hands
5) feet

37
Q

Give two histological features of SCCs which are considered ‘high risk’

A

1) poor differentiation
2) perineural invasion

38
Q

What referral system is used for anyone with a suspected SCC?

A

2 week wait

39
Q

What treatment is used for invasive SCCs?

A

surgical excision with a minimum of 4mm margins

40
Q

What treatment is used for metastatic SCCs?

A

surgical excision with radiotherapy and chemotherapy

41
Q

Do BCCs or SCCs have a precursor?

A

SCCs
- Actinic keratosis
-Bowen’s disease

42
Q

Are BCCs or SCCs more likely to metastasise?

A

SCCs

43
Q

Does BCCs or SCCs have a higher mortality rate?

A

SCCs has a higher mortality rate

44
Q

Case History 1: SCC

A

A 70-year-old previously healthy white man presents with multiple, hyperkeratotic, scaly papules on the face, scalp, and hands. Some papules have grown to become larger nodules that sometimes bleed and fail to heal. In the past he has had significant sun exposure including multiple blistering sunburns. Previously, he has had skin cancer on the face

45
Q

Case history 2: SCCs

A

A 60-year-old white woman presents with an enlarging scaly pink plaque on her forearm that is friable and bleeds easily. She has been taking ciclosporin (cyclosporine) for 4 years following a kidney transplant.

46
Q

Other presentations: SCCs

A

May also present as a non-healing wound, often attributed to trauma by the patient. Bowen’s disease (SCC in situ) may be misdiagnosed as dermatitis that fails to respond to treatment

Yr 3 - Dermatology (15 decks)

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