Clinical features and diagnosis of cutaneous squamous cell carcinoma (SCC)
- Jean Lee Lim, MD
Jean Lee Lim, MD
- Department of Dermatology
- Kaiser Permanente Medical Group, Santa Rosa, CA
- Maryam Asgari, MD, MPH
Maryam Asgari, MD, MPH
- Associate Professor
- Massachusetts General Hospital at Harvard Medical School
- Section Editors
- Robert S Stern, MD
Robert S Stern, MD
- Section Editor — Nonmelanoma Skin Cancer
- Professor of Dermatology
- Harvard Medical School
- June K Robinson, MD
June K Robinson, MD
- Section Editor — Nonmelanoma Skin Cancer
- Professor of Clinical Dermatology
- Northwestern University Feinberg School of Medicine
Cutaneous squamous cell carcinoma (SCC) presents with a wide variety of clinical manifestations, including papules, plaques, or nodules, and smooth, hyperkeratotic, or ulcerative lesions. Skin biopsies are required to confirm the diagnosis. Biopsies also provide information that is useful for staging.
The clinical presentation and diagnosis of SCC will be reviewed here. The epidemiology and risk factors for the development of SCC and the treatment of cutaneous SCC are reviewed separately. (See "Epidemiology and risk factors for cutaneous squamous cell carcinoma" and "Evaluation for locoregional and distant metastases in cutaneous squamous cell and basal cell carcinoma" and "Treatment and prognosis of cutaneous squamous cell carcinoma".)
Location — SCC can develop on any cutaneous surface, including the head, neck, trunk, extremities, oral mucosa, periungual skin, and anogenital areas (picture 1A-D). In fair-skinned individuals, SCCs most commonly arise in sites frequently exposed to the sun. In a cohort of 145 patients with SCC in Australia, the following distribution of SCC was observed .
●Head and neck (55 percent)
●Dorsum of the hands and forearms (18 percent)
- English DR, Armstrong BK, Kricker A, et al. Demographic characteristics, pigmentary and cutaneous risk factors for squamous cell carcinoma of the skin: a case-control study. Int J Cancer 1998; 76:628.
- Gloster HM Jr, Neal K. Skin cancer in skin of color. J Am Acad Dermatol 2006; 55:741.
- Asuquo ME, Ngim O, Ugare G, et al. Major dermatologic malignancies encountered in a teaching hospital surgical department in South Nigeria. Am J Clin Dermatol 2008; 9:383.
- Mora RG, Perniciaro C. Cancer of the skin in blacks. I. A review of 163 black patients with cutaneous squamous cell carcinoma. J Am Acad Dermatol 1981; 5:535.
- Eliezri YD, Silverstein SJ, Nuovo GJ. Occurrence of human papillomavirus type 16 DNA in cutaneous squamous and basal cell neoplasms. J Am Acad Dermatol 1990; 23:836.
- Stern RS, Bagheri S, Nichols K, PUVA Follow Up Study. The persistent risk of genital tumors among men treated with psoralen plus ultraviolet A (PUVA) for psoriasis. J Am Acad Dermatol 2002; 47:33.
- Veness MJ. Defining patients with high-risk cutaneous squamous cell carcinoma. Australas J Dermatol 2006; 47:28.
- Weinberg AS, Ogle CA, Shim EK. Metastatic cutaneous squamous cell carcinoma: an update. Dermatol Surg 2007; 33:885.
- 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 1992; 26:976.
- Reule RB, Golda NJ, Wheeland RG. Treatment of cutaneous squamous cell carcinoma with perineural invasion using Mohs micrographic surgery: report of two cases and review of the literature. Dermatol Surg 2009; 35:1559.
- Farasat S, Yu SS, Neel VA, et al. A new American Joint Committee on Cancer staging system for cutaneous squamous cell carcinoma: creation and rationale for inclusion of tumor (T) characteristics. J Am Acad Dermatol 2011; 64:1051.
- Kerr-Valentic MA, Samimi K, Rohlen BH, et al. Marjolin's ulcer: modern analysis of an ancient problem. Plast Reconstr Surg 2009; 123:184.
- Pekarek B, Buck S, Osher L. A Comprehensive Review on Marjolin's Ulcers: Diagnosis and Treatment. J Am Col Certif Wound Spec 2011; 3:60.
- Choa R, Rayatt S, Mahtani K. Marjolin's ulcer. BMJ 2015; 351:h3997.
- Chang JB, Kung TA, Cederna PS. Acute Marjolin's ulcers: a nebulous diagnosis. Ann Plast Surg 2014; 72:515.
- Tobin C, Sanger JR. Marjolin's Ulcers: A Case Series and Literature Review. Wounds 2014; 26:248.
- Al-Zacko SM. Malignancy in chronic burn scar: a 20 year experience in Mosul-Iraq. Burns 2013; 39:1488.
- Kadir AR. Burn scar neoplasm. Ann Burns Fire Disasters 2007; 20:185.
- Copcu E, Aktas A, Sişman N, Oztan Y. Thirty-one cases of Marjolin's ulcer. Clin Exp Dermatol 2003; 28:138.
- Yanofsky VR, Mercer SE, Phelps RG. Histopathological variants of cutaneous squamous cell carcinoma: a review. J Skin Cancer 2011; 2011:210813.
- Petter G, Haustein UF. Histologic subtyping and malignancy assessment of cutaneous squamous cell carcinoma. Dermatol Surg 2000; 26:521.
- Auerbach A, Mulvaney P, Goldberg D, et al. Single-Cell Squamous Carcinoma: An Underreported High-Risk Variant. Dermatol Surg 2016; 42 Suppl 1:S2.
- Marks R, Rennie G, Selwood TS. Malignant transformation of solar keratoses to squamous cell carcinoma. Lancet 1988; 1:795.
- Criscione VD, Weinstock MA, Naylor MF, et al. Actinic keratoses: Natural history and risk of malignant transformation in the Veterans Affairs Topical Tretinoin Chemoprevention Trial. Cancer 2009; 115:2523.
- Jeffes EW 3rd, Tang EH. Actinic keratosis. Current treatment options. Am J Clin Dermatol 2000; 1:167.
- Johnson TM, Saluja A, Fader D, et al. Isolated extragenital bowenoid papulosis of the neck. J Am Acad Dermatol 1999; 41:867.
- Shim WH, Park HJ, Kim HS, et al. Bowenoid Papulosis of the Vulva and Subsequent Periungual Bowen's Disease Induced by the Same Mucosal HPVs. Ann Dermatol 2011; 23:493.
- Gross G, Hagedorn M, Ikenberg H, et al. Bowenoid papulosis. Presence of human papillomavirus (HPV) structural antigens and of HPV 16-related DNA sequences. Arch Dermatol 1985; 121:858.
- Shabbir M, Minhas S, Muneer A. Diagnosis and management of premalignant penile lesions. Ther Adv Urol 2011; 3:151.
- Lucker GP, Speel EJ, Creytens DH, et al. Differences in imiquimod treatment outcome in two patients with bowenoid papulosis containing either episomal or integrated human papillomavirus 16. J Invest Dermatol 2007; 127:727.
- Part II Head and Neck. In: AJCC Cancer Staging Manual, 8th, Amid MB (Ed), Springer, New York 2017. p.53.
- CLINICAL FEATURES
- Clinical findings
- - SCC in situ (Bowen's disease)
- Erythroplasia of Queyrat
- - Invasive SCC
- - Other variants
- Oral SCC
- Verrucous carcinoma
- SCC of the lip
- Marjolin's ulcer
- - Cutaneous metastases
- - SCC in situ
- - Invasive SCC
- DIFFERENTIAL DIAGNOSIS
- Actinic keratoses
- Bowenoid papulosis
- Other disorders