Squamous cell skin cancer , also known as squamous cell carcinoma ( cSCC ), is one of the main types of skin cancer along with basal cell cancer , and melanoma. It usually appears as a hard lump with scaly peaks but can also form ulcers. Onset often occurs for months. Squamous cell skin cancer is more likely to spread to areas far from basal cell cancer.
The biggest risk factor is the high total exposure to ultraviolet radiation from the Sun. Other risks include previous scars, chronic wounds, actinic keratoses, brighter skin, Bowen's disease, arsenic exposure, radiation therapy, poor immune system function, basal cell carcinoma, and HPV infection. The risk of UV radiation is associated with total exposure, rather than early exposure. Tanning beds become another common source of ultraviolet radiation. It starts from the squamous cells found in the skin. Diagnosis is often based on skin examination and confirmed by tissue biopsy.
Decreased exposure to ultraviolet radiation and the use of sunscreen seems to be an effective method to prevent squamous cell skin cancer. Treatment is usually performed by surgical removal. This can be done with simple excision if the cancer is small or Mohs surgery is generally recommended. Other options may include the application of cold therapy and radiation. In cases where distant spread has occurred chemotherapy or biological therapy may be used.
By 2015, about 2.2 million people have cSCC at any given time. It makes up about 20% of all cases of skin cancer. About 12% of men and 7% of women in the United States develop cSCC at some point in time. While prognosis is usually good, if the prolonged spread of five-year survival is ~ 34%. By 2015 it resulted in approximately 51,900 deaths globally. The usual age of diagnosis is about 66. After successful treatment of one case of cSCC people at high risk of developing a further case.
Video Squamous cell skin cancer
Signs and symptoms
SCC skin begins as a small nodule and as it enlarges the center becomes necrotic and the slough and nodule turn into ulcers.
- Lesions caused by SCC are often asymptomatic
- Low-growing reddish skin or plaque
- Intermittent haemorrhage from the tumor, especially on the lips
- Clinical appearances vary greatly
- Usually tumors appear as ulcerated lesions with hard edges and are raised
- The tumor may be in the form of hard plaques or papules, often with opalescence qualities, with small blood vessels
- The tumor may lie beneath the surrounding skin level, and ultimately slit and attack the underlying tissue
- Tumors usually appear in areas exposed to sunlight (eg the back of the hand, scalp, lips, and superior pinna surface)
- On the lips, the tumor forms a small ulcer, which fails to heal and bleeds intermittently
- Evidence of chronic skin photodamases, such as multiple actinic keratoses (sun keratosis)
- Tumors grow relatively slowly
Spread
- Unlike basal cell carcinoma (BCC), squamous cell carcinoma (SCC) has a large metastatic risk
- The risk of metastasis is higher in SCC occurring in scars, on the lower lip or mucosa, and occurs in immunosuppressive patients.
Maps Squamous cell skin cancer
Cause
Squamous cell carcinoma is the second most common cancer of the skin (after basal cell carcinoma but more common than melanoma). Usually occurs in areas exposed to the sun. Sun exposure and immunosuppression are risk factors for skin SCC, with chronic sun exposure being the strongest environmental risk factor. There is a risk of metastasis starting more than 10 years after the diagnosis of squamous cell carcinoma, but the risk is low, although much higher than basal cell carcinoma. Squamous cell cancers of the lips and ears have high local recurrence rates and distant metastases (20-50%). In recent studies, it has also been shown that the removal or regulation of severe weighting of a gene titled Tpl2 (locus 2 progression tumor) may be involved in the development of normal keratinocytes into squamous cell carcinomas.
SCC represents about 20% of non-melanoma skin cancers, but due to their clearer nature and growth rate, they represent 90% of all head and neck cancers that were originally presented.
Most SCC are skin, and like all skin cancers, are the result of ultraviolet exposure. SCC usually occurs in parts of the body normally exposed to the Sun; face, ears, neck, hands, or arms. The main symptom is a growing lump that may have a rough surface, scaly and reddish spots. Unlike basal cell carcinoma, SCC carries significant risk of metastasis, often spreading to local nerves or lymph nodes,
During the early stages, it is sometimes known as Bowen disease.
Squamous cell carcinomas are generally treated with surgery, Mohs surgery or electrodessication and curettage. Non-surgical options for the treatment of skin SCC include topical chemotherapy, topical immune response modifiers, photodynamic therapy (PDT), radiotherapy, and systemic chemotherapy. The use of topical therapies, such as Imiquimod and PDT creams, is generally limited to premalignant (ie, actinic keratosis) and in situ lesions . Radiation therapy is the primary treatment option for patients whose surgery is not feasible and is an adjuvant therapy for those with a metastatic or high-risk, high-risk SCC. At present, systemic chemotherapy is used exclusively for patients with metastatic disease.
Immunosuppression
People who have received solid organ transplants are at an increased risk of developing squamous cell carcinoma due to the use of chronic immunosuppressive drugs. While the risk of developing all skin cancers increases with these drugs, this effect is particularly severe for SCC, with a hazard ratio as high as 250 reported, compared with 40 for basal cell carcinoma. Incidence of SCC increases with posttransplant time. Heart and lung transplant recipients are at the highest risk of developing SCC because more intensive immunosuppressive drugs are used. Squamous cell skin cancer in individuals undergoing immunotherapy or suffering from lymphoproliferative disorders (ie leukemia) tends to be much more aggressive, regardless of its location. The risk of skin cancer SCC, and non-melanoma generally, varies with the selected immunosuppressive drug regimen. The biggest risk is with calcineurin inhibitors such as cyclosporine and tacrolimus, and at least with mTOR inhibitors, such as sirolimus and everolimus. Antimetabolite azathioprine and mycophenolic acid have a medium risk profile.
Diagnosis
Diagnosis confirmed by tissue biopsy (s) suspected to be affected by SCC. For skin, look under skin biopsy.
The pathological appearance of squamous cell cancer varies with the depth of the biopsy. For that reason, biopsies including subcutaneous tissue and basalar epithelium, to the surface are necessary for the correct diagnosis. The performance of a shaving biopsy (see skin biopsy) may not have sufficient information for diagnosis. Inadequate biopsy may be read as actinic keratosis with follicular involvement. A deeper biopsy to the dermis or subcutaneous tissue can reveal the true cancer. Excisional biopsy is ideal, but not practical in most cases. An incisional or punch biopsy is preferred. Shaving biopsies are at least ideal, especially if only the shallow parts are obtained.
Prevention
Suitable sun-protective clothing, use of broad-spectrum sunscreen (UVA/UVB) with at least SPF 50, and avoiding intense exposure to sunlight can prevent skin cancer. A Cochrane review that examined the effects of sun protection (just sunscreen) in preventing the development of basal cell carcinoma or skin cell squamous cell carcinoma found that there was insufficient evidence to show whether sunscreens were effective for the prevention of one of these inherited keratinocyte cancers. However, the review finally states that the certainty of these results is low, so future evidence could greatly change this conclusion.
Management
Most squamous cell carcinomas are removed surgically. Some selected cases were treated with topical medications. Surgical excision with healthy free tissue margin is a frequent treatment modality. Radiotherapy, given as external beam radiotherapy or as brachytherapy (internal radiotherapy), can also be used to treat squamous cell carcinoma.
The Mohs operation is often used; regarded as the treatment of choice for squamous cell carcinoma of the skin, doctors have also used methods for the treatment of squamous cell carcinoma of the mouth, throat, and neck. The equivalent method of the CCPDMA standard can be used by the pathologist in the absence of a trained doctor Mohs. Radiation therapy is often used subsequently in types of cancer or patients at high risk.
Electrodication and curettage or EDC can be performed on selected squamous cell carcinomas of the skin. In areas where SCC is known to be non-aggressive, and where patients are not immunosuppressed, EDC can be performed with a good cure rate of enough.
High-risk squamous cell carcinomas, as defined by those that occur around the eyes, ears, or nose, are large, poorly differentiated, and grow rapidly, requiring more aggressive multidisciplinary management.
Nodal spread:
- Surgical block surgery if the nodes are palpable or in cases of Marjolin ulcers but the benefits of prophylactic block of lymph node dissection with Marjolin ulcers are not proven.
- Radiotherapy
- Adjuvant therapy may be considered in those at high risk for SCC even without evidence of localized mestastasis. Imiquimod (Aldara) has been used successfully for squamous cell carcinoma in situ in the skin and penis, but the morbidity and discomfort of this treatment is severe. The advantage is cosmetic results: after treatment, skin resembles normal skin without scarring and morbidity commonly associated with standard excision. Imiquimod is not FDA approved for any squamous cell carcinoma.
In general, squamous cell carcinoma has a high risk of local recurrence, and up to 50% relapse. A frequent skin examination with a dermatologist is recommended after treatment.
Prognosis
Long-term outcomes of squamous cell carcinoma depend on several factors: sub-types of carcinoma, available treatments, location and severity, and various variables related to the patient's health (accompanying illness, age, etc.). Generally, long-term outcome is positive, since less than 4% of cases of squamous cell carcinoma are at risk of metastasis. Certain forms of squamous cell carcinoma have a higher mortality rate. One study found squamous cell carcinoma of the penis had a much greater mortality rate than some other form of squamous cell carcinoma, that is, about 23%, although this relatively high mortality may be related to the likelihood of a latent disease diagnosis because patients who avoid examination genital to symptoms of weakening or refusing to perform scarring of the genitalia. Squamous cell carcinoma that occurs in organ transplant populations is also associated with a higher risk of death.
Epidemiology
Incidence of squamous cell carcinoma continues to increase worldwide. A recent study estimates that there are between 180,000 and 400,000 cases of SCC in the United States by 2013. Risk factors for squamous cell carcinoma vary with age, gender, race, geography, and genetics. Incidence of SCC increases with age and peak incidence is usually about 60 years. Men are affected with SCC at a 2: 1 ratio compared with women. Caucasians are more likely to be affected, especially those with fair Celtic skin and are chronically exposed to UV radiation. Squamous cell carcinoma of the skin is the most common among all body sites. Solid organ transplant recipients (heart, lungs, liver, pancreas, among others) are also at high risk of developing aggressive, high-risk SCC. There are also some rare congenital diseases that tend to malignant skin. In certain geographical locations, exposure to arsenic in well water or from industrial sources may increase the risk of SCC significantly.
See also
- List of skin conditions associated with an increased risk of nonmelanoma skin cancer
References
External links
- Information about Squamous Cell Carcinoma from The Skin Cancer Foundation
- DermNet NZ: Squamous cell carcinoma
- Squamous cell carcinoma in transplant recipients
- Includes TCC, CIS and SCC papillary tumors
Source of the article : Wikipedia
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