Dermatology Book

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Squamous Cell Carcinoma

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  1. See Also
    1. Nonmelanoma Skin Cancer
    2. Actinic Keratoses
  2. Epidemiology
    1. Incidence (US, 1998): 50,000/year
  3. Pathophysiology
    1. Arises from superficial layers of Keratinocytes
    2. Precursor lesions
      1. Actinic Keratoses
      2. Radiation and burn scars
  4. Signs
    1. Location
      1. Sun exposed areas
    2. Characteristics
      1. Nodule, patch or Plaque on indurated base
      2. Ulceration and crusting may be present
      3. Thick white scale may be present
      4. May form keratin horn
      5. Fleshy heaped-up edges of lesion
  5. Diagnosis: Skin Biopsy
    1. Raised lesion: Shave Biopsy if not pigmented
      1. Any suspicion of Melanoma needs full-thickness sample
    2. Flat lesions: Punch Biopsy or full excision
  6. Management
    1. Surgical excision
      1. Complete excision recommended over ED&C
        1. Due to risk of metastases
      2. Imperative to confirm negative margins
      3. Indications
        1. Small lesions less than size criteria for Moh's
        2. Slow growing, well differentiated lesions
        3. Negative for neural or vascular invasion
    2. Mohs' Microographic Surgery
      1. Indications
        1. Large lesions
          1. Central face, periorbital, periauricular: >6 mm
          2. Cheeks, forehead, neck, scalp: >10 mm
          3. Trunk, extremities: >20 mm
        2. Indistinct margins
        3. Recurrent lesions
        4. Lesion in close proximity to eyes, nose, mouth
        5. Preserve cosmetic appearance
      2. References
        1. Martinez (2001) Mayo Clin Proc 76:1253
  7. Course
    1. More rapid growth than Basal Cell Carcinoma
    2. Locally destructive skin cancer
    3. Metastasize in 3-4% of cases
  8. Prevention
    1. See Sun Exposure (lists general preventive measures)
    2. See Sunscreen
  9. References
    1. Habif (2004) Dermatology p. 744-7
    2. Stulberg (2004) Am Fam Physician 70:1481

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