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Squamous cell carcinoma of the skin

Last reviewed: 1 Apr 2025
Last updated: 01 Nov 2024

Summary

Definition

History and exam

Key diagnostic factors

  • growing tumors
Full details

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
Full details

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
  • thiazide diuretics and cardiac drugs
  • tattoos
Full details

Diagnostic tests

1st tests to order

  • biopsy
Full details

Tests to consider

  • CT scan
  • MRI scan
  • PET scan
  • CBC with differential
  • LFTs
Full details

Treatment algorithm

ACUTE

SCC in situ (Bowen disease)

invasive SCC

metastatic SCC

ONGOING

immunocompromised or high risk of metastatic disease

Contributors

Authors

Keyoumars Soltani, MD
Keyoumars Soltani

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
Adaobi Nwaneshiudu Obasi

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.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: squamous cell skin cancer [internet publication].Full text

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.Full text  Abstract

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.Full text  Abstract

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.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Squamous cell carcinoma of the skin images
  • Differentials

    • Actinic keratosis
    • Basal cell carcinoma
    • Seborrheic keratosis
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  • Guidelines

    • Guidelines for the diagnosis and treatment of cutaneous squamous cell carcinoma
    • NCCN clinical guidelines in oncology: vaginal cancer
    More Guidelines
  • Patient information

    Skin cancer (squamous cell)

    Staying safe in the sun

    More Patient information
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