Squamous Cell Carcinoma

Question 1

Risk factors for SSC?

Answer 1

• SMOKING
• SUN EXPOSURE
• premalignant lesions (actinic keratosis)
• age
• skin trauma
• exposure to carbon containing compounds
• asbestos
• arsenic
• ionizing radiation
• metals
• non solar UV eg welders
• 3xmore in men
• occupational with chronic low-grade sun exposure eg farmer / builder

Question 2

Presentation of SSC?

Answer 2

• solitary papule / nodule often ERODED at centre or CRUSTY, PURULENT or BLEEDING
• “fleshy lesion”
• may resemble giant warts but can be painful
• usually sun exposed areas
• often hard scaly dome
• can bleed / itch
• related to smoking might be on lower lip
• SSC in situ = Bowens disease

Question 3

Treatment of SSC?

Answer 3

Definitive is SURGICAL excision with 2mm - 10mm margin
(small 2-4mm, normal 5mm 95%success, high risk 10mm)

Can be treated with TOPICAL cream:

• 5-fluorouracil OD/BD for 4 weeks +
• immiquimod OD 5 days a week for 6 weeks
• can leave scare
• dont get a histological Dx
• never completely sure of cure

Can also us CRYOTHERAPY

Metastases are rare

Solar Keratoses

• superficial precursors to SCC
• often in sun exposed areas
• can treat with topical agents or cryotherapy