Squamous Cell Carcinoma

Question 1

What is it?

Answer 1

A locally invasive malignant tumour of the epidermal keratinocytes or its appendages, which has the potential to metastasise

Question 2

Risk factors

Answer 2

Excessive UV exposure
Pre-malignant skin conditions
Chronic inflammation
Immunosuppression and genetic predisposition

Question 3

Pre-malignant lesions:

Actinic keratosis (solar keratosis):

SCAM

Answer 3

S - Sun exposed sites
C - Red-yellow/skin coloured lesions
A - thick, rough, adherent, scaly
M - ??

Question 4

Pre-malignant lesions:

Actinic keratosis - other variants

Management

Answer 4

Cutaneous horns

Actinic cheilitis - a lip inflammation caused by long-term sunlight exposure. It usually appears as very chapped lips, then may turn white or scaly. AC may be painless, but it can lead to squamous cell carcinoma if left untreated.

Watch and wait
Removal for potential malignancy or for cosmetic reasons
Cyrotherapy

Question 5

Pre-malignant lesions:

Bowens disease

What is it?

SCAM

Management

Answer 5

SCC in situ - 1/30 become invasive SCC

S - Usually on lower leg
C - Red/pink
A - Scaly, well defined
M - plaque/patch

Cyrotherapy 5FU
Initial biopsy

Question 6

Signs

SCAM

What happens to the lesion over time?

What is an SCC on the lower lip linked to?

Answer 6

S - sun exposed areas
C - red/pink as ulcerated
A -
M - lesion - irregular

Increase in size

Smoking

Question 7

Management

Surgical - 2

Topical Rx if superficial

For large unresectable tumours

Answer 7

Surgical excision with 4mm margin
Mohs micrographic surgery

Topical imiquimod or 5FU if superficial

Radiotherapy