Squamous cell carcinoma of the skin occurs in keratinocytes, which are located in the epidermis.
Second most common nonmelanoma skin cancer worldwide, secondary to basal cell carcinoma.
Cumulative ultraviolet exposure and immunosuppression are major risk factors.
Treatments include nonsurgical destruction (e.g., using cryotherapy), topical and systemic chemotherapy, traditional surgical excision, and Mohs micrographic surgery.
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.
History and exam
Key diagnostic factors
- growing tumors
Other diagnostic factors
- previous skin cancer
- 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
- bone pain
- neurologic signs
- ultraviolet radiation exposure
- solid organ transplant recipient
- Fitzpatrick skin phototype
- hereditary skin conditions
- older age
- male sex
- ionizing radiation
- actinic keratosis
- previous skin cancer
- human papillomavirus
- tobacco smoking
- thiazide diuretics and cardiac drugs
1st investigations to order
Investigations to consider
- CT body scan
- MRI scan
- PET scan
- CBC with differential
- chest x-ray
- noninvasive imaging technologies
SCC in situ (Bowen disease)
immunocompromised or high risk of metastatic disease
Keyoumars Soltani, MD
Department of Medicine
Director of Immunopathology
Laboratory Section of Dermatology
The University of Chicago
KS declares that he has no competing interests.
Adaobi Nwaneshiudu Obasi, MD, PhD, FAAD
Medical Director, Dermatologist, and Dermatopathologist
Cutis Wellness Dermatology & Dermatopathology, PLLC
University of the Incarnate Word
Department of Family Medicine
ANO has received honorarium for lectures at 2020 Cynosure and PCCA meetings.
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.
CP and JMS declare that they have no competing interests.
Nanette Silverberg, MD
Clinical Professor of Dermatology
Columbia University College of Physicians and Surgeons
New York City
NS declares that she has no competing interests.
Iris Aronson, MD
Department of Dermatology
University of Illinois
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
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
JMG declares that she has no competing interests.
- Actinic keratosis
- Basal cell carcinoma
- Seborrheic keratosis
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Skin cancer (squamous cell)
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