SCC Overview

SCC accounts for 16% of all skin cancers. Compared with BCC, this type of skin cancer can grow faster, is more aggressive, and carries a greater risk for metastasis. Although cutaneous SCC is rarely fatal, these lesions can become large and bleed or ulcerate on a daily basis to the point of causing discomfort and pain.

Additionally, cutaneous SCC often develops on the head or neck, so lesion removal can result in disfigurement and can impair local structure functioning. The most common cause of SCC is UV radiation damage to p53 tumor suppressor gene.

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Keratinocytes in the skin then undergo rapid and uncontrolled cloning and growth. Further genetic defects are acquired during this process, leading to the invasion of SCC. Many other genetic abnormalities are associated with or are being studied in the development of SCC.

Immunosuppression resulting from immunosuppressive therapy following organ transplantation can lead to multiple SCCs. Therefore, all organ recipients should undergo full clinical skin examinations as part of their long-term follow up care. In addition, any form of chronic immunosuppression, such as that caused by human immunodeficiency virus (HIV) or acquired immune deficiency syndrome (AIDS), predisposes a person to SCC.

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Other risk factors for the development of SCC include exposure to not just UV radiation but other forms of radiation as well, exposure to known human carcinogens, and human papillomavirus (HPV) infection.

Clinical appearance. SCC often appears on sun-exposed parts of the body as an ulcerate plaque or papule with scaling or crusting, or as a horny wartlike growth. Symptoms suggestive of nerve involvement include numbness, twitching, and visual changes (if the lesion is on the head or face).8 SCC can be painful even if there is no nerve involvement.

Diagnosis. SCC is diagnosed by skin biopsy. A shave, tangential, or saucerization biopsy is adequate for the diagnosis of a solitary small lesion.

A punch biopsy would provide full thickness analysis and depth of invasion. Computed tomography (CT) imaging should be performed to investigate concerns of local soft-tissue involvement, and magnetic resonance imaging (MRI) should be performed to investigate concerns of nerve involvement. A fine-needle biopsy is required to evaluate nodule or local lymph node involvement.

If the pathology report describes the lesion as poorly differentiated, the level of atypia is most severe and may even make histology diagnosis difficult to differentiate between mesenchymal tumors, melanoma, or lymphoma. Both acantholytic (adenoid) SCC and spindle cell SCC have a more aggressive clinical course, and management should reflect that.8 

This article originally appeared on Clinical Advisor