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Navigating the Diagnosis and Characteristics of Squamous Cell Carcinoma

Jun 25 - 2024
Navigating the Diagnosis and Characteristics of Squamous Cell Carcinoma

Squamous Cell Carcinoma (SCC) Overview

Squamous cell carcinoma, a malignancy originating from the epidermal keratinocytes, stands as the second most prevalent form of skin cancer. While SCC is largely treatable, its potential to metastasize underscores the importance of early detection and specialist referral.

Etiological Factors and Risk Groups

Gender and Sun Exposure: Men are more susceptible than women, with the risk increasing with age due to cumulative sun exposure.

Phototherapy and Artificial Tanning: Long-term UVB and PUVA therapies, used for conditions like psoriasis,dermoscopy of actinic keratosis along with sunbed use, heighten the risk.

Genetic Predispositions: Individuals with fair complexions, including blonde hair and blue eyes, are at elevated risk.

Underlying Skin Conditions: Patients with xeroderma pigmentosum, albinism, or epidermolysis bullosa may develop SCC at a young age.

Immunosuppression: Those on immunosuppressive drugs, especially post-transplant, are at a higher risk with more aggressive disease progression.

Chronic Inflammation: Areas of persistent skin inflammation, such as leg ulcers, can transform into SCC.

Tobacco Use: Pipe smokers show an increased risk of lip SCC, possibly due to heat damage.

Clinical Presentation

Age and Lesion Development: Typically, SCC emerges in older individuals, though high-risk groups may develop lesions at a younger age.

Pain and Sensory Changes: Patients may experience discomfort, pain upon touch, bleeding, or sensory alterations.

Growth Rate: SCCs tend to grow faster than basal cell carcinomas.

Morphological Characteristics: The initial sign is often induration, which can present as nodular, plaque-like, verrucous, or ulcerated, with ill-defined borders and inflamed surrounding tissue.

Distribution and Morphology

Sun-Exposed Sites: SCCs commonly arise on sun-exposed areas, such as the hands, forearms, face, and in males, the lower lip and pinna.

Morphological Variants: The tumor can be well-differentiated (less aggressive) with a keratotic surface that may ulcerate as it grows, or moderate-poorly differentiated (more aggressive) with sparse or absent keratin and a tendency towards ulceration.

SCC in Skin of Color

Prevalence and Aggressiveness: SCC is the most frequent skin cancer in skin of color, with a potentially more aggressive course.

Affected Sites: Common regions include the head, neck, legs, feet, and anogenital area.

Dermoscopic Features in SCC Diagnosis

Dermoscopic examination, while supportive to clinical assessment, may reveal:

A central keratin mass or ulceration.

Targetoid hair follicles with a yellow to light-brown center and a white rim, often at the periphery.

White, structureless areas.

Vascular structures, which can be looped or linear-irregular; poorly differentiated tumors may exhibit a chaotic polymorphous vascular pattern.

Understanding the risk factors, clinical presentation, and dermoscopic features of SCC is vital for prompt diagnosis and effective treatment strategies. The variability in SCC's appearance, particularly in skin of color, highlights the importance of dermatoscopic evaluation in achieving accurate and early detection.