Squamous cell carcinoma of the skin

Epidemiology
- SCC accounts for 18% of all skin cancer
- Second most common skin cancer, after BCC
Risk factors
- Chronic sun exposure
- Transplantation (transplant-related immunosuppression increases the risk 65-fold)
- Precancerous lesions
  - Actinic keratosis
  - Bowen disease (SCC in situ)
  - Leukoplakia
- Radiation
- Chronic scars, ulcers
- Arsenic, tar
Clinical features
- Painless, non-healing, bleeding ulcer or nodule
- Rapid growing
- On sun-exposed areas
  - Face and neck
  - Lower lip
Prognosis
- Low risk of metastasis (5%)
- Worse prognosis in transplant patients
Diagnosis
- Punch biopsy or after surgical excision
Treatment
- Surgery
  - Surgical excision with 5 mm safety border
  - Primary treatment is almost all cases
- Radiotherapy
  - If surgery is not an option
  - As adjuvant therapy if high-risk features are discovered during pathological staging
- Immune therapy
  - For advanced SCC
  - Cemiplimab – anti-PD-1
- Alternatives for superficial and small SCCs
  - Cryosurgery
- Mohs micrographic surgery
- For low-risk, small SCC
  - Cryotherapy
  - Curettage
- For metastasis
  - Chemotherapy
    - Platina
    - 5-FU
  - EGFR inhibitors – cetuximab
  - PD-1 inhibitor – cemeplimab
Follow-up
- Physical examination
- Regional ultrasound
- Chest x-ray
- Abdominal US
- Sun protection