Squamous Cell Carcinoma (SCC, Squamous Cell Cancer)

by Carlo Raj, MD

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    00:02 Our topic here is squamous cell carcinoma of the skin.

    00:05 Chronic UV exposure once again, maybe immunosuppressed patient.

    00:09 Maybe you have a patient that was exposed to -- well, remember injury taking place, maybe such as osteomyelitis resulting in squamous cell cancer of the sinus.

    00:20 Maybe arsenic.

    00:21 Okay, there is a pretty long list of things that may result in squamous cell cancer of the skin.

    00:30 Morphology here.

    00:31 If it’s squamous cells, then you can expect there to be hyperkeratotic papule upon exposure to the sun.

    00:37 And then here, as a rule of thumb, below the lower lip.

    00:40 But once again, if you find that on the forehead, it’s scaly and it’s not umbilicated and upon histologic examination, we’ll talk about these keratin pearls and these prickles, intercellular bridges.

    00:54 Yes, I said prickles.

    00:56 We talked about that earlier.

    00:57 And this will be pretty significant specific for squamous cell cancer here of the skin.

    01:04 What was the premalignant condition that you may want to keep in mind for squamous cell cancer? Once again, exposure to UV rays.

    01:11 Good.

    01:11 That was called actinic keratosis.

    01:15 Let’s talk further about squamous cell cancer of the skin.

    01:17 It’s number 2 skin cancer overall.

    01:20 Squamous cell cancer of the skin more common on hands and mucosa than BCC.

    01:27 Higher metastatic potential than BCC, but not by much.

    01:30 Is that clear? Yes, has a higher metastatic potential, but it’s not like -- It’s 10%, okay? If BCC has less than 0.05, then obviously higher than 0.05.

    01:42 If you basically begin at 0, you know what I mean? You don’t have to go much higher for it to be a higher potential for metastasis.

    01:49 Higher metastatic potential on the ears and on the lips is something that you want to keep in mind.

    01:54 However, as opposed to BCC, in which I showed you and I’ve given you the most common presentation.

    02:00 We find the basal layer being affected and you have umbilication that is taking place.

    02:05 Here, it’s going to be scaly-like appearance with squamous cell.

    02:11 So what exactly is undergoing such changes in squamous cell cancer? It’s proliferation and we’ve talked about the term atypical, atypical, atypical.

    02:21 Atypical to you should mean that the nuclei is undergoing such malignant changes in which obviously it is representing neoplastic change.

    02:29 Now, what is it that's undergoing atypical change? What kind of cells? These are atypical keratinocytes.

    02:35 Arising from where? Epidermis and infiltrating down towards the dermis.

    02:40 These are more eosinophilic and glassy appearance.

    02:43 And if you take a look at this, we have what’s known as your keratin pearls.

    02:47 Very, very significant for squamous cell cancer.

    02:51 You do not find keratin pearls in BCC.

    02:55 In BCC, what did you find? You found those basal cell that resemble your stratum basale in which increased proliferation and then may invade the dermis quite quickly.

    03:08 If you take a look at the picture here, you’ll notice that here once again, more eosinophilic and the fact that we find our keratin pearls.

    03:17 Here, we’ll take a look at management as we have done with basal cell carcinoma.

    03:21 Here with squamous cell cancer, if it’s superficial, curettage.

    03:24 Controversial, but electrodessication.

    03:26 Cream, maybe 5-FU.

    03:28 All other forms: Excision.

    03:30 Remember, just because you find this, it doesn’t mean that you let it go because it has a lower metastatic potential, you still need to get in there and control it perhaps surgically.

    03:40 The differential diagnoses for squamous cell cancer include the following.

    03:44 Seborrheic keratosis.

    03:46 What does that mean to you? I told you in terms of appearance, it will be stuck on.

    03:50 Maybe it would be white-yellow or commonly dark like chocolate.

    03:54 You have your slowly growing type of behavior of the seborrheic keratosis.

    03:58 And the more likely to be pigmented more so than squamous cells.

    04:02 Squamous cell will be scaly.

    04:04 Our topic here is differential diagnoses for squamous cell cancer.

    04:08 Wart: Generally smaller.

    04:11 Often presents a rough and verrucous type of surface.

    04:15 Think of your condyloma acuminata.

    04:18 And we have central thrombosed capillaries, which are common within the verruca or wart.

    04:24 And of course, the organisms here will be a virus on the lower end.

    04:31 As a differential, we have sebaceous hyperplasia.

    04:34 Enlargement of oil-producing type of gland on the face.

    04:38 Most often will occur in elderly males and generally smaller than cancer.

    04:43 And also umbilicated like that we saw with molluscum contagiosum.

    04:48 Actinic keratosis.

    04:50 Well, the only thing that you want to pay attention to truly here is with actinic keratosis, premalignancy.

    04:56 And so therefore, the appearance or identification of your atypical keratinocyte is much less significant than what you would find with actual squamous cell cancer of the skin.

    About the Lecture

    The lecture Squamous Cell Carcinoma (SCC, Squamous Cell Cancer) by Carlo Raj, MD is from the course Neoplastic Skin Diseases.

    Included Quiz Questions

    1. Squamous cell carcinoma
    2. Basal cell carcinoma
    3. Seborrheic keratosis
    4. Actinic keratosis
    5. Wart
    1. Squamous cell carcinoma
    2. Wart
    3. Seborrheic keratosis
    4. Sebaceous hyperplasia
    5. Basal cell carcinoma
    1. UV exposure
    2. Chemical exposure
    3. Genetics
    4. Exposure to smoking
    5. Caucasian race

    Author of lecture Squamous Cell Carcinoma (SCC, Squamous Cell Cancer)

     Carlo Raj, MD

    Carlo Raj, MD

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