Squamous Cell Carcinoma Flashcards
What is Squamous Cell Carcinoma?
Malignant tumour that arises from supra-basal keratinocytes
= This cancer starts in the layers of skin cells just above the basal layer, where keratinocytes produce the protein keratin. It can spread to other parts of the body if left untreated
What are the typical characteristics of squamous cell carcinoma lumps?
- Scaly or ulcerated lumps or
- Warty/hyperkeratotic (crusted) lumps
- or Ulcers
What is the growth and spread pattern of squamous cell carcinoma?
(1) Locally invasive
(2) Low but definite risk of metastasis
(3) Bigger and deeper lesions are more likely to spread
(4) Poor prognosis if it metastasises
Where does squamous cell carcinoma commonly arise on the body?
SCC often arises on sun-damaged skin in the elderly, particularly on the
1. head
2. neck
3. hands
4. forearms
What are the high-risk sites for squamous cell carcinoma?
ears, lips, and scalp
How does squamous cell carcinoma typically grow?
SCC may grow rapidly, and it can be painful and bleed
What is the first-line management for squamous cell carcinoma?
Surgical excision with a wide margin, and biopsy of the excised tissue
How does squamous cell carcinoma differ from basal cell carcinoma in terms of growth and spread?
(1) SCC
= is locally invasive and has a low but definite risk of metastasis.
(2) BCC
= is typically slow-growing, locally destructive, and rarely metastasises
What is the most common skin cancer for those patients who are immunosurpressed?
SCC
A 77-year-old man presents to his GP with an ulcerated lesion on the side of his head. He says he has had it for a few weeks and it is getting bigger. On examination, there is a lesion 7mm in diameter, with an ulcerated core. It looks deep. The patient is a type 1 on the Fitzpatrick scale. He is otherwise fit and well.
Given the history and examination findings, why is the answer SSC?
- Location
= Side of head, common in sun-exposed areas. - Ulceration
= Deep, ulcerated core, typical of SCC. - Rapid Growth
= Getting bigger in a few weeks, SCC grows quickly. - Fair Skin (Fitzpatrick Type 1)
= Increased risk of SCC due to UV sensitivity. - Elderly
= More common in older individuals. - Deep appearance
= Suggests local invasion, typical of SCC
Which cells do squamous cell carcinomas arise from?
Keratinocytes
A 76-year-old man comes to the GP practice worried about a skin change. He has been diagnosed with an actinic keratosis on his scalp 2 years ago and has had topical 5-fluorouracil treatment and imiquimod for it, with no resolution. He says it has gotten bigger in the last 2 months. Inspection shows a nodular hyperkeratotic lesion.
What is the most appropriate course of action?
2 week referral to dermatology
What is the invasive squamous cell carcinoma (SCC) that arises in areas of previously traumatised or chronically inflamed skin, such as scars from burns?
Marjolin ulcer
A 68-year-old Caucasian man presents with a lesion on his scalp for the last 6 weeks. It has gradually increased in size and is associated with discomfort and some bleeding.
He has a history of a renal transplant 10 years ago, type 2 diabetes mellitus and hypertension. There is no family history of skin cancer.
On examination, there is a non-pigmented indurated plaque on the scalp with surrounding inflammation.
What is the most likely diagnosis? and why.
SCC
= Renal transplant suggest immunospression
