section name header

Information

Editors

AlexanderSalava
SariKoskenmies

Squamous Cell Carcinoma

See also the article on precancerous lesions preceding squamous cell carcinoma Precancerous Lesions Preceding Squamous Cell Carcinoma (Actinic Keratosis and Carcinoma in Situ, or Bowen's Disease).

Essentials

  • Squamous cell carcinoma (SCC, epidermoid/spinocellular/squamocellular carcinoma) develops from the epidermal cells as a result of long term exposure to UV radiation.
  • It may metastasise to nearby lymph nodes.
  • SCC may arise directly on healthy looking skin, but more frequently it develops on a precancerous lesion, such as:
  • SCC is always treated surgically in specialized care.
  • Immunosuppressive therapy lasting for several years, e.g. in organ transplant recipients, predisposes the patient to SCC.

Diagnosis

  • SCC is usually a clearly demarcated, reddish or skin-coloured nodule frequently with a hyperkeratotic and ulcerated surface (Image 4).
  • No telangiectasias are present on the surface as is the case in typical basal cell carcinoma (BCC) Basal Cell Carcinoma.
  • SCC is often a rapidly growing and partly ulcerated skin tumour on areas of skin unprotected against the sun, such as the face, the backs of the hands or lower legs.
  • The final diagnosis is histological.
  • The risk of metastasis depends on:
    • tumour-related risk factors, such as location in a risk area (ear lobe, lip, scalp), large size, thickness, rapid growth, histological type
    • patient-related risk factors, such as immunosuppressive medication, history of radiotherapy to or chronic inflammation of the tumour area.
  • Keratoacanthoma is a rapidly growing well differentiated SCC (Images 5 6 7).

Treatment

  • SCC is treated surgically in specialized care.
  • There should be at least a 5-mm margin of healthy tissue (a histological margin of at least 2 mm).
  • In cases with a high risk of recurrence, wider surgical margins are recommended.
  • Examinations to exclude metastasis to lymph nodes (imaging, sentinel lymph nodes) should be performed on a case by case basis.
  • The frequency and length of follow-up is determined by the risk of recurrence and the stage of the tumour.
  • Keratoacanthoma is a SCC with low risk of recurrence. A 5-mm margin of healthy tissue should be aimed at in its removal.

Specialist consultation

  • If SCC is diagnosed by skin biopsy or excision of a skin lesion in primary health care, the patient should be referred to specialized care.

SCC of the lip

  • Most commonly encountered on the lower lip (Images 8 9).
  • Starts as a sore or ulcer usually preceded by actinic cheilitis or leukoplakia.
  • Lip cancer is managed surgically in specialized care by excising the tumour with adequate margins followed by a reconstruction.
  • Lip cancer may metastasise to the lymph nodes under the lower jaw, and these should be palpated at follow-up examinations.