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