Squamous Cell Carcinoma (SCC)

Info & Pathophysiology

Source: MedPix (NLM, NIH)

Malignancy (>2cm dia) originating from proliferating keratinocytes in stratum spinosum. Less common, but more likely to metastasize than basal cell carcinoma (BCC).

Risk Factors: chronically damaged skin (e.g. inflammation, burns, ulcers), UV exposure, arsenic ingestion, immunosuppression

Clinical Diagnosis (Cutaneous subtype originating from actinic keratoses): crusty, scaly, raised, erythema around scales

Subtypes/Other Manifestations:

  • SCC in situ (Bowen’s): does not invade past basement membrane, limited to epidermis
  • Can be firm keratotic papules/plaques/nodules (more differentiated) or granulomas/ulcerative/necrotic tissue (poorly differentiated)
  • Cutaneous horn: big wart projection

Pathophysiology: genetic dysregulation and mutation of TP53

Histological Characteristics

Presence of Keratin Pearl in dermis (concentric layers with thickening of epidermis), highly eosinophilic

Acanthosis (epidermal thickening)

Dyskeratotic cells

Source: Wikimedia Commons

Treatment

Since higher risk of metastasis, first line treatment for cutaneous SCC is surgery (except SCC in situ)

Low Risk (<2cm, ≤ 6mm invasion beyond subcutaneous fat) treatment: standard surgical excision

  • Standard Surgical Excision: vertical slide cuts in elliptical-shaped incision; margin examined post-op

High Risk: Mohs micrographic surgery

  • Mohs: oblique excision, horizontal slices of cuts until no cancerous tissue detected; margins examined during surgery

SCC in situ treatment: curettage/excision, photodynamic therapy (use biological activator cream over lesion with light/radiation treatment), topical fluorouracil or imiquimod

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