Flashcards in Squamous Cell Carcinoma Deck (66)
What is squamous cell carcinoma?
A malignant tumour that arises from the keratinising cells of the epidermis or its appendages
How does squamous cell carcinoma spread?
It is locally invasive, and has the potential to metastasise to other organs in the body
What are the risk factors for squamous cell carcinoma?
- Chronic UVR exposure
- Susceptibility to UV light exposure
- Chemical carcinogens
- HPV infection
- Ionising radiation
- Chronic inflammation
- Genetic conditions
- Pre-malignant conditions
What is the result of chronic UVR exposure increasing the risk of squamous cell carcinoma?
High rates in countries like Australia
Other than living in hot countries, what can cause increased UVR exposure?
- Frequent holidays in the sun
- Outdoor occupations
- Leisure pursuits
- Use of tanning beds
Give 2 examples of things that indicate a susceptibility to UV light exposure
- Fair skin
- Blonde/red hair
Give 3 examples of chronic inflammation that can increase risk of SCC
- Chronic ulcers
- Lupus vulgaris
Give 3 examples of genetic conditions that increase risk of SCC
- Xeroderma pigmentosum
Give an example of a pre-malignant condition that increases the risk of SCC
How might SCC present?
- Indurated nodular keratinising or crusted tumour, that may ulcerate
- Ulcer without evidence of keratinisation
- Reddish skin plaque
Is the clinical appearance of SCC variable?
What are the differentials for SCC?
- Malignant melanoma
- Solar keratosis
- Pyogenic granuloma
- Seborrhoeic warts
- Plantar warts or verrucas
What are the primary investigations for SCC?
- Visual inspection
- Removal for histology where necessary
What types of biopsy may be used in SCC?
- Excisional biopsy
- Incisional or punch biopsy
What happens in an excision biopsy?
The whole lesion is excised
When is an excision biopsy used in SCC?
Small lesions that are accessible and not in cosmetically sensitive areas, or near to vital structures
Under what anaesthesia are excision biopsy for SCC carried out?
Local anaesthesia for most lesions
How much should be taken in excision biopsy for SCC?
- Full thickness of skin
- Wide margins
Why should the full thickness of the skin be taken in SCC?
Determine depth of spread
Why should the excision be well wide of margins in SCC?
To achieve clearance
What happens in incisional or punch biopsy?
Part of the lesion is excised
When is incisional or punch biopsy used in SCC?
When the lesion is large, in cosmetically sensitive areas, or close to vital structures
What may investigations be required for in advanced SCC?
To assess the extent of disease
What investigations may be done to assess extent of disease in advanced SCC?
- CT or MRI scanning
- Histological examination of clinically enlarged nodes
How can histological examination of clinically enlarged nodes be carried out?
Fine needle aspiration or excisional biopsy
When should you consider a 2WW for SCC?
For people with a skin lesion that raises suspicion of squamous cell carcinoma
What is Tis in SCC?
Carcinoma in situ
What is T1 in SCC?
Tumour 2cm or less
What is T2 in SCC?
Tumour >2cm but <5cm