Squamous cell carcinoma of the skin: Difference between revisions

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Squamous cell carcinoma is the second most common [[skin cancer|cancer of the skin]] (after [[basal cell carcinoma]] but more common than [[melanoma]]). It usually occurs in areas exposed to the sun, and can generally be treated by [[excision]] or [[mohs surgery]] only.  
Squamous cell carcinoma is the second most common [[skin cancer|cancer of the skin]] (after [[basal cell carcinoma]] but more common than [[melanoma]]). It usually occurs in areas exposed to the sun, and can generally be treated by [[excision]] or [[mohs surgery]] only.  


Sunlight exposure and [[immunosuppression]] are risk factors for SCC of the skin with chronic sun exposure being the strongest environmental risk factor.<ref name="mdconsult"/> The risk of metastasis is low, but is much higher than basal cell carcinoma.  
Sunlight exposure and [[immunosuppression]] are risk factors for SCC of the skin with chronic sun exposure being the strongest environmental risk factor.<ref> name="mdconsult"</ref> The risk of metastasis is low, but is much higher than basal cell carcinoma.  


Squamous cell cancers of the lip and ears have high metastatic and recurrence rate (20 to 50%)<ref>http://www.aad.org/public/publications/pamphlets/sun_squamous.html</ref>.  Squamous cell cancers of the skin in individuals on immunotherapy or having lymphoproliferative disorders (leukemias) are much more aggressive, regardless of their location.<ref>http://www.skincarephysicians.com/skincancernet/squamous_cell_carcinoma.html</ref>
Squamous cell cancers of the lip and ears have high metastatic and recurrence rate (20 to 50%)<ref>http://www.aad.org/public/publications/pamphlets/sun_squamous.html</ref>.  Squamous cell cancers of the skin in individuals on immunotherapy or having lymphoproliferative disorders (leukemias) are much more aggressive, regardless of their location.<ref>http://www.skincarephysicians.com/skincancernet/squamous_cell_carcinoma.html</ref>

Revision as of 16:55, 12 June 2012

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Squamous cell carcinoma of the skin Microchapters

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Overview

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Pathophysiology

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Differentiating Squamous cell carcinoma of the skin from other Diseases

Epidemiology & Demographics

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Diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2], Raviteja Guddeti, M.B.B.S. [3]

Overview

Historical Aspects

Pathophysiology

Epidemiology and Demographics

Risk Factors

Screening

Causes of Squamous cell carcinoma

Differential Diagnosis

Natural History Complications and Prognosis

Clinical Features

Squamous cell carcinoma history and symptoms

Signs & Symptoms

  • The lesion caused by SCC is often asymptomatic
  • Ulcer or reddish skin plaque that is slow growing
  • Intermittent bleeding from the tumor, especially on the lip
  • The clinical appearance is highly variable
  • Usually the tumor presents as an ulcerated lesion with hard, raised edges
  • The tumor may be in the form of a hard plaque or a papule, often with an opalescent quality, with telangiectasia
  • The tumor can lie below the level of the surrounding skin, and eventually ulcerates and invades the underlying tissue
  • The tumor commonly presents on sun-exposed areas (e.g. back of the hand, scalp, lip, and superior surface of pinna)
  • On the lip, the tumor forms a small ulcer, which fails to heal and bleeds intermittently
  • Evidence of chronic skin photodamage, such as multiple actinic keratoses (solar keratoses)
  • The tumor grows relatively slowly
  • Unlike basal cell carcinoma (BCC), squamous cell carcinoma (SCC) has a substantial risk of metastasis
  • Risk of metastasis is higher in SCC arising in scars, on the lower lips or mucosa, and occurring in immunosupressed patients. About *one-third of lingual and mucosal tumors metastasize before diagnosis (these are often related to tobacco and alcohol use)

Diagnosis

Diagnosis is via a biopsy. For the skin, look under skin biopsy.

The pathological appearance of a squamous cell cancer varies with the depth of the biopsy. For that reason, a biopsy including the subcutanous tissue and basalar epithelium, to the surface is necessary for correct diagnosis. The performance of a shave biopsy (see skin biopsy) might not acquire enough information for a diagnosis. An excision biopsy is ideal, but not practical in most cases. An incisional or punch biopsy is preferred. A shave biopsy is least ideal, especially if only the superficial portion is acquired.

Physical Examination

Skin

Squamous cell carcinoma of the skin is often caused by long term exposure to the sun. To be diagnosed, a biopsy is done where a sample is taken and examined under a microscope by a Pathologist. If it is found to be cancerous, a surgery is done to remove it.

Squamous cell carcinomas account for about 20% of non-melanoma skin cancers, (with basal cell carcinomas accounting for about 80%), and are clinically more significant because of their ability to metastasize. Squamous cell carcinoma is usually developed in the epithelial layer of the skin and sometimes in various mucous membranes of the body.

Squamous cell carcinoma is the second most common cancer of the skin (after basal cell carcinoma but more common than melanoma). It usually occurs in areas exposed to the sun, and can generally be treated by excision or mohs surgery only.

Sunlight exposure and immunosuppression are risk factors for SCC of the skin with chronic sun exposure being the strongest environmental risk factor.[1] The risk of metastasis is low, but is much higher than basal cell carcinoma.

Squamous cell cancers of the lip and ears have high metastatic and recurrence rate (20 to 50%)[2]. Squamous cell cancers of the skin in individuals on immunotherapy or having lymphoproliferative disorders (leukemias) are much more aggressive, regardless of their location.[3]

Australian scientist Ian Frazer who developed the cervical cancer vaccine, says that animal tests have been effective in preventing squamous cell carcinoma in animals, and there may be a human vaccine against this kind of skin cancer within the decade.[4]

Ear Nose and Throat





Esophagus

Esophageal cancer may be due to either squamous cell carcinoma (ESCC) or adenocarcinoma (EAC). SCCs tend to occur closer to the mouth, while adenocarcinomas occur closer to the stomach. Dysphagia (difficulty swallowing, solids worse than liquids) and odynophagia are common initial symptoms. If the disease is localized, esophagectomy may offer the possibility of a cure. If the disease has spread, chemotherapy and radiotherapy are commonly used.

Penis

When squamous cell carcinoma in situ (Bowen's disease) is found on the penis, it is called erythroplasia of Queyrat[10]. This type of cancer respond very well to an experimental agent called Aldara.

Prostate

When associated with the prostate, squamous cell carcinoma is very aggressive in nature. It is difficult to detect as there is no increase in prostate specific antigen levels seen; meaning that the cancer is often diagnosed at an advanced stage.

Lung

When associated with the lung, it often causes ectopic production of parathyroid hormone-related protein (PTHrP), resulting in hypercalcemia.

Vagina and cervix

Vaginal squamous cell carcinoma spreads slowly and usually stays near the vagina, but may spread to the lungs and liver. This is the most common type of vaginal cancer.

Cervix: Squamous cell carcinoma

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Experimental treatments

In 2007, Australian biopharmaceutical company Clinuvel Pharmaceuticals Limited began clinical trials with a melanocyte-stimulating hormone called melanotan (known by the International Nonproprietary Name afamelanotide, formerly CUV1647)[11] to provide photoprotection for organ transplant patients against squamous cell carcinoma of the skin and actinic keratosis.[12][13]

While Mohs surgery is frequently utilized and often considered the treatment of choice for squamous cell carcinoma of the skin, physicians have utilized the method for the treatment of squamous cell carcinoma of the mouth, throat, and neck.[14]

Aldara (Imiquimod) has been used with great success for squamous cell carcinoma in situ of the skin and the penis. After treatment, the skin resembles normal skin without the usual scarring and morbidity associated with standard excision. Imiquimod is not FDA approved for any squamous cell carcinoma.

References

  1. name="mdconsult"
  2. http://www.aad.org/public/publications/pamphlets/sun_squamous.html
  3. http://www.skincarephysicians.com/skincancernet/squamous_cell_carcinoma.html
  4. Cosmos Online - Skin cancer vaccine within reach (http://www.cosmosmagazine.com/news/2327/skin-cancer-vaccine-within-reach)
  5. http://picasaweb.google.com/mcmumbi/USMLEIIImages
  6. http://picasaweb.google.com/mcmumbi/USMLEIIImages
  7. http://www.ghorayeb.com
  8. http://www.ghorayeb.com
  9. http://www.ghorayeb.com
  10. http://www.emedicine.com/derm/TOPIC144.HTM
  11. "World Health Organisation assigns CUV1647 generic name" (PDF). Clinuvel. 2008. Retrieved 2008-06-17.
  12. Clinuvel » Investors » FAQs
  13. PharmaAsia - Clinuvel’s Drug Begins Global Phase II Skin Cancer Trials
  14. Gross, K.G., et al. Mohs Surgery, Fundamentals and Techniques. 1999, Mosby.

External links


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