Summary
Definition
Cutaneous squamous cell carcinoma (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].
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
- ionizing radiation
- carcinogens
- actinic keratosis
- previous skin cancer
- human papillomavirus
- tobacco smoking
- thiazide diuretics and cardiac drugs
- tattoos
Diagnostic investigations
1st investigations to order
- biopsy
Investigations to consider
- CT body scan
- MRI scan
- PET scan
- CBC with differential
- LFTs
- chest x-ray
Emerging tests
- noninvasive imaging technologies
Treatment algorithm
SCC in situ (Bowen disease)
invasive SCC
metastatic 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
Nanette Silverberg, MD
Clinical Professor of Dermatology
Columbia University College of Physicians and Surgeons
New York City
NY
Disclosures
NS declares that she has no competing interests.
Iris Aronson, MD
Associate Head
Associate Professor
Department of Dermatology
University of Illinois
Chicago
IL
Disclosures
IA declares that she has no competing interests.
Keyvan Nouri, MD
Professor of Dermatology & Otolaryngology
Director of Mohs, Dermatologic & Laser Surgery
Director of Surgical Training
Department of Dermatology & Cutaneous Surgery
University of Miami
Miami
FL
Disclosures
KN declares that he has no competing interests.
Jane McGregor, MA, MB, BChir, MRCP, MD
Senior Lecturer and Honorary Consultant Dermatologist (Barts and the London NHS Trust)
Institute of Cellular and Molecular Science
London
UK
Disclosures
JMG declares that she has no competing interests.
Differentials
- Actinic keratosis
- Basal cell carcinoma
- Seborrheic keratosis
More DifferentialsGuidelines
- NCCN clinical practice guidelines in oncology: vulvar cancer (squamous cell carcinoma)
- NCCN clinical practice guidelines in oncology: penile cancer (squamous cell carcinoma)
More GuidelinesPatient leaflets
Skin cancer (squamous cell)
Staying safe in the sun
More Patient leaflets
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