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SUMMARY
Squamous cell carcinoma (SCC) is the malignant neoplasm of keratinocytes. It is the second most common type of skin cancer worldwide.
The main pathogenic contributors to SCC are light skin pigmentation, extensive exposure to ultraviolet (UV) radiation, chronic inflammation or scarring, and chronic immunosuppression.
Biopsy facilitates both diagnosis of SCC and identification of histopathologic variants of SCC.
Treatment options for SCC are based on tumor and patient characteristics that affect the risk of SCC recurrence and metastasis. Treatments for low-risk SCC include standard excision, electrodesiccation and curettage, and radiation therapy. Treatments for high-risk SCC include Mohs micrographic surgery, excision with complete margin assessment, standard excision, radiation therapy, and chemotherapy.
Treatment for SCC with nodal or distant metastases should be formulated in multidisciplinary teams; management plans may include surgery, radiation, programmed death-1 (PD-1) inhibitors, epidermal growth factor receptor (EGFR) inhibitors, and systemic chemotherapy.
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DON’T FORGET
For SCC chemoprevention, immunosuppressed and other high-risk patients may take nicotinamide, capecitabine, or synthetic retinoids.
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CLINICAL PEARLS
A nonhealing wound or area that is not responding to a prescribed treatment should be biopsied as it may be an SCC.
Patients with SCC typically have evidence of sun damage in the form of actinic keratosis and solar lentigines on sun-exposed skin.
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PATIENT EDUCATION POINTS
Patients can lower the risk of developing SCC by practicing sun-protective measures such as applying sunscreen, wearing long sleeve shirts, and avoiding direct sunlight.
Patients diagnosed with one SCC are at higher risk of developing more skin cancers in their lifetime. Therefore, it is recommended that they monitor their skin regularly, practice sun-protective behaviors, and visit their dermatologist regularly.
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Cutaneous squamous cell carcinoma (SCC) is the malignant neoplasm of epidermal keratinocytes.1 It is the second most common type of skin cancer, and its incidence is only surpassed by basal cell carcinoma (BCC).2 The pathogenesis of SCC is driven by a combination of genetic and environmental factors, with the most significant contributors being ultraviolet (UV) light, skin color, and immunosuppression. It is locally invasive and has metastatic potential, so it needs to be identified and treated early, particularly in high-risk individuals such as recipients of organ transplants. Clinically, SCC most often appears as a scaly patch, indurated plaque, nodule, or hyperkeratotic ulcer (Figure 7-1). A biopsy is required to confirm the diagnosis and stage the neoplasm. Treatment modalities include standard excision, Mohs micrographic surgery, electrodesiccation and curettage, cryotherapy, and radiation. The type of treatment most appropriate for an SCC depends on the presence and number of high-risk characteristics of the tumor, the≈patient’s comorbidities, and the patient’s tolerance and ability to follow-up with dermatology care.
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