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| {{DiseaseDisorder infobox | | | __NOTOC__ |
| Name = Squamous cell carcinoma, NOS |
| | {{Squamous cell carcinoma}} |
| Image = Squamous Cell Carcinoma.jpg |
| | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
| Caption = Tends to arise from pre-malignant lesions, actinic keratoses; surface is usually scaly and often ulcerates (as shown here). |
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| ICD10 = C44 |
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| ICD9 = {{ICD9|173}} |
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| ICDO = {{ICDO|8070|3}} |
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| eMedicineSubj = derm |
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| eMedicineTopic = 401 |
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| MedlinePlus = 000829 |
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| }}
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| {{SI}}
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| {{CMG}}
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| {{Editor Help}} | | {{CMG}}; '''Associate Editor(s)-in-Chief:''' [[User:Aditya Govindavarjhulla|Aditya Govindavarjhulla, M.B.B.S.]] [mailto:agovi@wikidoc.org], [[User:Raviteja Reddy Guddeti|Raviteja Guddeti, M.B.B.S.]] [mailto:ravitheja.g@gmail.com], {{Faizan}}{{Anum}} |
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| == Overview == | | ==[[Squamous cell carcinoma of the skin overview|Overview]]== |
| In [[medicine]], '''squamous cell carcinoma''' is a form of [[cancer]] of the [[carcinoma]] type that may occur in many different organs, including the [[skin]], [[mouth]], [[esophagus]], [[prostate]], [[lung]]s, and [[cervix]]. It is a malignant tumor of [[epithelium]] that shows [[squamous cell]] differentiation. This type of [[cancer]] can be seen on the skin, lips, inside the mouth, throat or [[esophagus]]. This type of cancer is characterized by red, scaly skin that becomes an open sore.
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| == Epidemiology and Demographics == | | ==[[Squamous cell carcinoma of the skin historical perspective|Historical Perspective]]== |
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| Squamous cell carcinoma affects more than 200,000 people in the United States alone every year. | | ==[[Squamous cell carcinoma of the skin classification|Classification]]== |
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| Incidence of squamous cell carcinoma varies with age, gender, race, geography, and genetics. The incidence of SCC increases with age and the peak incidence is usually around 66 years old. Males are affected with SCC at a ratio of 2:1 in comparison to females. Caucasians are more likely to be affected, especially those with fair Celtic skin, if chronically exposed to UV radiation. There are also a few rare congenital diseases predispose to cutaneous malignancy. Incidence of SCC has also been found to increase with decreasing latitude (e.g. southern US, Australia). Tumors are more common on the left side in the US and on the right side in England. This is probably due to asymmetric sun exposure during driving. In certain geographic locations, exposure to arsenic in well water or from industrial sources may significantly increase the risk of SCC. <ref name="mdconsult">[http://www.mdconsult.com/das/pdxmd/body/107722350-3/761088681?type=med&eid=9-u1.0-_1_mt_1014682 Cutaneous squamous cell carcinoma]</ref>
| | ==[[Squamous cell carcinoma of the skin pathophysiology|Pathophysiology]]== |
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| ==Risk Factors== | | ==[[Squamous cell carcinoma of the skin causes|Causes]]== |
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| Smoking is a significant risk factor. Other risk factors include sun exposure, radiation therapy, exposure to carcinogens, chronic skin irritation or inflammation, genetic diseases, and presence of premalignant lesions. Squamous cell cancer can also occur after organ (e.g. heart, kidney) transplantation. Anti-rejection drugs, that ensure the organ is not rejected by the body, can also suppress the immune system. This can be a major factor towards squamous cell skin cancer.
| | ==[[Squamous cell carcinoma of the skin differential diagnosis|Differenting Squamous cell carcinoma of the skin from other Diseases]]== |
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| ==Related conditions== | | ==[[Squamous cell carcinoma of the skin epidemiology and demographics|Epidemiology and Demographics]]== |
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| * [[Erythroplasia of Queyrat]]
| | ==[[Squamous cell carcinoma of the skin risk factors|Risk Factors]]== |
| * [[Keratoacanthoma]] is a low-grade malignancy of the skin. It originates in the [[sebaceous gland|pilo-sebaceous glands]], and is similar in clinical presentation and microscopic analysis to squamous cell carcinoma, except that it contains a central [[keratin]] plug. Statistically, it is less likely to become invasive than squamous cell carcinoma.
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| * [[Bowen's disease]] is a sunlight-induced skin disease, and is considered to be an early form of squamous cell carcinoma.
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| * [[Marjolin's ulcer]] is a type of squamous cell carcinoma that arises from a non-healing [[ulcer]] or burn wound.
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| * [[Melanoma]]
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| * [[Basal Cell Carcinoma]]
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| ==Terminology== | | ==[[Squamous cell carcinoma of the skin screening|Screening]]== |
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| A carcinoma can be characterized as either [[Carcinoma in situ|''in situ'']] (confined to the original site) or ''[[invasive]]''.
| | ==[[Squamous cell carcinoma of the skin natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ==Clinical features== | | ==Diagnosis== |
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| Approximately 200,000 cases of cutaneous squamous cell carcinoma occur in the US per year resulting in ~2000 deaths (Miller and Weinstock, 1994). Excessive ultraviolet radiation exposure, immunosuppression, human papilloma virus infection, certain chronic dermatoses, and topical arsenic exposure are all risk factors for developing squamous cell carcinoma (Schwartz and Stoll, 1999). Solid organ transplant recipients commonly develop squamous cell carcinoma in the setting of immunosuppression and in some instances develop several hundred separate primary tumors over the span of a several years (Jensen et al., 1999).
| | [[Squamous cell carcinoma of the skin staging|Staging]] | [[Squamous cell carcinoma of the skin history and symptoms|History and Symptoms]] | [[Squamous cell carcinoma of the skin physical examination|Physical Examination]] | [[Squamous cell carcinoma of the skin laboratory findings|Laboratory Findings]] | [[Squamous cell carcinoma of the skin electrocardiogram|Electrocardiogram]] | [[Squamous cell carcinoma of the skin chest x ray|Chest X Ray]] | [[Squamous cell carcinoma of the skin CT|CT]] | [[Squamous cell carcinoma of the skin MRI|MRI]] | [[Squamous cell carcinoma of the skin echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Squamous cell carcinoma of the skin other imaging findings|Other Imaging Findings]] | [[Squamous cell carcinoma of the skin other diagnostic studies|Other Diagnostic Studies]] |
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| Most squamous cell carcinomas arise on the sun-damaged skin of the head and neck, with fewer lesions arising on the extremities and occasional tumors occurring on the trunk. Early lesions frequently present as a red, scaly spots. Later lesions may form nodules or firm plaques, either of which can ulcerate ( http://tray.dermatology.uiowa.edu). Diagnosis is established by biopsy and histopathological confirmation. Complete excision is curative in the vast majority of cases. Occasionally squamous cell carcinoma will invade along the perineural layer of peripheral nerves and will extend well beyond the clinically apparent mass. Local recurrence is more common in these instances and when present on the head, direct intracranial extension may occur. Metastases to draining lymph nodes occurs in a minority of cases and disseminated disease is the cause of most squamous cell carcinoma-related deaths. Higher rates of metastasis (~15%) are observed with primary lesions of the lips or ears (Rowe et al., 1992). Radiation therapy is helpful in some cases of locally recurrent disease in which complete resection is difficult to achieve and in cases of limited metastatic disease.
| | ==Treatment== |
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| ==Pathology==
| | [[Squamous cell carcinoma of the skin medical therapy|Medical Therapy]] | [[Squamous cell carcinoma of the skin surgery|Surgery]] | [[Squamous cell carcinoma of the skin primary prevention|Primary Prevention]] | [[Squamous cell carcinoma of the skin secondary prevention|Secondary Prevention]] | [[Squamous cell carcinoma of the skin cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Squamous cell carcinoma of the skin future or investigational therapies|Future or Investigational Therapies]] |
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| The development of squamous cell carcinoma is frequently a multistep process. Early lesions tend to be either actinic keratoses, with atypia of the basal keratinocytic layer of the epidermis or squamous cell carcinoma in situ, in which keratinocytic atypia spans the full thickness epidermis.
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| These precursors are frequently present adjacent to invasive squamous cell carcinomas which invade the dermis as nests, islands, or cords squamous cells with or occasionally as individual cells. Several grading schemes have been developed for squamous cell carcinoma and incorporate the extent of keratinization (a form of differentiation) and nuclear atypia (Broders, 1932). A widely used scheme divides tumors into well, moderately, or poorly differentiated.
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| Although poorly differentiated tumors tend to behave more aggressively, well-differentiated tumors can also give rise to metastasis and result in death. Several histologic variants of squamous cell carcinoma have been documented, including verrucous, spindle cell and pseudovascular.
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| Frequently an actinic keratosis or squamous cell carcinoma overlies the invasive component and the two are focally contiguous. Occasionally squamous tumors arise rapidly, have a crater-form morphology and spontaneously regress. These tumors are known as keratoacanthomas. Some craterform squamous lesions do not regress, but continue to invade and grow and represent invasive squamous cell carcinomas.
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| ==Signs & Symptoms== | |
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| *The lesion caused by SCC is often [[asymptomatic]]
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| *Ulcer or reddish skin plaque that is slow growing
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| *Intermittent bleeding from the tumor, especially on the lip
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| *The clinical appearance is highly variable
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| *Usually the tumor presents as an ulcerated lesion with hard, raised edges
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| *The tumor may be in the form of a hard plaque or a [[papule]], often with an opalescent quality, with [[telangiectasia]]
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| *The tumor can lie below the level of the surrounding skin, and eventually ulcerates and invades the underlying tissue
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| *The tumor commonly presents on sun-exposed areas (e.g. back of the hand, scalp, lip, and superior surface of [[pinna]])
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| *On the lip, the tumor forms a small ulcer, which fails to heal and bleeds intermittently
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| *Evidence of chronic skin photodamage, such as multiple [[actinic keratoses]] (solar keratoses)
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| *The tumor grows relatively slowly
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| *Unlike basal cell carcinoma (BCC), squamous cell carcinoma (SCC) has a substantial risk of [[metastasis]]
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| *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)
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| == Diagnosis ==
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| Diagnosis is via a [[biopsy]]. For the skin, look under [[skin biopsy]].
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| 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.
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| === Physical Examination ===
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| ==== Skin ====
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| 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.
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| Squamous cell carcinomas account for about 20% of non-melanoma [[skin cancer]]s, (with [[basal cell carcinoma]]s 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.
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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.
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| 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.
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| 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>
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| 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.<ref>Cosmos Online - Skin cancer vaccine within reach (http://www.cosmosmagazine.com/news/2327/skin-cancer-vaccine-within-reach)</ref>
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| ==== Ear Nose and Throat ====
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Squamous cell carcinoma oral 001.jpg|Squamous cell carcinoma in oral cavity
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| Image:Squamous cell carcinoma oral 002.jpg|Squamous cell carcinoma in oral cavity
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| Image:Squamous cell carcinoma oral 003.jpg|Squamous cell carcinoma in oral cavity
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:squamous cell skin cancer.jpg|Squamous cell skin cancer.<ref>http://picasaweb.google.com/mcmumbi/USMLEIIImages</ref>
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| Image:Squamous_cell_carcinoma.jpg|A large squamous cell carcinoma of the tongue<ref>http://picasaweb.google.com/mcmumbi/USMLEIIImages</ref>
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| Image:AuricleMelanoma SqCC.jpg|This patient had two adjacent cancers. The flat black lesion below the antitragus is a malignant melanoma. The white elevated keratotic lesion is a squamous cell carcinoma <ref>http://www.ghorayeb.com</ref>.
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Head oral scc.jpg|Squamous Cell Cancer of the Mouth: Irregular, necrotic appearing tissue on the inside of the mouth due to extensive squamous cell cancer. Patient has limited ability to open his mouth (aka trismus) as a result of the infiltrating cancer.
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| Image:head_oral_scc1.jpg|Squamous Cell Cancer, Base of Tongue: Note white area with swelling, right base of tongue.
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Head_oral_scc2.jpg|Squamous Cell Cancer of the Mouth: Cancer that began along the lower gum line has spread to left submandibular lymph nodes.
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| Image:Head_oral_scc3.jpg|Squamous Cell Cancer of the Mouth: Cancer that began along the lower gum line has spread to left submandibular lymph nodes.
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Auriclesqccastellateexcision.jpg|Recurrent squamous cell carcinoma of the auricle (far left) excised with a stellate incision across the antihelix<ref>http://www.ghorayeb.com</ref>.
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| Image:Auricle003.jpg|The final result of the excision<ref>http://www.ghorayeb.com</ref>.
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| </gallery>
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| </div>
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| ===Esophagus===
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| [[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.
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| ====Penis====
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| When squamous cell carcinoma in situ (Bowen's disease) is found on the penis, it is called erythroplasia of Queyrat<ref>http://www.emedicine.com/derm/TOPIC144.HTM</ref>. This type of cancer respond very well to an experimental agent called Aldara.
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| ====Prostate====
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| 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.
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Squamous cell carcinoma of prostate.jpg|Prostate: Squamous cell carcinoma
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| Image:Squamous cell carcinoma of prostate 2.jpg|Prostate: Squamous cell carcinoma
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| </gallery>
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| </div>
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| ====Lung====
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| When associated with the lung, it often causes ectopic production of [[parathyroid hormone-related protein]] (PTHrP), resulting in [[hypercalcemia]].
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Oral cancer (1) squamous cell carcinoma histopathology.jpg|[[Biopsy]] of a highly differentiated squamous cell carcinoma of the mouth. [[H&E stain|Haematoxylin & eosin stain]].
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| Image:Ca bronchus.jpg|Photograph of a squamous cell carcinoma. Tumour is on the left, obstructing the bronchus (lung). Beyond the tumour the bronchus is inflammed and contains mucus
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| </gallery>
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| </div>
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| ====Vagina and cervix====
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| 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]].
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| === Cervix: Squamous cell carcinoma===
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| <youtube v=zB47nE-i8dQ/>
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| <youtube v=J3kULzKGzws/>
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| ==Experimental treatments==
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| 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)<ref name="Clinuvel-INN">{{Cite web|url=http://www.clinuvel.com/resources/pdf/asx_announcements/2008/20080617WHOGenericName.pdf|title=World Health Organisation assigns CUV1647 generic name|accessdate=2008-06-17|publisher=Clinuvel|year=2008|format=[[Portable Document Format|PDF]]}}</ref> to provide [[photoprotection]] for organ transplant patients against squamous cell carcinoma of the skin and [[actinic keratosis]].<ref name="Clinuvel">[http://www.clinuvel.com/en/faqs/ Clinuvel » Investors » FAQs<!-- Bot generated title -->]</ref><ref name="PharmaAsia">[http://www.pharmaasia.com/article-6618-clinuvelsdrugbeginsglobalphaseiiskincancertrials-Asia.html PharmaAsia - Clinuvel’s Drug Begins Global Phase II Skin Cancer Trials]</ref>
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| 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.<ref>Gross, K.G., et al. Mohs Surgery, Fundamentals and Techniques. 1999, Mosby.</ref>
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| 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.
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| ==References==
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| <references/>
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| ==External links==
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| *[http://www.skincancer.org/squamous/index.php Information on Squamous Cell Carcinoma from The Skin Cancer Foundation]
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| * [http://www.emedicine.com/DERM/topic401.htm Article by Stephen D Hess, MD, PhD]
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| * [http://www.dermnetnz.org/lesions/squamous-cell-carcinoma.html DermNet NZ: Squamous cell carcinoma]
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| * [http://www.skintherapyletter.com/2004/9.4/2.html Squamous cell carcinoma in transplant recipients]
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| | [[Squamous cell carcinoma of the skin case study one|Case #1]] |
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| {{Diseases of the skin and appendages by morphology}} | | {{Diseases of the skin and appendages by morphology}} |
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| {{Genital neoplasia}} | | {{Genital neoplasia}} |
| {{Epithelial neoplasms}} | | {{Epithelial neoplasms}} |
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