Squamous cell carcinoma of the skin natural history, complications and prognosis
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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
Natural History
Once Squamous cell carcinoma (SCC) develops on the skin it grows slowly. If neglected and once it reaches the size of 2 cm and more it is three times more likely to spread to other areas than the smaller lesions. Usual size ranges from 1 cm to 5 cm. It is the mechanical interference of this fungiform exophytic lesion that brings it to the notice of the patient or the clinician.
Complications
Prognosis
This lesion has a cure rate of 95% - 98%. But once the lesion spreads to other regions beyond skin, like lymph nodes and internal organs less than half of the patients live five years. A sub set of SCC carries the risk of local recurrence, nodal or distant metastasis (usually to the lungs) and eventually death. Tumors in this sub set are termed high risk SCC. Tumor related factors in high risk SCC are
- Tumor size greater than 2 cm (1.5 cm for lesions on ear or lip) - Lesions less than 2 cm have a metastatic potential of 9.1% whereas in those of size more than 2 cm the rates spike up to 30.3%.
- Invasion to subcutaneous fat : less than 2 mm - 95% survival rate, from 2-9 mm - 80% survival rate, more than 9 mm - 65% survival rate.
- Poorly differentiated cells
- Recurrent tumor
- Perineural involvement - the metastatic rate in such involvement can reach 45%. The degree of nerve involvement likely has a major impact on the prognosis. [1]
References
- ↑ Rowe DE, Carroll RJ, Day CL Jr. Prognostic factors for local recurrence, metastasis, and survival rates in squamous cell carcinoma of the skin, ear, and lip. Implications for treatment modality selection. J Am Acad Dermatol. Jun 1992;26(6):976-90