Squamous cell carcinoma of the skin

From greek.doctor
  • 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