Squamous Cell Carcinoma

Diagnosis: Squamous Cell Carcinoma

Raised, firm, flesh–colored nodule covered with hemorrhagic crusts arises on the vermillion border of the lower lip

Clinical Presentation

Raised, firm, flesh–colored nodule covered with hemorrhagic crusts arises on the vermillion border of the lower lip

Clinical History

Submitted by Alaa Saad. Originally posted September 1, 2010.

Treatment

See case discussion.

Differential Diagnosis

• Keratoacanthoma • Basal cell carcinoma • Actinic keratosis (hypertrophic) • Verruca vulgaris • Bowen disease • Amelanotic melanoma • Prurigo nodularis

Key Learnings

• Second most common skin cancer — arises from keratinocytes • UV radiation is the primary cause; UVB induces p53 mutations • Risk hierarchy: immunosuppression (organ transplant recipients 65-250× risk), chronic wounds/scars (Marjolin ulcer), radiation, arsenic • High-risk features: >2cm, poor differentiation, perineural invasion, location (ear, lip), immunosuppression, depth >6mm • SCC of the lip and ear has higher metastatic potential (~5-10%) vs. sun-exposed skin (~2-5%) • Organ transplant recipients: SCC:BCC ratio reverses (SCC becomes more common) • Cemiplimab (anti-PD-1) approved for advanced/unresectable cutaneous SCC

Tags: squamous, cell, carcinoma, alaa saad