Squamous cell carcinoma of the skin
Summary
Definition
Cutaneous SCC is the proliferation of atypical, transformed keratinocytes in the skin with malignant behavior. It ranges from in situ tumors (also known as Bowen disease) to invasive tumors and metastatic disease. Precursor lesions for SCCs are called actinic (or sun-damage) keratosis.[Figure caption and citation for the preceding image starts]: Squamous cell carcinoma on the dorsal hand with evidence of extensive sun damageFrom the private collection of Dr Nwaneshiudu and Dr Soltani [Citation ends].
The management of metastatic disease is beyond the scope of the topic.
History and exam
Key diagnostic factors
- growing tumors
Other diagnostic factors
- previous skin cancer
- bleeding
- crusting
- evidence of sun damage to skin
- tender or itchy nonhealing wound originally caused by trauma
- erythematous papules or plaques
- thin, flesh-colored or erythematous plaques
- dome-shaped nodule
- exophytic, fungating, verrucous nodules, or plaques
- ulcerated tumors
- lymphadenopathy
- bone pain
- hepatomegaly
- neurologic signs
Risk factors
- ultraviolet radiation exposure
- solid organ transplant recipient
- immunosuppression
- Fitzpatrick skin phototype
- hereditary skin conditions
- older age
- male sex
- exposure to carcinogens
- actinic keratosis
- previous skin cancer
- exposure to ionizing radiation
- human papillomavirus
- tobacco smoking
- use of thiazide diuretics or cardiac drugs
- tattoos
Diagnostic investigations
1st investigations to order
- biopsy
Investigations to consider
- CT scan
- MRI scan
- CBC with differential
- LFTs
Treatment algorithm
SCC in situ (Bowen disease)
invasive SCC
locally advanced SCC
immunocompromised or high risk of metastatic disease
Contributors
Authors
Keyoumars Soltani, MD
Professor
Department of Medicine
Director of Immunopathology
Laboratory Section of Dermatology
The University of Chicago
Chicago
IL
Disclosures
KS declares that he has no competing interests.
Adaobi Nwaneshiudu Obasi, MD, PhD, FAAD
Medical Director, Dermatologist, and Dermatopathologist
Cutis Wellness Dermatology & Dermatopathology, PLLC
Preceptor
University of the Incarnate Word
Department of Family Medicine
Laredo
TX
Disclosures
ANO has received honorarium for lectures at 2020 Cynosure and PCCA meetings.
Acknowledgements
Prof K. Soltani and Dr A. I. Nwaneshiudu would like to gratefully acknowledge Dr Carlos Paz and Dr Jessica M. Sheehan, the previous co-contributors to this topic.
Disclosures
CP and JMS declare that they have no competing interests.
Peer reviewers
Catherine G. Chung, MD
Professor of Dermatology and Pathology
The Ohio State University
Wexner Medical Center
OH
Declarações
CGC declares she has no competing interests.
Créditos aos pareceristas
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Declarações
As afiliações e declarações dos pareceristas referem--se ao momento da revisão.
Referências
Principais artigos
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: squamous cell skin cancer [internet publication].Texto completo
Kim JYS, Kozlow JH, Mittal B, et al. Guidelines of care for the management of cutaneous squamous cell carcinoma. J Am Acad Dermatol. 2018 Mar;78(3):560-78.Texto completo Resumo
Keohane SG, Botting J, Budny PG, et al. British Association of Dermatologists guidelines for the management of the people with cutaneous squamous cell carcinoma 2020. Br J Dermatol 2021;184:401-14.Texto completo Resumo
Stratigos AJ, Garbe C, Dessinioti C, et al. European consensus-based interdisciplinary guideline for invasive cutaneous squamous cell carcinoma: part 2. Treatment - update 2023. Eur J Cancer. 2023 Nov;193:113252.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Actinic keratosis
- Basal cell carcinoma
- Seborrheic keratosis
Mais Diagnósticos diferenciaisDiretrizes
- NCCN clinical practice guidelines in oncology: penile cancer (squamous cell carcinoma)
- NCCN clinical guidelines in oncology: vaginal cancer
Mais DiretrizesFolhetos informativos para os pacientes
Skin cancer (squamous cell)
Staying safe in the sun
Mais Folhetos informativos para os pacientes
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