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Chapter 30: Squamous Cell Carcinoma

INTRODUCTION

KEY POINTS

  • Squamous cell carcinoma (SCC) is more common in those with lighter skin types; however, it does occur in darker skin and tends to carry greater disease morbidity and mortality in this population.

  • In darker skin, it more commonly occurs in an ulcerative form in areas of burns and/or chronic scarring.

  • SCCs can mimic the appearance of verruca and basal cell carcinomas.

image

FIGURE 30-1.

Pink-white vegetative ulcerated plaque with peripheral crusting representing a Marjolin ulcer arising in a burn on the lower mucocutaneous lip. Note the peripheral hyperpigmentation periorally and on the cheeks from the patient’s burn. (From Usatine RP, Smith MA, Mayeaux EJ Jr, et al. The Color Atlas and Synopsis of Family Medicine, 3rd ed. New York, NY: McGraw Hill; 2019, Figure 178-3. Reproduced with permission from Richard P. Usatine, MD.)

A photo shows an irregular tumorous outgrowth in the lower lip.
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FIGURE 30-2.

Well-circumscribed ulcerative yellow-red plaque with surrounding erythema arising in a chronic venous ulcer with background lipodermatosclerosis and stasis dermatitis on a lower extremity. (Reproduced with permission from Wolff K, Johnson RA, Saavedra AP, et al. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology, 8th ed. New York, NY: McGraw Hill; 2017, Figure 17-12.)

A patient with an annular, ulcerative plaque ranging from yellow to red to black. A large area surrounding the plaque is red. A white border surrounds much of the plaque.
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FIGURE 30-3.

Ulcerated vegetative pink plaque representing a squamous cell carcinoma on the left buttock arising in a darker-skinned person with chronic inflammation secondary to hidradenitis suppurativa. (Reproduced with permission from Kang S, Amagai M, Bruckner AL, et al. Fitzpatrick’s Dermatology, 9th ed. New York, NY: McGraw Hill; 2019, Figure 84-8.)

The image shows a photograph depicting squamous cell carcinoma arising in long-standing hidradenitis suppurativa on the buttocks.
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FIGURE 30-4.

Well-circumscribed dark-brown plaque with normal-appearing skin centrally, representing Bowen disease on the forearm of a Black man. (Reproduced with permission from Taylor SC, Kelly AP, Lim HW, et al. Taylor and Kelly’s Dermatology for Skin of Color, 2nd ed. New York, NY: McGraw Hill; 2016, Figure 45-5.)

A patient with brown skin exhibits a hyperpigmented dark brown to black plaque. The center of the plaque contains normal skin.
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FIGURE 30-5.

Well-demarcated pink scaly plaque with an overlying central scab on the forearm of a Hispanic woman. (Reproduced with permission from Taylor SC, Kelly AP, Lim HW, et al. Taylor and Kelly’s Dermatology for Skin of Color, 2nd ed. New York, NY: McGraw Hill; 2016, Figure 45-7.)

A patient with light brown skin with a pink, scaly plaque on the ventral forearm. The plaque has some crusting and is outlined in marker.
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FIGURE 30-6.

Well-circumscribed pink and brown plaque on the upper extremity. (From Usatine RP, Smith MA, Mayeaux EJ Jr, et al. The Color Atlas and Synopsis of Family Medicine, 3rd ed. New York, NY: McGraw Hill; 2019, Figure 173-7. Reproduced with permission from Richard P. Usatine, MD.)

A photo shows two flat, pinkish lesions. One appears small and round with raised borders. Other lesion is larger and irregular in shape.
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FIGURE 30-7.

Pink-grey scaly plaque mimicking features of a basal cell carcinoma on the thenar eminence of the ...

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