Squamous Cell Carcinoma

Question 1

The second most common form of skin cancer is squamous cell carcinoma in the UK. What is the annual incidence of squamous cell carcinoma each year?

1 - 80
2 - 8000
3 - 80,000
4 - 800,000

Answer 1

3 - 80,000
- 4.7% increase in incidence between 2013-2019

Question 2

Are the number of deaths associated with squamous cell carcinoma going up or down?

Answer 2

• up
• increase of 40% in last 10 years
• people are living longer, which may explain these changes

Question 3

The second most common form of skin cancer is squamous cell carcinoma in the UK. Where do they most commonly affect?

1 - legs and arms
2 - head and back
3 - head and neck
4 - legs and face

Answer 3

3 - head and neck
- specifically more common on the mouth and ears

• linked to Cumulative UV exposure

Question 4

Which layer of the skin do squamous cell cancers typically originate from?

1 - melanocytes
2 - keratinocytes
3 - merkel cells
4 - basal cells

Answer 4

2 - keratinocytes

Question 5

Which of the following mutations in keratinocytes is associated with squamous cell carcinomas?

1 - APC
2 - BRAF
3 - P53
4 - PTCH

Answer 5

3 - P53

Question 6

Which of the following is NOT a risk factor for squamous cell carcinoma?

1 - Ultraviolet radiation
2 - Immunosuppression
3 - Fairer skin
4 - Solid organ transplant
5 - Increasing age
6 - Female sex
7 - Ionising radiation
8 - Sites of chronic inflammation

Answer 6

6 - Female sex

Being male is a risk factor for SCC

Question 7

Which of the following skin cancers is most common in patients with Fitzpatrick skin types V and VI?

1 - basal cell carcinoma
2 - squamous cell carcinoma
3 - malignant melanoma

Answer 7

2 - squamous cell carcinoma

Question 8

Of the 4 images below, which is a squamous cell carcinoma?

Answer 8

• top right

Question 9

Which of the following is NOT a key feature of a squamous cell carcinoma?

1 - Firm to palpate (may be nodular/plaque-like)
2 - May ulcerate and bleed
3 - May be tender/painful
4 - Has telangiectasia
5 - May have a crusty (keratotic) top with a nodular base

Answer 9

4 - Has telangiectasia

These are common in basal cell carcinomas

Question 10

Can squamous cell carcinomas be painful?

Answer 10

• yes
• this is how to distinguish between SCC and BCC

Question 11

Do squamous or basal cell carcinomas grow more aggressively?

Answer 11

• squamous cell carcinomas

Question 12

Is bowens disease malignant?

Answer 12

• yes

Referred to as squamous cell carcinoma in situ

Part of a spectrum before the development of SCC

Question 13

Is actinic keratosis cancerous?

Answer 13

• no

These are pre-cancerous cells

Part of a spectrum before the development of SCC

Question 14

Squamous cell carcinomas (SCC) can grow aggressively. Which of the following is NOT a high risk for SCC that needs treating quickly?

1 - Mouth, ears
2 - <2cm diameter
3 - Moderate – poor differentiation
4 - Immunosuppressed
5 - Invading beyond dermis

Answer 14

2 - <2cm diameter
- typically anything >2cm is worrying

Question 15

Do patients who are immunocompromised have an increased or decreased risk of skin cancer?

Answer 15

• increased risk
• must wear sun cream even in winter

Especially those patients who have had a solid tumour transplant

Question 16

Excision is the main stay of treatment in patients with squamous cell carcinoma. What is a typical margin that is aimed for?

1 - 1-2mm
2 - 4-6mm
3 - 8-12mm
4 - 10-20mm

Answer 16

2 - 4-6mm
- depends on the location and risk

• radiotherapy is typically used as an adjunct rather than alone if unable to completely excise

Question 17

What is the ONLY modifiable risk factor for skin cancer?

1 - sun exposure
2 - weight
3 - immunotherapy
4 - smoking

Answer 17

1 - sun exposure

Question 18

Avoiding peak UV times can help mitigate the risks associated with skin cancer. What are peak UV times?

1 - 9am - 1pm
2 - 11am - 12pm
3 - 11am - 3pm
4 - 1-3pm

Answer 18

3 - 11am - 3pm

Question 19

Which of the following are ways to minimise UV exposure and reduce the risk of skin cancer?

1 - Wear hats, sun glasses, clothes
2 - Sunscreen on face and as needed elsewhere
3 - Broad spectrum of >SPF30
4 - Suncream containing UVA: 4-5 stars
5 - all of the above

Answer 19

5 - all of the above

Question 20

Which 2 of the following can be used for bowens disease, also referred to as SCC in situ?

1 - cryotherapy
2 - topical 5-fluorouracil
3 - Mohs micrographic surgery
4 - radiotherapy and chemotherapy

Answer 20

1 - cryotherapy
2 - topical 5-fluorouracil

Question 21

Which of the following can be used to treat SCC?

1 - cryotherapy
2 - topical 5-fluorouracil
3 - Mohs micrographic surgery
4 - radiotherapy and chemotherapy

Answer 21

3 - Mohs micrographic surgery

If metastic disease is present, this would most likley be surgery, then chemotherapy and radiotherapy

Question 22

A 47-year-old woman is seen in the Nephrology clinic as part of her follow-up for end-stage renal failure secondary to autosomal dominant polycystic kidney disease. She has hypertension, for which she is taking ramipril, but is otherwise relatively well. As such, she is offered the option of a renal transplant.

What malignancy is she most likely to develop if she does proceed to transplantation?

1 - Basal cell carcinoma of the skin
2 - Malignant melanoma
3 - Post-transplant lymphoproliferative disorder (PTLD)
4 - Renal cell carcinoma
5 - Squamous cell carcinoma of the skin

Answer 22

5 - Squamous cell carcinoma of the skin

Question 23

A 53-year-old man presents to his GP with a skin lesion on his lower left leg. He describes an increasing size nodule below his left knee overlying a previous burn scar he acquired 20 years ago in a house fire. He first noticed this about 3 weeks ago. He is normally fit and well and takes no other medications. He does however smoke 20 cigarettes a day. On examination, there is a non-tender 3x3cm nodule with some developing ulceration overlying a large thermal burn scar below the left knee.

What is the most likely diagnosis?

1 - Actinic keratosis
2 - Basal cell carcinoma (BCC)
3 - Diabetic ulcer
4 - Malignant melanoma
6 - Squamous cell carcinoma (SCC)

Answer 23

6 - Squamous cell carcinoma (SCC)

A non-healing painless ulcer associated with a chronic scar is indicative of squamous cell carcinoma (SCC)