Updated: 3/24/2019

Squamous Cell Carcinoma (SCC) of the Skin

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Snapshot
  • A 70-year-old man presents to the dermatologist’s office for his annual skin exam. He complains of a large pink lesion on his cheek that oozes and bleeds. It never seemed to heal properly. He is concerned, because he knows that he should have used more sunscreen throughout his life.
 
Introduction
  • Invasive primary skin malignancy arising from keratinocytes of skin or mucosa
  • Epidemiology
    • common in fair-skinned individuals
    • common in elderly patients
    • 2nd most common form of skin cancer (first is basal cell carcinoma )
    • risk factors
      • sun exposure 
      • actinic keratosis
      • immunosuppression (similar to treatment after organ transplant)
      • arsenic exposure
      • old scars or burns 
      • xeroderma pigmentosum
      • ionizing radiation
  • Pathogenesis
    • damage to keratinocytes
    • metastases are rare
  • Keratoacanthoma is a variant of low-grade squamous cell carcinoma
    • grows rapidly and regresses spontaneously
Presentation
  • Symptoms
    • typically asymptomatic
  • Physical exam
    • red, poorly defined base with adherent yellow or white scale
    • smooth, dull, red, dome-shaped nodule with ulcerated center
    • frequently on sun-exposed areas
      • face, neck, hands, ears
      • common on lower lips
      • lesions often against a background of sun-damaged skin
Evaluation
  • Diagnosis by skin biopsy 
    • atypical keratinocytes and malignant cells
    • invasion into dermis
    • keratin “pearls” on histology
Differential Diagnosis
  • Actinic keratosis
  • Actinic cheilitis
Treatment
  • Surgical
    • wide local excision with negative margins
Prognosis, Prevention, and Complications
  • Prognosis
    • if treated, very excellent prognosis
  • Prevention
    • sun avoidance
    • sunscreen use
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Questions (7)
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(M1.ON.14.51) A 71-year-old man presents to his primary care physician with the lesion seen in Figure A. He states that it has been present for several months. He has no significant past medical history and is a retired construction worker. What would be the expected pathology on biopsy? Tested Concept

QID: 104262
FIGURES:
1

Palisading basal cells

19%

(6/32)

2

Keratin pearls

47%

(15/32)

3

S-100 postive staining cells

9%

(3/32)

4

Parakeratosis

12%

(4/32)

5

Cowdry inclusions

12%

(4/32)

M 2 B

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(M1.ON.14.57) A 62-year-old man presents to your office for evaluation of a chronic ulcer on the plantar aspect of his right foot. He has a history of peripheral vascular disease and poorly-controlled diabetes mellitus. He states that he has had this ulcer for years, but that it seems to be growing. On examination of his right foot you note the heaped up edges surrounding the ulcer (Figure A). A wedge biopsy reveals irregular masses of anaplastic epidermal cells proliferating down to the dermis and the pathologist reports "keratin pearls". What is the diagnosis? Tested Concept

QID: 106379
FIGURES:
1

Melanoma

1%

(2/152)

2

Squamous cell carcinoma

84%

(127/152)

3

Basal cell carcinoma

8%

(12/152)

4

Osteomyelitis

3%

(4/152)

5

Plantar fasciitis

3%

(5/152)

M 2 B

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(M1.ON.13.1) A 58-year-old lifeguard develops squamous cell carcinoma of the skin on his forehead. Which of the following most likely preceded the development of this carcinoma? Tested Concept

QID: 101308
1

Hamartomatous lesion of sebaceous glands

2%

(4/162)

2

Dry, scaly, hyperkeratotic papule

67%

(108/162)

3

A single, large pink patch

5%

(8/162)

4

Dermatophyte infection

0%

(0/162)

5

UVC exposure

25%

(41/162)

M 1 E

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