Squamous Cell

carcinoma
By: Kainat Sheraz
211210284
SKIN LAYERS

Skin can be divided into two layers:

Outer epidermis
Inner dermis
Hypodermis

The epidermis is 5% of the skin and is

composed of five layers of keratinised,
stratified squamous epithelium; the strata:

basalis (deep)
Spinosum
Granulosum
lucidum
Corneum (superficial).
 Definition and epidemiology

SCC is a malignant tumour of keratinising cells of the epidermis or its

appendages.
It arises from the stratum basalis of the epidermis and expresses
cytokeratins 1 and 10

The second most common form of skin cancer

● Men > Women

● Strongly-related to cumulative sun exposure in White

skinned individuals

● Middle aged/elderly.
Risk factors:
● Cumulative UV exposure (from the sun or from tanning beds) is the most
significant risk factor, especially for individuals with:
● Light skin tones
● History of sunburns or recreational tanning
● Close geographic proximity to the equator
● Male sex
● Older age; SCC typically affects individuals > 60 years of age.
● Chronic immunosuppression (e.g., HIV, solid organ transplant recipient)
● Exposure to chemical carcinogens (e.g., coal tars, arsenic) or ionizing
radiation
● Chronic inflammation (chronic sinus tracts, pre-existing scars, osteomyelitis,
burns,vaccination points)
● High-risk human papillomavirus infection (for anogenital and periungual SCC)
● Genetic predisposition
 CLinical presentation of SCC
Symptom and duration:
Complains of a lump, or of bleeding and discharge from an ulcer, ~ 1-2 months.
Tenderness:
Not painful unless invasion happens.
Color:
Dark red brown color.
Course:
Gradually enlarging with everted edges + necrotic floor covered with blood or granulation +surrounded by
inflamed, indurated skin
Discharge:
Copious, bloody, purulent and foul-smelling.
Local lymph nodes:
often enlarged (not always by tumor)
Mobility: immobile = invasion
Complications: bleeding (can be fatal), infection
Site : exposed skin of the head and neck (lower lip, external ear and peri-auricular region, or forehead and
scalp), hands, forearms and upper trunk
 Precursors
Actinic (solar) keratoses (AK) :
Areas of permanent sun damage in which there is

● Dyskeratosis
● Partial-thickness
● Cellular atypia
● Subepidermal inflammation

but an intact basement membrane

Most improve after moisturisation and remain as
erythematous macules
Up to 20% form SCC

AK with keratinous surface with a height greater than

its base diameter = keratin horn
10% will have an underlying SCC
 Keratoacanthomas

▪ (self-limiting, keratoacanthoma-like SCCs )

▪ common in men
▪ usually originates from hair follicle, found in sun-exposed skin(
face or limbs)
▪ rapidly-growing (days to weeks)
▪ they are nodular tumors, exhibiting symmetry around a central,
keratin-filled crater, with surrounded inflamed skin
▪ if left untreated can starve itself & necrotize leaving a scar.
▪Tx: excision (excision scar is often better than that which
remains after resolution)
 SCC IN SITU AKA (Bowen’s disease)

Often develops as full-thickness dysplasia in hypertrophic

Actinic keratosis .
Presents as :
● Slowly enlarging
● Erythematous scaly plaque
● Occur anywhere on the mucocutaneous surface of the
body
- On the glans penis, it is called erythroplasia of Queyrat(Paget’s
disease)
 Marjolin's ulcer
● Is a term used to describe a rare type of cSCC arising in sites of chronic
wounds or scars .
● The malignant transformation is usually slow, with an average latency
time of approximately 30 years.
● The tumor may initially present as an ulceration that fails to heal;
nodules may develop as the lesion progresses. Other clinical signs
include rolled or everted wound margins, excessive granulation tissue,
rapid increase in size, and bleeding on touch.
● SCCs arising in the setting of chronic wounds or scars are typically
aggressive and are associated with a poor prognosis .
● The risk of local recurrence after treatment or metastasis is
approximately 20 to 30 percent .
 MACROSCOPIC FEATURES
The appearance of SCC may be :

● plaque like
● Smooth nodular
● Papillomatous
● verrucous
● All ulcerate eventually, as they grow.

The ulcers have a characteristic red everted edge and the floor
of the ulcer resembles granulation tissue and bleeds easily .

● The skin around the ulcer is inflamed, indurated .

Location :

● Most commonly on the face and neck

Typical locations include the lower lips, ears And hands .

 Broder’s Grading

SCC can be graded

histologically according to
Broder’s grading
Staging
 Prognosis
Aetiology: SCCs that arise in
Depth : the deeper the lesion, the worse the prognosis
burn scars, osteomyelitis skin
● <2mm, metastasis is highly unlikely sinuses, chronic ulcers and
● >6 mm, 15% of SCC will have metastasis. areas of skin that have been
irradiated have a higher
Surface size: metastatic potential.
● Immunosuppression: SCCs will
lesions >2 cm have a worse prognosis
invade further in those with
Histological grade: the higher the Broder’s grade, the impaired immune response.
worse the prognosis.
Microscopic invasion: of lymphovascular spaces or
nerve tissue carries a high risk of metastatic disease The overall rate of metastasis
Site : on the lips + ears = higher local recurrence is 2% for SCC (usually to
rates regional nodes) with a local
In the Extremities fare worse than those on the trunk. recurrence rate of 20%
Diagnosis
Biopsy: should extend into the mid-reticular dermis for
suspicious lesions Techniques
● Punch biopsy
● Wedge biopsy may also be considered, especially for
larger lesions (e.g., Marjolin ulcer)
● Excisional biopsy in some cases
● Shave biopsy is generally only considered for carcinoma-
in-situ
Findings
● Atypical keratinocytes: polygonal cells with atypical
nuclei
● Keratin pearls (also called epithelial nests): deposits of
keratin that are surrounded by concentric layers of
atypical keratinocytes
Further evaluation: may be indicated in cases with high-risk
features to look for regional and/or systemic metastasis.
● Imaging (e.g., CT, MRI)
● Lymph node biopsies, FNAC
 Management
Surgical Excision : Surgical Excision Of The Lesion
Along With A Rim Of Normal Skin Is The Primary
Method Of Treatment
Radiotherapy :
● Cryotherapy Or Curettage May Be Used In The
Case Of Carcinoma-In-Situ; Its Use Is ● Adjuvant Treatment In Cases
Contraindicated In Patients With Invasive scc. With High-Risk Features
● Primary Treatment When
Scc Measures <2 Cm >> A 4 mm Clearance Margin surgery is not feasible (E.G.,
Scc Measures > 2cm >> A 1-Cm Clearance Margin Patient Is Unfit For Surgery)
Marjolin’s ulcer : requires wide excision with 1 cm margin
Mohs Micrographic Surgery : Chemotherapy : 5-Fluorouracil,
●
Epidermal Growth Factor Inhibitors)
Increasingly Used In Place Of Standard Surgical
Excision. ● Indicated In Case Of Systemic
● Tumor Is Removed Layer By Layer, And Each
Metastasis
Layer Is Examined For Tumor Cells
● Adjuvant Treatment In Cases
● for invasive SCC in the facial region/cosmetic
With High-Risk Features
impact (Mohs surgery to achieve high cure rates
while sparing normal tissue)
 Mohs Micrographic Surgery

95% of local recurrence and regional metastases occur within 5

Follow years, thus follow-up beyond this period is not indicated.
up:
 Resource:

Thank You!